有机磷中毒患者PCT和hs-CRP变化及临床意义
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摘要
目的探讨降钙素原(PCT)及超敏C反应蛋白(hs-CRP)在有机磷农药中毒患者中的变化及其意义。方法回顾性分析急性有机磷农药中毒的110例患者,按其有机磷农药中毒程度分为轻、中、重3种,其中轻度中毒32例,中度中毒41例,重度中毒37例。采用免疫比浊法测定血清超敏C反应蛋白,并以105例健康者作为对照组。并对这110例患者按是否合并感染分为感染组和非感染组,采用半定量固相免疫色谱法测定(PCT-Q)动态监测血清PCT浓度。结果急性有机磷中毒组血清超敏C反应蛋白高于对照组(P<0.05),并且随着中毒程度的加重,血清超敏C反应蛋白呈升高趋势(P<0.05)。有机磷中毒患者院内感染率为37.6%,感染组与对照组血清PCT浓度比较有统计学意义(P<0.05),PCT≥0.5 ng/ml用来预测院内感染的敏感度、特异度、阳性预测值、阴性预测值分别为95.7%,79.4%,77.6%,96.2%。结论急性有机磷农药中毒患者血清超敏C反应蛋白水平与中毒的轻重程度相关,可作为有机磷农药中毒早期诊断的重要参考指标之一;动态监测血清PCT浓度能预测有机磷中毒患者早期的感染情况的发生。
Objective To explore the PCT and hs-CRP changes and its significance of patients with organophosphorus pesticide poisoning. Methods A retrospective analysis of 110 patients of acute organophosphorus pesticide poisoning was made and according to the degree of organic phosphorus pesticide poisoning, it was divided into three types, including 32 cases of mild poisoning, 41 cases of moderate poisoning, 37 cases of severe poisoning. Immune turbidimetric method is used to determine hs-CRP 105 cases of healthy subjects is as control group. And the 110 patients is divided into infection group and non infection group, by semi-quantitative solid-phase immune chromatography(PCT- Q) dynamic monitoring serum PCT concentrations. Results The serum high sensitive C reactive protein in the acute organophosphorus poisoning group was significantly higher than that in the control group(P<0.05), and With the increase of the degree of poisoning, serum high sensitive C reactive protein was increased(P<0.05). The nosocomial infection rate was 37.6% in patients with organophosphorus poisoning. Compared with the control group, the serum PCT concentration was statistically significant(P<0.05), PCT ≥ 0.5 ng/ml used to predict the nosocomial infection of sensitivity, specificity, positive predictive value, negative predictive value were 95.7%, 79.4%, 77.6%, 96.2%. Conclusion The level of serum high sensitive C reactive protein in patients with acute organophosphorus pesticide poisoning is related to the severity of poisoning. It can be used as an important reference index for early diagnosis of organophosphorus pesticide poisoning. Dynamic monitoring of serum PCT levels can predict the occurrence of early infection in patients with organophosphorus poisoning.
Objective To explore the PCT and hs-CRP changes and its significance of patients with organophosphorus pesticide poisoning. Methods A retrospective analysis of 110 patients of acute organophosphorus pesticide poisoning was made and according to the degree of organic phosphorus pesticide poisoning, it was divided into three types, including 32 cases of mild poisoning, 41 cases of moderate poisoning, 37 cases of severe poisoning. Immune turbidimetric method is used to determine hs-CRP 105 cases of healthy subjects is as control group. And the 110 patients is divided into infection group and non infection group, by semi-quantitative solid-phase immune chromatography(PCT- Q) dynamic monitoring serum PCT concentrations. Results The serum high sensitive C reactive protein in the acute organophosphorus poisoning group was significantly higher than that in the control group(P<0.05), and With the increase of the degree of poisoning, serum high sensitive C reactive protein was increased(P<0.05). The nosocomial infection rate was 37.6% in patients with organophosphorus poisoning. Compared with the control group, the serum PCT concentration was statistically significant(P<0.05), PCT ≥ 0.5 ng/ml used to predict the nosocomial infection of sensitivity, specificity, positive predictive value, negative predictive value were 95.7%, 79.4%, 77.6%, 96.2%. Conclusion The level of serum high sensitive C reactive protein in patients with acute organophosphorus pesticide poisoning is related to the severity of poisoning. It can be used as an important reference index for early diagnosis of organophosphorus pesticide poisoning. Dynamic monitoring of serum PCT levels can predict the occurrence of early infection in patients with organophosphorus poisoning.
引文
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[12]王汉蛟.87例重症有机磷中毒救治探讨[J].中华医师进修杂志,2009,32(z2):130-131.
[2]张艳华.血清C-反应蛋白测定在诊断感染中的价值[J].齐齐哈尔医学院学报,2009,30(23):2904.
[3]石岩,刘大为.降钙素原在全身性感染诊治中的研究进展[J].中华内科杂志,2011,50(5):444-446.
[4]葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:855-857.
[5]Sutherland A,Thomas M,Brandon RA,et al.Development and validation of a novel molecular biomarker diagnostic test for the early detection of sepsis[J].Crit Care,2011,15(3):R149.
[6]李雪华,黄少兴,卓丽文.血清降钙素原检测在细菌感染性疾病中的诊断意义[J].现代医院,2013,13(2):57-58.
[7]穆根华,李文强.急性有机磷农药中毒患者心电图的改变[J].中国急救医学,2010,30(1):73-76.
[8]刘林修,刘思管,程文伟.血清单核细胞趋化蛋白-1在急性有机磷农药中毒中的表达及临床意义[J].中国急救医学,2011,31(1):69-70.
[9]Auriti C,Fiscarelli E,Ronchetti MP,et al.Procalcitonin in detecting neonatal nosocomial sepsis[J].Arch Dis Chilld Fetal Neonatal ED,2012,97(5):F368-F370.
[10]庄荣,林盂相,孔万权.机械通气治疗急性有机磷中毒并发呼吸衰竭[J].中国基层医药,2009,16(5):793-794.
[11]惠永平,张金凤,吴萍,等.血液灌流治疗急性有机磷中毒的临床观察[J].国际移植与血液净化杂志,2010,8(4):48-49.
[12]王汉蛟.87例重症有机磷中毒救治探讨[J].中华医师进修杂志,2009,32(z2):130-131.