急性有机磷农药中毒患者急性时相反应蛋白的检测分析及临床意义
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摘要
目的探讨急性有机磷农药中毒(AOPP)患者三种急性时相反蛋白(APRP):载脂蛋白A1(apoA1)、清蛋白(Alb)、C-反应蛋白(CRP)的检测分析及临床意义。方法 AOPP患者52例(其中,重度中毒12例,中度中毒20例,轻度中毒20例),空腹静脉采血3mL,日产7600型自动生化分析仪免疫比浊法检测血清apoA1、CRP,溴甲酚绿法检测血清Alb。另选取30名门诊健康体检者对照。结果 AOPP患者血清apoA1为(1.08±0.32)g/L、Alb为(38.3±5.1)g/L,较对照组(1.33±0.16)及(44.6±5.4)g/L分别有极显著的降低(P<0.01);CRP(14.22±16.21)mg/L较对照组(2.31±2.11)mg/L有极显著性的升高(P<0.01),且中、重度中毒组三项指标均较轻度中毒组有明显改变(P<0.01),重度中毒组除apoA1外均较中度中毒组有显著性改变(P<0.01),Alb水平进一步下降,CRP升高则更为显著。结论 AOPP时血清apoA1、Alb、CRP改变是全身炎症反应综合征(SIRS)、多脏器损伤的综合表现,观测上述三种APRP的变化,对病情判定、疗效观察均具有重要临床意义。
Objective To investigate the detection and analysis of three kinds of acute-phase reaction protein (APRP) including apolipoprotein A1 (apoA1), albumin (Alb) and C-reactive protein (CRP) in patients with acute organophosphorus pesticide poisoning (AOPP) and its clinical significance. Methods Fifty two cases of AOPP (including 12 cases of severe poisoning, 20 cases of moderate poisoning and 20 cases of mild poisoning) were included in the study and 3 mL of fasting venous blood were collected from each of them. Sserum apoA1 and CRP of the blood sample were analyzed with immunoturbidimetry assasy using Nissan 7600 automatic biochemical analyzer and serum Alb was analyzed with bromocresol green. 30 cases of outpatients were selected as healthy controls. Results Serum apoA1of (1.08±0.32) g/L and Alb of (38.3±5.1) g/L in AOPP patients were significantly lower than those of (1.33±0.16) and (44.6±5.4) g/L respectively in the control group (P < 0.01); and CRP of (14.22±16.21) mg/L was significantly higher than that of (2.31±2.11) mg/L in the control group (P < 0.01). And in severe poisoning group the three indicators showed significant changes compared with those of mild poisoning group (P < 0.01). Except for apoA1 scores, the indicators of the severe poisoning group also showed significant changes compared with moderate poisoning group (P < 0.01), with further decrease in Alb level and more significant increase of CRP level. Conclusion Changes of apoA1, Alb and CRP levels in AOPP patients are indicative of a systemic inflammatory response syndrome (SIRS) and multiple organ damage. Thus monitoring of the changes of the above three kinds of APRP is important for the diagnosis of the disease and the evaluation of treatment efficacy.
Objective To investigate the detection and analysis of three kinds of acute-phase reaction protein (APRP) including apolipoprotein A1 (apoA1), albumin (Alb) and C-reactive protein (CRP) in patients with acute organophosphorus pesticide poisoning (AOPP) and its clinical significance. Methods Fifty two cases of AOPP (including 12 cases of severe poisoning, 20 cases of moderate poisoning and 20 cases of mild poisoning) were included in the study and 3 mL of fasting venous blood were collected from each of them. Sserum apoA1 and CRP of the blood sample were analyzed with immunoturbidimetry assasy using Nissan 7600 automatic biochemical analyzer and serum Alb was analyzed with bromocresol green. 30 cases of outpatients were selected as healthy controls. Results Serum apoA1of (1.08±0.32) g/L and Alb of (38.3±5.1) g/L in AOPP patients were significantly lower than those of (1.33±0.16) and (44.6±5.4) g/L respectively in the control group (P < 0.01); and CRP of (14.22±16.21) mg/L was significantly higher than that of (2.31±2.11) mg/L in the control group (P < 0.01). And in severe poisoning group the three indicators showed significant changes compared with those of mild poisoning group (P < 0.01). Except for apoA1 scores, the indicators of the severe poisoning group also showed significant changes compared with moderate poisoning group (P < 0.01), with further decrease in Alb level and more significant increase of CRP level. Conclusion Changes of apoA1, Alb and CRP levels in AOPP patients are indicative of a systemic inflammatory response syndrome (SIRS) and multiple organ damage. Thus monitoring of the changes of the above three kinds of APRP is important for the diagnosis of the disease and the evaluation of treatment efficacy.
引文
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[2]刘海英,王吉寿,杨义明,等.急性有机磷农药中毒患者血液血脂和脂蛋白测定[J].中国急救医学,2002,22(12):685-686.
[3]董广涛,王秀洁,唐正坤,等.全身炎症反应综合征载脂蛋白A1的变化及临床意义[J].中国急救医学,2006,26(2):108-110.
[4]李艳辉,姜兴权,孙宏治,等.IL-6、IL-10及TNF-α在急性有机磷农药中毒引发MODS中的作用及临床意义[J].中国急救医学,2006,26(11):804-805.
[5]许国根,徐远胜,徐芝君,等.全身炎症反应综合征患者血浆C-反应蛋白变化与内毒素水平关系的研究[J].中国急救医学,2010,30(7):602-604.
[6]Moshage H.Cytokines and the hepatic acute phase response[J].J Pathraid,2007,181(3):258-266.
[7]Doraid J,Steven EW,Mare GJ,et al.Growth hormone attenuates the acute-phase response to thermal injury[J].Arch Surg,2006,132(11):1171-1175.
[8]De Maio A,De Mooney ML,Matesic LE,et al.Genetic component in the inflammatory response induced by bacterial lipopolysaccharide[J].Shock,2008,10(2):319-323.