Dynamic changes in metabolic indexes following organophosphorus poisoning and their correlation with prognosis in hospital
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摘要:
目的 有机磷中毒具有发病急、变化快等特点，若处理不及时可出现昏迷，甚至死亡。代谢指标在急性有机磷中毒后处于动态变化中，并具有预测有机磷中毒预后的潜能。为此本研究通过测量有机磷中毒患者代谢指标动态变化情况，探讨有机磷中毒患者代谢指标动态变化情况及其与预后的相关性。 方法 纳入2021年1月—2022年12月浙江省人民医院淳安分院急诊医学科治疗的245例有机磷中毒患者为研究对象，采集所有患者中毒后72 h内血样，分析患者代谢指标动态变化。同时收集有机磷中毒患者预后情况，采用Cox回归方程分析有机磷中毒患者代谢指标动态变化与预后的相关性。 结论 中毒后72 h内患者随机血糖、钠离子、血肌酐、血尿素氮均处于动态变化中，但氯离子水平变化不明显。245例患者中共56例患者死亡纳入预后不良组，189例患者好转纳入好转组；Cox回归分析显示，高钠离子变化值(HR=2.958，P=0.021)、血肌酐变化值(HR=4.759，P < 0.001)、血尿素氮变化值(HR=7.101, P < 0.001)及年龄大(HR=1.109, P=0.001)、中毒至入院时间长(HR=6.872, P < 0.001)是有机磷中毒患者死亡的危险因素，乙酰胆碱酯酶(AChE)活性高(HR=0.910)是有机磷中毒患者死亡的保护因素(P < 0.05)。 结论 中毒后72 h内患者随机血糖、钠离子、血肌酐、血尿素氮均处于动态变化中，但氯离子水平变化不明显，且钠离子、血肌酐、血尿素氮动态变化情况及年龄、中毒至入院时间、AChE活性与有机磷中毒患者预后显著相关。 Abstract:Objective Organophosphorus poisoning has an acute onset and progresses rapidly. Without timely treatment, it may lead to coma or even death. Metabolic indexes change dynamically following acute organophosphorus poisoning, which have the potential value to predict the prognosis of organophosphorus poisoning. Therefore, this study explores the correlation between the dynamic changes of metabolic indexes and prognosis of patients. Methods From January 2021 to December 2022, 245 patients with organophosphorus poisoning at the Emergency Medicine Department of the Chun' an Branch of Zhejiang Provincial People' s Hospital were selected as the research object. The blood samples were collected within 72 hours post-poisoning, and the dynamic changes of metabolic indexes were analyzed. At the same time, the prognosis of patients with organophosphorus poisoning were collected, and the correlation between the dynamic changes in metabolic indexes and prognosis was analyzed by Cox regression analysis. Results The random blood sugar, sodium ion, serum creatinine, and blood urea nitrogen all changed dynamically within 72 hours after poisoning, while the chloride ion level showed no significant variation. Among the 245 patients, 56 (poor prognosis group) died, while 189 (improved prognosis group) recovered. The sodium ion (HR=2.958, P=0.021), serum creatinine (HR=4.759, P < 0.001), blood urea nitrogen (HR=7.101, P < 0.001), old age (HR=1.109, P=0.001), and longer time from poisoning to admission (HR=6.872, P < 0.001) were the risk factors for the death of patients with organophosphate poisoning. High AChE activity was identified as a protective factor for the death of patients with organophosphorus poisoning (HR=0.910, P < 0.05). Conclusion The patients' random blood sugar, sodium ion, serum creatinine, and blood urea nitrogen exhibit dynamic changes within 72 hours after poisoning, while chloride ion levels remain stable. Dynamic changes in sodium ion, serum creatinine, and blood urea nitrogen, as well as age, time to admission, and AChE activity, are significantly related to the prognosis of patients with organophosphorus poisoning. -
Key words:
- Organophosphorus poisoning /
- Metabolism /
- Dynamic change /
- Prognosis
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表 1 急性有机磷中毒患者随机血糖动态变化分析(x±s，mmol/L)
Table 1. Dynamic changes of random blood glucose levels in patients with acute organophosphorus poisoning(x±s, mmol/L)
组别 例数 入院时 中毒后4 h 中毒后12 h 中毒后24 h 中毒后36 h 中毒后48 h 中毒后72 h 好转组 189 6.89±1.78 7.40±1.39 8.10±1.09 8.83±1.92 7.21±1.30 5.69±1.58 5.26±1.35 预后不良组 56 7.32±1.41 11.34±1.43 9.68±1.57 8.65±1.74 6.72±1.81 5.80±1.01 5.44±1.14 F值 2.073 20.789 8.312 0.745 2.220 0.663 1.104 P值 0.039 < 0.001 < 0.001 0.457 0.028 0.503 0.271 注：重复测量方差分析，F组间=250.700，F时间=110.400，F交互=58.500，均P < 0.001。 
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表 2 急性有机磷中毒患者钠离子动态变化分析(x±s，mmol/L)
Table 2. Dynamic changes of sodium ion in patients with acute organophosphorus poisoning(x±s, mmol/L)
组别 例数 入院时 中毒后4 h 中毒后12 h 中毒后24 h 中毒后36 h 中毒后48 h 中毒后72 h 好转组 189 139.79±0.88 139.15±0.24 138.98±0.87 138.63±0.72 138.32±0.41 138.00±0.39 137.94±0.83 预后不良组 56 139.51±0.60 139.34±0.54 138.57±0.66 138.23±0.83 137.90±0.89 137.55±0.64 137.24±0.72 F值 2.942 3.101 4.136 3.768 4.145 5.950 6.877 P值 0.004 0.023 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 注：重复测量方差分析，F组间=277.600，F时间=104.800，F交互=8.816，均P < 0.001。
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表 3 急性有机磷中毒患者氯离子动态变化分析(x±s，mmol/L)
Table 3. Dynamic analysis of chloride ion levels in patients with acute organophosphorus poisoning(x±s, mmol/L)
组别 例数 入院时 中毒后4 h 中毒后12 h 中毒后24 h 中毒后36 h 中毒后48 h 中毒后72 h 好转组 189 99.74±1.83 99.45±1.54 99.02±1.11 98.78±1.67 98.71±1.80 98.52±1.61 98.45±1.54 预后不良组 56 99.36±1.45 99.21±1.30 99.12±1.21 99.07±1.16 98.91±1.80 98.75±1.84 98.17±1.56 F值 1.781 1.291 0.635 1.592 0.830 0.975 1.183 P值 0.076 0.198 0.526 0.113 0.408 0.331 0.240 注：重复测量方差分析，F组间=13.310，P < 0.001；F时间=0.158，P=0.692；F交互=1.453，P=0.191。
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表 4 急性有机磷中毒患者血肌酐动态变化分析(x±s，μmol/L)
Table 4. Dynamic analysis of serum creatinine in patients with acute organophosphorus poisoning(x±s, μmol/L)
组别 例数 入院时 中毒后4 h 中毒后12 h 中毒后24 h 中毒后36 h 中毒后48 h 中毒后72 h 好转组 189 81.25±10.34 82.51±10.60 83.34±12.43 84.64±16.74 85.31±12.40 86.69±15.88 86.89±17.98 预后不良组 56 82.41±13.50 96.11±12.20 115.32±14.41 126.64±15.73 137.50±15.50 153.67±15.76 168.24±13.33 F值 0.694 8.711 17.379 19.499 26.913 31.666 40.179 P值 0.489 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 注：重复测量方差分析，F组间=295.400，F时间=3318.000，F交互=224.300，均P < 0.001。
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表 5 急性有机磷中毒患者血尿素氮动态变化分析(x±s，mmol/L)
Table 5. Dynamic analysis of blood urea nitrogen in patients with acute organophosphorus poisoning(x±s, mmol/L)
组别 例数 入院时 中毒后4 h 中毒后12 h 中毒后24 h 中毒后36 h 中毒后48 h 中毒后72 h 好转组 189 5.86±1.35 6.02±1.12 6.25±1.33 6.74±1.63 6.80±1.79 6.91±1.80 7.03±1.12 预后不良组 56 5.97±1.88 6.31±1.40 6.76±1.85 7.25±1.34 7.64±1.72 7.99±1.87 8.46±1.54 F值 0.480 1.656 2.260 2.631 3.596 4.371 7.593 P值 0.632 0.100 0.025 0.009 < 0.001 < 0.001 < 0.001 注：重复测量方差分析，F组间=43.330，F时间=75.960，F交互=4.966，均P < 0.001。
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表 6 预后不良组与好转组急性有机磷中毒患者基线资料比较
Table 6. Comparison of baseline data between the poor prognosis group and improved group in patients with acute organophosphorus poisoning
项目 好转组(n=189) 预后不良组(n=56) 统计量 P值 性别[例(%)] 男性 82(43.39) 21(37.50) 0.614a 0.433 女性 107(56.61) 35(62.50) 年龄[M(P25, P75)，岁] 23.00(18.00, 31.00) 27.00(25.00, 40.00) 3.190b 0.003 合并基础疾病[例(%)] 是 29(15.34) 8(14.29) 0.038a 0.846 否 160(84.66) 48(85.71) 是否进食[例(%)] 是 131(69.31) 36(64.29) 0.503a 0.478 否 58(30.69) 20(35.71) 口服农药剂量(x±s，mL) 56.37±15.21 61.24±20.28 1.950c 0.053 口服农药类型[例(%)] 稀释液 57(30.16) 19(33.93) 0.287a 0.592 原液 132(69.84) 37(66.07) 中毒至入院时间[M(P25, P75)，h] 2.2(0.3, 3.6) 3.1(1.1, 3.9) 2.500b 0.015 呼吸(x±s，次/min) 16.32±4.57 17.57±5.21 1.620c 0.109 心率(x±s，次/min) 77.45±18.82 81.72±16.27 1.662c 0.100 平均动脉压(x±s, mmHg) 118.83±25.36 119.43±19.32 0.189c 0.850 白细胞计数(x±s，×109/L) 9.81±1.36 10.47±2.84 1.683c 0.097 血小板计数(x±s，×109/L) 40.24±7.41 38.72±10.77 0.989c 0.326 AChE活性(x±s，%) 39.12±6.56 35.44±9.20 2.791c 0.007 PaCO2(x±s，mmHg) 45.42±13.42 49.41±15.69 1.725c 0.088 PaO2(x±s，mmHg) 90.60±12.50 85.86±24.11 1.416c 0.162 心电图表现[例(%)] QT间期延长 60(31.75) 19(33.93) 0.094a 0.759 传导阻滞 43(22.75) 10(17.86) 0.610a 0.435 ST-T改变 13(6.88) 8(14.29) 3.025a 0.082 PR间期延长 7(3.70) 5(8.93) 2.532a 0.112 T波倒置 7(3.70) 4(7.14) 1.192a 0.275 注：a为χ2值，b为Z值，c为t值。1 mmHg=0.133 kPa。
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表 7 好转组与预后不良组有机磷中毒患者代谢指标变化水平比较(x±s)
Table 7. Comparison of metabolic indexes between the improved group and the poor prognosis group in patients with acute organophosphorus poisoning(x±s)
组别 例数 随机血糖
(mmol/L)钠离子
(mmol/L)氯离子
(mmol/L)血肌酐
(μmol/L)血尿素氮
(mmol/L)好转组 189 1.63±0.40 1.85±0.34 1.29±0.39 5.64±1.33 1.17±0.34 预后不良组 56 1.88±0.53 1.96±0.31 1.19±0.36 85.83±10.72 2.46±0.63 t值 3.265 2.280 1.791 55.851 14.702 P值 0.002 0.025 0.077 < 0.001 < 0.001
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表 8 代谢指标变化值与有机磷中毒患者预后的Cox回归模型分析
Table 8. Cox regression analysis of metabolic index changes and prognosis in patients with organophosphorus poisoning
变量 B SE Waldχ2 P值 HR值 95% CI 随机血糖变化值 0.326 0.502 0.421 0.517 1.385 0.518~3.703 钠离子变化值 1.084 0.471 5.302 0.021 2.958 1.175~7.446 血肌酐变化值 1.560 0.210 55.199 < 0.001 4.759 3.154~7.182 血尿素氮变化值 1.960 0.482 16.555 < 0.001 7.101 2.762~18.255 年龄 0.104 0.031 11.029 0.001 1.109 1.043~1.180 中毒至入院时间 1.927 0.371 26.986 < 0.001 6.872 3.321~14.220 AChE活性 -0.094 0.024 15.244 < 0.001 0.910 0.868~0.954
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