急性百草枯中毒患者的肾功能指标变化及其临床意义.docVIP

急性百草枯中毒患者的肾功能指标变化及其临床意义 　　doi：10.3969/j.issn.1007-614x.2014.14.40 　　摘 要 目的：探讨急性百草枯（Parqual，PQ）中毒的肾功能指标动态变化及其临床意义。方法：对中毒组（43例）和对照组（20例）进行血清胱抑素（CysC）、肌酐（CREA）、尿素氮（BUN）、β2-微球蛋白（β2-MG）及尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）的测定，依据对照组和中毒存活组、死亡组的肾功能指标的变化结果进行统计学分析。结果：急性PQ中毒患者死亡组的急性肾功能异常显著高于存活组，在CysC和NGAL测量值的动态变化上显著高于存活组；CysC以1.94μmol/L为截断点时，预测急性PQ中毒患者死亡的敏感度66.7%，特异性95.6%；尿NGAL以58.64μg/L为截断点时，预测急性PQ中毒患者死亡的敏感度72.2%，特异性91.1%。结论：急性PQ中毒患者早期出现肾功能异常提示预后不佳。动态监测CysC和尿NGAL变化可指导临床治疗。 　　关键词 百草枯中毒 急性肾损伤 血清胱抑素 　　The changes and clinical significance of renal function in patients with acute paraquat poisoning 　　Li Jing1，Li Yong2，Tian Jianyuan2，Shou Songtao（Author for correspondence）1，Li Teng2 　　Emergency Department of General Hospital Affiliated to Tianjin Medical University，3000521 　　Emergency Department of Affiliated Hospital of Jining Medical College of Jining City in Shandong Province2720002， 　　Abstract Objective：To explore the dynamic changes of the indexes of renal function and its clinical significance of acute paraquat poisoning.Methods：Serum cystatin C（CysC），creatinine（CREA），blood urea nitrogen（BUN），β2-microglobulin（β2-MG）and urinary neutrophil gelatinase associated lipocalin（NGAL）of poisoning group（43 cases）and control group（20 cases）were measured.We observed the changes in renal function indexes of the control group，the poisoning survival group， and poisoning death group，and took statistical analysis.Results：In patients with acute PQ poisoning，acute renal dysfunction of poisoning death group was significantly higher than the survival group.Dynamic changes of CysC and NGAL measurements were significantly higher than the survival group.When the CysC with 1.94umol/L was as the cut-off point，the sensitivity of prediction of death in patients with acute PQ poisoning was 66.7%，specificity was 95.6%.When the Urinary NGAL with 58.64μg/L was as the cut-off point，the sensitivity of prediction of death in patients with acute PQ poisoning was 72.2%，specificity was 91.1%.Conclusion：In patients