论文部分内容阅读
目的分析急性有机磷农药中毒(AOPP)患者血清心肌酶变化。方法收集医院收治的AOPP患者120例的临床资料,根据中毒严重程度将患者分为轻、中、重度中毒组,观察3组血清天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶MB(CKMB)、α-羟丁酸脱氢酶(α-HBDH)浓度、胆碱酯酶活性及急性生理和慢性健康状况评估Ⅱ(APACHEⅡ)评分。根据临床症状体征、心肌酶谱、心电图结果将120例AOPP患者分为中毒性心肌炎组(n=88)和非中毒性心肌炎组(n=32),检测3组血清AST、LDH、CK、CKMB、α-HBDH浓度、胆碱酯酶活性及APACHEⅡ评分。另选取同期进行体检的健康人60例作为正常组。结果中毒组血清AST、LDH、CK、CKMB、α-HBDH浓度较正常组明显升高,胆碱酯酶活性较正常组明显降低,差异有统计学意义(P<0.05);且随着中毒程度加重,血清AST、LDH、CK、CKMB、α-HBDH浓度、APACHEⅡ评分逐渐升高,胆碱酯酶活性逐渐降低,差异有统计学意义(P<0.05)。中毒性心肌炎组血清AST、LDH、CK、CKMB、α-HBDH浓度、APACHEⅡ评分较非中毒性心肌炎组明显升高,胆碱酯酶活性较非中毒性心肌炎组明显降低,差异有统计学意义(P<0.05)。Sperman相关分析显示,AOPP并发中毒性心肌炎患者血清心肌酶与中毒严重程度、APACHEⅡ呈正相关性,与胆碱酯酶浓度呈负相关性(P<0.05)。结论血清心肌酶谱变化是反映AOPP患者中毒严重程度的血清标志物,AOPP并发中毒性心肌炎患者血清心肌酶谱与中毒严重程度、胆碱酯酶活性及APACHEⅡ评分有关。
Objective To analyze the changes of serum myocardial enzymes in patients with acute organophosphorus pesticide poisoning (AOPP). Methods The clinical data of 120 patients with AOPP admitted to the hospital were collected. According to the severity of poisoning, the patients were divided into mild, moderate and severe poisoning groups. Serum aspartate aminotransferase (AST), lactate dehydrogenase (LDH) ), Creatine kinase (CK), CKMB, α-HBDH, cholinesterase and acute physiological and chronic health status Ⅱ (APACHE Ⅱ) score. 120 patients with AOPP were divided into toxic myocarditis group (n = 88) and non-toxic myocarditis group (n = 32) according to clinical signs, myocardial enzymes and electrocardiogram results. Serum AST, LDH, CK and CKMB , Α-HBDH concentration, cholinesterase activity and APACHEⅡscore. Another 60 healthy subjects selected for the same period as the normal group. Results Serum levels of AST, LDH, CK, CKMB and α-HBDH in the poisoning group were significantly higher than those in the normal group, and the activity of cholinesterase was significantly lower than that in the normal group (P <0.05) Serum AST, LDH, CK, CKMB, α-HBDH concentration, APACHE Ⅱ score gradually increased, cholinesterase activity decreased, the difference was statistically significant (P <0.05). The levels of serum AST, LDH, CK, CKMB, α-HBDH and APACHEⅡ in patients with toxic myocarditis were significantly higher than those in non-toxic myocarditis group and those in non-toxic myocarditis group were significantly lower than those in non-toxic myocarditis group P <0.05). Sperman correlation analysis showed that serum myocardial enzymes in AOPP complicated with toxic myocarditis were positively correlated with the severity of poisoning and APACHEⅡ, and negatively correlated with the concentration of cholinesterase (P <0.05). Conclusion The change of serum myocardial enzymes is a serum marker reflecting the severity of poisoning in AOPP patients. The serum myocardial enzymes of patients with AOPP complicated with toxic myocarditis are related to the severity of poisoning, cholinesterase activity and APACHEⅡscore.