早期肺部CT磨玻璃影体积比可预测急性百草枯中毒患者的死亡率。
The volume ratio of ground glass opacity in early lung CT predicts mortality in acute paraquat poisoning.
作者信息
Kang Xin, Hu Da-Yong, Li Chang-Bin, Li Xin-Hua, Fan Shu-Ling, Liu Yong, Tang Guang-Yu, Ai Zi-Sheng, Wu Tianfu, Mohan Chandra, Zhou Xin J, Liu Jun-Yan, Peng Ai
机构信息
Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
出版信息
PLoS One. 2015 Apr 1;10(4):e0121691. doi: 10.1371/journal.pone.0121691. eCollection 2015.
BACKGROUND
Pulmonary injury is the main cause of death in acute paraquat (PQ) poisoning. However, whether quantitative lung computed tomography (CT) can be useful in predicting the outcome of PQ poisoning remains unknown. We aimed to identify early findings of quantitative lung CT as predictors of outcome in acute PQ poisoning.
METHODS
Lung CT scanning (64-slide) and quantitative CT lesions were prospectively measured for patients after PQ intoxication within 5 days. The study outcome was mortality during 90 days follow-up. Survival curves were derived by the Kaplan-Meier method, and mortality risk factors were analyzed by the forward stepwise Cox regression analysis.
RESULTS
Of 97 patients, 41 (42.3%) died. Among the eight different types of lung CT findings which appeared in the first 5-day of PQ intoxication, four ones discriminated between survivors and non-survivors including ground glass opacity (GGO), consolidation, pneumomediastinum and "no obvious lesion". With a cutoff value of 10.8%, sensitivity of 85.4% and specificity of 89.3%, GGO volume ratio is better than adopted outcome indicators in predicting mortality, such as estimated amount of PQ ingestion, plasma or urine PQ concentration, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores. GGO volume ratios above 10.8% were associated with increased mortality (hazard ratio, 5.82; 95% confidence interval, 4.77-7.09; P < 0.001).
CONCLUSIONS
The volume ratio of GGO exceeding 10.8% is a novel, reliable and independent predictors of outcome in acute PQ poisoning.
背景
肺损伤是急性百草枯（PQ）中毒的主要死亡原因。然而，定量肺部计算机断层扫描（CT）是否有助于预测PQ中毒的结局尚不清楚。我们旨在确定定量肺部CT的早期发现，作为急性PQ中毒结局的预测指标。
方法
对PQ中毒后5天内的患者进行前瞻性肺部CT扫描（64排）和定量CT病变测量。研究结局为90天随访期间的死亡率。采用Kaplan-Meier法绘制生存曲线，并通过向前逐步Cox回归分析分析死亡风险因素。
结果
97例患者中，41例（42.3%）死亡。在PQ中毒后第1个5天出现的8种不同类型的肺部CT表现中，有4种可区分存活者和非存活者，包括磨玻璃影（GGO）、实变、纵隔气肿和“无明显病变”。GGO体积比的截断值为10.8%，敏感性为85.4%，特异性为89.3%，在预测死亡率方面优于采用的结局指标，如PQ摄入量估计值、血浆或尿液PQ浓度、急性生理与慢性健康状况评分系统（APACHE）II和序贯器官衰竭评估（SOFA）评分。GGO体积比高于10.8%与死亡率增加相关（风险比，5.82；95%置信区间，4.77-7.09；P<0.001）。
结论
GGO体积比超过10.8%是急性PQ中毒结局的一种新的、可靠且独立的预测指标。
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