Zhao Y, Tian Z G, Xu T, Gao F H, Guo Y Y, Wang G J, Xu Y G
Occupational Poisoning Department of Xuzhou Tumor Hospital. Xuzhou 221005, China.
Affiliated Hospital of Xuzhou Medical University. Xuzhou 221000, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020 Feb 20;38(2):140-144. doi: 10.3760/cma.j.issn.1001-9391.2020.02.014.
To investigate the CT features of lung injury induced by paraquat poisoning and its relationship with prognosis, and to provide reference for the judgment of the condition and prognosis of paraquat poisoning. 146 cases of paraquat poisoning patients were treated in the Third People's Hospital of Xuzhou City from January 2013 to April 2016. The cases were divided into mild group, moderate-severe group and fulminant group according to the concentration of paraquat in urine. The clinical data and CT imaging findings were analyzed and reconstructed in three-dimensional reconstruction. The extent of the lesion was observed and the relationship between CT and prognosis was explored. Paraquat lung injury has many manifestations on CT images, and it's performance can be intersecting at the same time. Early lesions lighter cases, late CT imaging lesions can be completely absorbed or residual fibrosis, the prognosis was good; the early lesion was pulmonary consolidation, pleural effusion cases, the late CT image was usually pleural thickening and bronchiectasis, the prognosis was relatively good; early lesions were large patches of ground glass opacity cases, finally, pulmonary fibrosis was common, the mortality rate of 56.57%. There were significant differences in the extent of lung injury between different groups (<0.001) , and the difference in mortality was statistically significant when the lung injury was different (<0.001) . Multivariate stepwise Logistic regression analysis showed that ground-glass opacity ( value=2.013) , interstitial lung fibrosis (=3.779) and mediastinal emphysema (=33.118) were risk factors for death of lung injury caused by paraquat poisoning (<0.05) . There were many manifestations on CT images of paraquat lung injury, and the manifestations of paraquat lung injury can be intersecting at the same time. The pulmonary manifestations and outcomes of different paraquat types were different. The CT manifestations of lung injury in paraquat poisoning were mainly exudative changes at early stage, and can be gradually absorbed or evolved into interstitial changes at later stage. The cumulative damage range can be used as a reference for evaluating the prognosis. Ground-glass opacity, interstitial pulmonary fibrosis and mediastinal emphysema are the risk factors for death of lung injury caused by paraquat poisoning.
探讨百草枯中毒致肺损伤的CT特征及其与预后的关系，为百草枯中毒病情及预后判断提供参考。选取2013年1月至2016年4月在徐州市第三人民医院救治的146例百草枯中毒患者，根据尿中百草枯浓度将病例分为轻症组、中重症组和暴发型组。分析其临床资料及CT影像表现，并进行三维重建。观察病变范围，探讨CT表现与预后的关系。百草枯肺损伤CT图像表现多样，且可同时交叉存在。早期病变较轻者，后期CT影像病变可完全吸收或残留纤维化，预后良好；早期病变为肺部实变、胸腔积液者，后期CT图像多为胸膜增厚及支气管扩张，预后相对较好；早期病变为大片磨玻璃影者，最终多出现肺纤维化，死亡率为56.57%。不同组间肺损伤范围差异有统计学意义（<0.001），肺损伤程度不同时死亡率差异有统计学意义（<0.001）。多因素逐步Logistic回归分析显示，磨玻璃影（值=2.013）、间质性肺纤维化（=3.779）及纵隔气肿（=33.118）是百草枯中毒致肺损伤死亡的危险因素（<0.05）。百草枯肺损伤CT图像表现多样，且可同时交叉存在。不同类型百草枯的肺部表现及转归不同。百草枯中毒肺损伤CT表现早期以渗出性改变为主，后期可逐渐吸收或演变为间质改变。累积损伤范围可作为评估预后的参考。磨玻璃影、间质性肺纤维化及纵隔气肿是百草枯中毒致肺损伤死亡的危险因素。
