首过血液灌流后血浆浓度对中重度急性百草枯中毒患者具有较高的预测价值。

Plasma Concentration After the First Hemoperfusion has a High Predictive Value in Medium Level Acute Paraquat-Poisoned Patients.

机构信息

Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou.

Department of Intensive Care Medicine, Yiwu Hospital Affiliated to Wenzhou Medical University.

出版信息

Ther Drug Monit. 2021 Dec 1;43(6):797-806. doi: 10.1097/FTD.0000000000000889.

DOI:10.1097/FTD.0000000000000889

PMID:34780392

Abstract

BACKGROUND

Paraquat ( PQ) is very poisonous to humans and animals and there is no effective clinical antidote . The efficacy of hemoperfusion (HP) treatment for PQ poisoning remains controversial. To explore new ways to predict the prognosis of patients with acute PQ poisoning and assist in the development of better hemopurification treatment strategies.

METHODS

The clinical data of patients who were intoxicated with PQ through contact were diagnosed with PQ poisoning by high-performance liquid chromatography. Samples were collected by the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January 2012 to November 2016. Based on the prognosis, the patients were grouped into survival and death groups. Comparisons of the differences in the clinical indexes were performed, including the initial concentration of PQ at admission, PQ concentration after first HP, the number of HP cartridges used for the first hemoperfusion, whether HP was combined with continuous renal replacement therapy, and the number of concurrent organ injuries between the 2 groups. In addition, data were analyzed using multivariate logistic regression models and receiver operating characteristic curves. Moreover, prognostic factors in patients with acute PQ poisoning were analyzed.

RESULTS

Overall, 128 patients with acute PQ poisoning were enrolled in this study. The median plasma PQ concentrations of the patients at admission were 21 and 834 ng/mL (range: 50-1,099,118 ng/mL). The multiple logistic regression model revealed that the initial concentration of PQ and the PQ concentration after the first perfusion were independent risk factors for death in patients with acute PQ poisoning. The PQ concentration in the survival group after the first HP was <516 ng/mL and was mainly distributed at approximately 100 ng/mL. The percentage of patients whose concentration after the first HP was <516 ng/mL in the death group was only 19%.

CONCLUSIONS

The initial plasma PQ concentration after admission and PQ concentration after the first HP are risk factors for death in patients with acute PQ poisoning. Moreover, PQ concentration after the first HP had a high predictive value for death. When the initial plasma PQ concentration after admission ranges from 50 ng/mL to 5000 ng/mL, the rapid reduction in plasma PQ concentration after HP treatment could improve the prognosis of patients with acute PQ poisoning.

摘要

背景

百草枯（PQ）对人和动物都非常有毒，目前没有有效的临床解毒剂。血液灌流（HP）治疗百草枯中毒的疗效仍存在争议。为了探索预测急性百草枯中毒患者预后的新方法，并协助制定更好的血液净化治疗策略。

方法

通过高效液相色谱法诊断接触致 PQ 中毒患者为 PQ 中毒。2012 年 1 月至 2016 年 11 月，温州医科大学第一附属医院急诊重症监护病房采集样本。根据预后，将患者分为存活组和死亡组。比较两组之间临床指标的差异，包括入院时 PQ 的初始浓度、首次 HP 后 PQ 浓度、首次血液灌流使用的 HP 盒数、是否联合连续性肾脏替代治疗以及两组之间并发器官损伤的数量。此外，使用多变量逻辑回归模型和受试者工作特征曲线进行数据分析。分析急性 PQ 中毒患者的预后因素。

结果

共有 128 例急性 PQ 中毒患者纳入本研究。患者入院时的中位血浆 PQ 浓度分别为 21 和 834 ng/ml（范围：50-1099118 ng/ml）。多变量逻辑回归模型显示，急性 PQ 中毒患者的初始 PQ 浓度和首次灌注后 PQ 浓度是死亡的独立危险因素。首次 HP 后存活组的 PQ 浓度<516 ng/ml，主要分布在 100 ng/ml 左右。首次 HP 后浓度<516 ng/ml 的死亡组患者百分比仅为 19%。

结论

入院后初始血浆 PQ 浓度和首次 HP 后 PQ 浓度是急性 PQ 中毒患者死亡的危险因素。此外，首次 HP 后 PQ 浓度对死亡有较高的预测价值。当入院后初始血浆 PQ 浓度在 50ng/ml 至 5000ng/ml 范围内时，HP 治疗后血浆 PQ 浓度的快速降低可改善急性 PQ 中毒患者的预后。