Wang Weizhan, Liu Qian, Xu Wenpin, Liu Tiezhen, Zhu Baoyue, Qi Hongna, Xiao Qingmian, Wang Pu, Li Yaqin
Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, Hebei, China. Corresponding author: Zhu Baoyue, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 Dec;34(12):1320-1324. doi: 10.3760/cma.j.cn121430-20210902-01311.
To investigate the effect of continuous hemoperfusion (HP) on the levels of soluble CD14 isoform (sCD14-st) and neutrophil gelatinase-associated lipocalin (NGAL) on patients with diquat (DQ) poisoning and its significance.
A total of 86 patients with acute DQ poisoning admitted to the department of emergency medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to August 2021 were enrolled and divided into the intermittent HP group (40 cases) and the continuous HP group (46 cases) according to the random number table method. All patients received basic treatment and continuous veno-venous hemofiltration (CVVH) within 24 hours after admission. On this basis, the intermittent HP group received HP treatment within 2 hours, lasting 2 hours each time for every 8 hours, 3 times in all; the continuous HP group received continued HP treatment until there was no DQ component in urine samples. Serum NGAL levels were detected in all patients before treatment and at 3 hours, 12 hours, 24 hours, 2 days, 3 days, 5 days, and 7 days after treatment. At the same time, serum sCD14-st, blood lactate (Lac), arterial partial pressure of oxygen (PaO), serum creatinine (SCr), MB isoenzyme of creatine kinase (CK-MB) and interleukin-18 (IL-18) levels were detected before treatment and at 24 hours, 3 days, and 7 days after treatment. Kaplan-Meier survival curve was drawn to analyze the 28-day survival of patients.
Before treatment, there was no significant difference in serum NGAL, sCD14-st, Lac, PaO, SCr, CK-MB and IL-18 levels between the two groups. With the prolongation of treatment, the serum levels of NGAL, sCD14-st, Lac, SCr, CK-MB and IL-18 in the intermittent HP group increased at first and then decreased. Serum levels of NGAL, sCD14-st, CK-MB and IL-18 reached their peaks at 24 hours after treatment, and the Lac and SCr levels reached their peaks at 3 days after treatment. In addition, the levels of the above indexes at each time point in the continuous HP group were all significantly lower than those in the intermittent HP group [after 24 hours of treatment: NGAL (μg/L) was 345.90±30.75 vs. 404.24±38.79, sCD14-st (ng/L) was 1 941.88±298.02 vs. 2 656.35±347.93, CK-MB (U/L) was 30.67±9.11 vs. 43.28±8.06, IL-18 (ng/L) was 139.49±16.29 vs. 177.98±27.85; 3 days of treatment: Lac (mmol/L) was 2.98±0.26 vs. 3.72±0.49, SCr (μmol/L) was 125.01±24.24 vs. 156.74±28.88; all P < 0.05]. However, there was no significant difference in PaO levels between the two groups at each time point after treatment. The Kaplan-Meier survival curve showed that the 28-day mortality of patients in the continuous HP group was significantly lower than that in the intermittent HP group [26.09% (12/46) vs. 52.50% (21/40); Log-Rank test: χ = 7.288, P = 0.007].
Continuous HP could effectively reduce serum sCD14-st, NGAL levels and 28-day mortality in patients with DQ poisoning, with good curative effect.
探讨持续血液灌流（HP）对百草枯（DQ）中毒患者可溶性CD14异构体（sCD14-st）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平的影响及其意义。
选取2018年5月至2021年8月在河北医科大学附属哈励逊国际和平医院急诊科收治的86例急性DQ中毒患者，根据随机数字表法分为间歇性HP组（40例）和持续性HP组（46例）。所有患者入院后24小时内均接受基础治疗及持续静静脉血液滤过（CVVH）。在此基础上，间歇性HP组在2小时内进行HP治疗，每8小时1次，每次持续2小时，共3次；持续性HP组持续进行HP治疗直至尿样中无DQ成分。检测所有患者治疗前及治疗后3小时、12小时、24小时、2天、3天、5天和7天的血清NGAL水平。同时，检测治疗前及治疗后24小时、3天和7天的血清sCD14-st、血乳酸（Lac）、动脉血氧分压（PaO）、血清肌酐（SCr）、肌酸激酶MB同工酶（CK-MB）和白细胞介素-18（IL-18）水平。绘制Kaplan-Meier生存曲线分析患者28天生存率。
治疗前，两组患者血清NGAL、sCD14-st、Lac、PaO、SCr、CK-MB和IL-18水平比较，差异无统计学意义。随着治疗时间延长，间歇性HP组血清NGAL、sCD14-st、Lac、SCr、CK-MB和IL-18水平先升高后降低。血清NGAL、sCD14-st、CK-MB和IL-18水平在治疗后24小时达到峰值，Lac和SCr水平在治疗后3天达到峰值。此外，持续性HP组各时间点上述指标水平均显著低于间歇性HP组[治疗24小时后：NGAL（μg/L）为345.90±30.75比404.24±38.79，sCD14-st（ng/L）为1941.88±298.02比2656.35±347.93，CK-MB（U/L）为30.67±9.11比43.28±8.06，IL-18（ng/L）为139.49±16.29比177.98±27.85；治疗3天后：Lac（mmol/L）为2.98±0.26比3.72±0.49，SCr（μmol/L）为125.01±24.24比156.74±28.88；均P<0.05]。然而，治疗后各时间点两组患者PaO水平比较，差异无统计学意义。Kaplan-Meier生存曲线显示，持续性HP组患者28天死亡率显著低于间歇性HP组[26.09%（12/46）比52.50%（21/40）；Log-Rank检验：χ²=7.288，P=0.007]。
持续HP可有效降低DQ中毒患者血清sCD14-st、NGAL水平及28天死亡率，疗效良好。
