【摘要】：研究背景及目的百草枯(paraquat,PQ)是一種高效能的除草劑,是我國最常見的農藥中毒類型,目前尚無特效對癥解毒藥物。急性腎損傷(acute kidney injury,AKI)是百草枯中毒的常見并發(fā)癥之一,是預測百草枯中毒患者死亡的獨立危險因素,百草枯中毒患者合并急性腎功能損傷時,死亡率高達66%。百草枯中毒患者急性腎功能損傷死亡率之所以居高不下,主要是缺乏早期、敏感診斷手段,未能及時的治療,從而錯過最佳的治療時機。因此,早期及時發(fā)現(xiàn)百草枯中毒患者是否合并AKI,及時干預治療,成為臨床上提高存活率的一個關鍵因素。目前臨床上主要以血肌酐和尿素作為診斷急性腎損傷的主要依據(jù),但肌酐及尿素并不能早期及時反映腎臟功能損害。研究發(fā)現(xiàn),中性粒細胞明膠蛋白酶相關性載脂蛋白(neutrophil gelatinase associated lipocalin,NGAL)與急性腎臟功能損傷有較高的相關性,可能對急性腎功能損傷早期診斷、預防、治療后預后改善等方面有重要意義,但在百草枯中毒急性腎損傷中的應用尚不明確,相關研究較少。本文的目的是探討血、尿NGAL變化在百草枯中毒急性腎損傷中的診斷價值。研究方法收集2014年12月至2015年12月鄭州大學第一附屬醫(yī)院急診科收治的100例急性百草枯中毒患者,根據(jù)監(jiān)測指標分百草枯中毒急性腎損傷組和非腎損傷組,記錄患者入院第1天、第3天和第5天血及尿NGAL值,同時記錄血肌酐、尿素動態(tài)變化水平。血肌酐、尿素、血NGAL、尿NGAL各時間段差異比較采用獨立樣本t檢驗進行分析。采用受試者工作曲線(ROC)分析檢測各指標對急性百草枯中毒發(fā)生急性腎損傷的預測效果及敏感度和特異度,并確定血、尿NGAL的最佳診斷臨界值。Spearman相關分析判斷血、尿NGAL變化與百草枯中毒急性腎損傷有無相關性。結果本研究發(fā)現(xiàn),百草枯中毒急性腎損傷組與非腎損傷組相比,第1天血NGAL、尿NGAL值在兩組間差別有統(tǒng)計學意義(P0.05),而第1天血肌酐及尿素值在兩組間則無顯著性統(tǒng)計學差異(P0.05)。在第3天和第5天,血肌酐、尿素、血NGAL、尿NGAL在兩組間差異均有統(tǒng)計學意義(P0.05)。ROC曲線分析發(fā)現(xiàn),急性百草枯中毒早期(第1天)患者血NGAL、尿NGAL、血肌酐和尿素的AUC分別為0.85、0.89、0.73、0.64,早期血NGAL、尿NGAL的AUC值明顯大于血肌酐及尿素,而在第3天時血NGAL、尿NGAL、血肌酐、尿素AUC分別是0.89、0.88、0.88、0.86,各曲線下面積無明顯差異。在第5天時血NGAL、尿NGAL、血肌酐、尿素AUC分別是0.85、0.87、0.89、0.86,各曲線下面積差異不明顯。Spearman相關性分析結果顯示,早期血、尿NGAL變化與百草枯中毒急性腎損傷有明顯的正相關(P0.05)。結論血、尿NGAL與百草枯中毒急性腎損傷密切相關,可以作為敏感的、可靠的百草枯中毒急性腎臟損傷的新型指標。
[Abstract]:Background and objective Paraquat (paraquat,PQ) is a highly effective herbicide and the most common type of pesticide poisoning in China. Acute renal injury (acute kidney injury,AKI) is one of the common complications of paraquat poisoning and an independent risk factor for predicting the death of paraquat poisoning patients. The mortality rate of paraquat poisoning patients with acute renal function injury is as high as 66%. The reason why the mortality rate of acute renal function injury in paraquat poisoning patients is high is the lack of early sensitive diagnostic means and the failure to treat in time so as to miss the best treatment opportunity. Therefore, early and timely detection of paraquat poisoning patients with AKI, intervention and treatment in time has become a key factor to improve the survival rate. At present, blood creatinine and urea are the main basis for the diagnosis of acute renal injury, but creatinine and urea can not reflect the renal function damage early and timely. It has been found that neutrophil gelatinase-associated apolipoprotein (neutrophil gelatinase associated lipocalin,NGAL) has a high correlation with acute renal function injury, and may be early diagnosis and prevention of acute renal function injury. It is important to improve the prognosis after treatment, but the application in acute renal injury caused by paraquat poisoning is not clear, and there are few related studies. The purpose of this paper is to investigate the diagnostic value of NGAL changes in blood and urine in acute renal injury caused by paraquat poisoning. Methods from December 2014 to December 2015, 100 patients with acute paraquat poisoning were collected from the emergency department of the first affiliated Hospital of Zhengzhou University. According to the monitoring indexes, they were divided into acute renal injury group and non-renal injury group. The NGAL values of blood and urine were recorded on the 1st, 3rd and 5th day after admission, and the dynamic changes of serum creatinine and urea were also recorded. The differences of serum creatinine, urea and NGAL, urine NGAL were analyzed by independent t test. The predictive effect, sensitivity and specificity of each index in predicting acute renal injury caused by acute paraquat poisoning were determined by (ROC) analysis of the operating curve of the subjects, and the best diagnostic critical value of NGAL in blood and urine was determined. Blood was judged by Spearman correlation analysis. There is no correlation between urinary NGAL and acute renal injury caused by paraquat poisoning. Results in this study, compared with non-renal injury group and paraquat poisoning acute renal injury group, there was a significant difference in serum NGAL, urine NGAL between the two groups on the first day (P0.05). On the first day, there was no significant difference in creatinine and urea between the two groups (P0.05). On the 3rd and 5th day, serum creatinine, urea and NGAL, urine NGAL were significantly different between the two groups (P0.05). ROC curve analysis showed that the early stage of acute paraquat poisoning (day 1) patients with serum NGAL, urine NGAL,) were significantly different between the two groups. The AUC of serum creatinine and urea were 0.85t 0.89U 0.73C 0.64, respectively. The AUC value of early NGAL, urine NGAL was significantly higher than that of serum creatinine and urea. On the 3rd day, the serum creatinine of serum NGAL, urine NGAL, and urea AUC were 0.8880.88 鹵0.880.86, respectively. There was no significant difference in area under each curve. On the 5th day, the levels of serum creatinine and urea AUC in NGAL, urine NGAL, and urea AUC were 0.85-0.87 / 0.86, respectively, and there was no significant difference in the area under the curve. The results of Spearman correlation analysis showed that the early blood, the blood of early stage, had no significant difference between the two groups. Urinary NGAL was positively correlated with acute renal injury caused by paraquat poisoning (P0.05). Conclusion NGAL in blood and urine is closely related to acute renal injury caused by paraquat poisoning and can be used as a new sensitive and reliable marker for acute renal injury of paraquat poisoning.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R595.4
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本文編號：2360241