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目的探讨同步测定血清肌酸激酶的同功酶(CK-MB)与血清肌酸激酶(CK)比值及肌钙蛋白I(cTnI)在急性有机磷农药中毒(AOPP)中的变化及其在病情判断、评估中的临床意义和实用价值。方法对868例原未有心、肺、脑、肾、骨骼各其他结缔组织疾病的AOPP患者于中毒后12h时抽取空腹静脉血4ml同步测定CK、CK-MB及cTnI,并计算出CK-MB/CK比值,另选同期测定288例健康查体者的血清CK、CK-MB、CK-MB/CK及cTnI作为对照组。结果轻、中、重中毒组的CK、CK-MB及cTnI与正常对照组比较,中度组与轻度组、重度组与中度组比较均显著升高(P<0.01)。CK-MB/CK比值:轻度、中度、重度中毒组与对照组比较显著低于对照组(P<0.01);重度中毒组显著低于中度中毒组(P<0.01);中度中毒组显著低于轻度中毒组(P<0.01);发生中间综合征(IMS)组显著低于未发生IMS组。结论①CK-MB/CK比值变化与AOPP中毒程度呈负相关,cTnI与AOPP中毒程度呈正相关,可用于协助AOPP临床分级、病情判断及指导AOPP的急诊、救治和预后评估;②在中度、重度急性AOPP患者中,发生IMS几率与CK、CK-MB/CK及cTnI存在着密切相关性。在一定范围内,CK-MB/CK比值越小、CK及cTnI值越大,则发生IMS的几率越高。对本组资料进行统计学处理所得的函数方程可作为早期IMS的有效预报指标,更有利于对AOPP患者早期实施更具个体化的救治方案,为AOPP患者并发IMS及心脏猝死提供了一个客观、灵敏的早期评估判断指标。
Objective To investigate the changes of serum creatine kinase (CK-MB) and serum creatine kinase (CK) ratio and cTnI in acute organophosphorus pesticide poisoning (AOPP) Judgment, evaluation of the clinical significance and practical value. Methods CK, CK-MB and cTnI were determined simultaneously in 868 AOPP patients who had no other connective tissue diseases of heart, lung, brain, kidney and bone at 12h after poisoning. CK-MB / CK ratio, the other selected 288 cases of healthy people were measured serum CK, CK-MB, CK-MB / CK and cTnI as a control group. Results Compared with the normal control group, CK, CK-MB and cTnI of mild, moderate and severe poisoning group were significantly increased (P <0.01) in moderate and mild group, severe group and moderate group. The ratio of CK-MB / CK in mild, moderate and severe poisoning group was significantly lower than that in control group (P <0.01), severe poisoning group was significantly lower than moderate poisoning group (P <0.01) Group was significantly lower than the mild poisoning group (P <0.01); intermediate syndrome (IMS) group was significantly lower than the IMS group did not occur. Conclusions ① The change of CK-MB / CK ratio is negatively correlated with the degree of AOPP poisoning. CTnI is positively correlated with the degree of AOPP poisoning. It can be used to assist in the classification of AOPP, judgment of the disease and guide the emergency diagnosis, treatment and prognosis evaluation of AOPP. In acute AOPP patients, there is a close correlation between the incidence of IMS and CK, CK-MB / CK and cTnI. Within a certain range, the smaller the CK-MB / CK ratio, the larger the CK and cTnI values, the higher the chance of IMS occurring. The function equation obtained from the statistical processing of this group of data can be used as an effective predictor of early IMS, more conducive to the early implementation of AOPP patients with more individualized treatment plan, providing AOPP patients with IMS and sudden cardiac death provides an objective and sensitive Early assessment to determine indicators.