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1、急性百草枯中毒患者的肾功能指标变化及其临床意义doi:10.3969/j.issn.1007-614x.2014.14.40摘要目的:探讨急性百草枯(Parqual,PQ)中毒的肾功能指标动态变化及其临床意义。方法:对中毒组(43例)和对照组(20例)进行血清胱抑素(CysC)、肌酉干(CREA)、尿素氮(BUN)、B2-微球蛋白(B2-MG)及尿屮性粒细胞明胶酶相关脂质运载蛋白(NGAL)的测定,依据对照组和中毒存活组、死亡组的肾功能指标的变化结果进行统计学分析。结果:急性PQ中毒患者死亡组的急性肾功能异常
2、显著高于存活组,在CysC和NGAL测量值的动态变化上显著高于存活组;CysC以1.94pmol/L为截断点时,预测急性PQ中毒患者死亡的敏感度66.7%,特异性95.6%;尿NGAL以58.64Pg/L为截断点时,预测急性PQ屮毒患者死亡的敏感度72.2%,特异性91.1%o结论:急性PQ中毒患者早期出现肾功能异常提示预后不佳。动态监测CysC和尿NGAL变化可指导临床治疗。关键词百草枯中毒急性肾损伤血清胱抑素Thechangesandclinicalsignificanceofrenalfunctioni
3、npatientswithacuteparaquatpoisoningLiJingl,LiYong2,TianJianyuan2,ShouSongtao(Authorforcorrespondence)1,LiTeng2EmergencyDepartmentofGeneralHospitalAffiliatedtoTianjinMedicalUniversity,3000521EmergencyDepartmentofAffiliatedHospitalofJiningMedicalCollegeofJini
4、ngCityinShandongProvince2720002,AbstractObjective:Toexplorethedynamicchangesoftheindexesofrenalfunctionanditsclinicalsignificaneeofacuteparaquatpoisoning.Methods:SerumcystatinC(CysC),creatinine(CREA),bloodureanitrogen(BUN),P2-microglobulin(B2-MG)andurinaryn
5、eutrophilgelatinaseassociatedlipocalin(NGAL)ofpoisoninggroup(43cases)andcontrolgroup(20cases)weremeasured.Weobservedthechangesinrenalfunctionindexesofthecontrolgroup,thepoisoningsurvivalgroup,andpoisoningdeathgroup,andtookstatisticalanalysis.Results:Inpatie
6、ntswithacutePQpoisoning,acuterenaldysfunctionofpoisoningdeathgroupwassignificantlyhigherthanthesurvivalgroup.DynamicchangesofCysCandNGALmeasurementsweresignificantlyhigherthanthesurvivalgroup.WhentheCysCwith1.94umol/Lwasasthecut-offpoint,thesensitivityofpre
7、dictionofdeathinpatientswithacutePQpoisoningwas66.7%,specificitywas95.6%.WhentheUrinaryNGALwith58.64ug/Lwasasthecut-offpoint,thesensitivityofpredictionofdeathinpatientswithacutePQpoisoningwas72.2%,specificitywas91.1%.Conclusion:InpatientswithacutePQpoisonin
8、g,earlyrenalfunctionabnormalitiespredictpoorprognosis.DynamicmonitoringofthechangesofCysCandurinaryNGALcanguideclinicaltreatment.KeywordsPQpoisoning;Acutekidneyinjury;SerumcystatinC百草枯(1,10-二甲基-4,40-联毗