白细胞和中性粒细胞计数对敌草快中毒病人出院生存状况的预测价值

张源达; 谢而付; 陈旭锋; 王喆

doi:10.13898/j.cnki.issn.1000-2200.2022.12.024

白细胞和中性粒细胞计数对敌草快中毒病人出院生存状况的预测价值

Predictive value of white blood cell and neutrophil count on the survival status of patients with diquat poisoning after discharge

摘要

摘要:
目的探讨敌草快（DQ）中毒病人临床特点及预后的影响因素，评估白细胞（WBC）、中性粒细胞计数对DQ中毒病人出院生存状况的预测价值。
方法收集DQ中毒病人41例，按出院生存状况分为存活组30例和死亡组11例，分析2组病人的临床和实验室指标，采用logistic回归分析病人预后的影响因素，利用ROC曲线评价中毒后24 h的WBC以及中性粒细胞计数水平对DQ中毒病人出院生存状况的预测价值。此外，分析2组病人中毒后24 h、72 h的WBC和中性粒细胞计数水平，以评估WBC、中性粒细胞计数的动态变化与DQ中毒病人出院生存状况可能存在的关联。
结果死亡组病人的年龄、体质量指数（BMI）、中毒剂量以及接受机械通气的比例显著高于存活组，而接受连续性肾脏替代治疗（CRRT）的比例、住院时间均显著低于存活组（P < 0.01）。死亡组中毒后24 h的WBC、中性粒细胞计数显著高于存活组（P < 0.05）。logistic回归分析显示，除中毒剂量外，分组比较存在显著差异的各变量回归意义明显（P < 0.05）。在加入性别、年龄作为调整变量后再行回归分析，结果显示仅住院时间、是否进行机械通气、中毒后24 h的WBC和中性粒细胞计数有统计学意义（P < 0.05）。ROC曲线分析显示，当中毒后24 h的中性粒细胞计数、WBC分别以11.765×10⁹/L和29.345×10⁹/L作为cut-off值，可获得最大曲线下面积（AUC：0.816±0.080，95%CI：0.660~0.973，P < 0.01和AUC：0.783±0.088，95%CI：0.611~0.955，P < 0.05）。存活组病人中毒后72 h的WBC、中性粒细胞计数均显著低于中毒后24 h（P < 0.05），而死亡组病人中毒后72 h的WBC、中性粒细胞计数虽然平均水平也低于中毒后24 h，但差异无统计学意义（P>0.05）。
结论DQ中毒病人中毒后24 h的WBC和中性粒细胞计数水平可以作为预测其出院生存状况的有效因子，对WBC、中性粒细胞计数水平的动态监测有助于判定DQ中毒病人的不良预后。

Abstract:
ObjectiveTo explore the clinical characteristics and prognostic factors of diquat (DQ) poisoning patients, and evaluate the predictive value of white blood cell (WBC) and neutrophil count on the survival status of DQ poisoning patients after discharge.
MethodsAccording to the survival status after discharge, 41 patients with DQ poisoning were divided into survival group (n=30) and death group (n=11).The clinical and laboratory index of the two groups were analyzed.The influencing factors of patients' prognosis were analyzed by logistic regression.ROC curve was used to evaluate the predictive value of WBC and neutrophil count 24 h after poisoning on the survival status of patients with DQ poisoning.In addition, the levels of WBC and neutrophil count at 24 h and 72 h after poisoning in the two groups were analyzed to evaluate the possible correlation between the dynamic changes of WBC and neutrophil count and the discharge survival status of DQ poisoning patients.
ResultsThe age, body mass index, toxic dose and the proportion of mechanical ventilation in the death group were significantly higher than those in the survival group, while the proportion of CRRT and the length of hospital stay were significantly lower than those in the survival group (P < 0.01).The levels of WBC and neutrophil count 24 h after poisoning in the death group were significantly higher than the survival group (P < 0.01).Logistic regression analysis showed that except for the poisoning dose, the value of variables with significant differences in group comparison was obvious (P < 0.05).After adding gender and age as adjustment variables, the results of logistic regression analysis showed that only the length of hospital stay, mechanical ventilation or not, WBC and neutrophil count 24 h after poisoning were significant (P < 0.05).The ROC curve analysis showed that when 11.765×10⁹/L and 29.345×10⁹/L were used as cutoff values of the neutrophil count and WBC 24 h after poisoning respectively, the maximum area under the curve can be obtained (AUC: 0.816±0.080, 95%CI: 0.660-0.973, P < 0.01 and AUC: 0.783±0.088, 95%CI: 0.611-0.955, P < 0.05).The levels of WBC and neutrophil counts in the survival group at 72 hours after poisoning were significantly lower than those at 24 h after poisoning (P < 0.05).By contrast, the average levels of WBC and neutrophil count in the death group at 72 hours after poisoning were also lower than that at 24 h after poisoning, but the difference was not significant.
ConclusionsWBC and neutrophil count in patients with DQ poisoning 24 hours after poisoning can be used as effective factors to predict their survival after discharge, and the dynamic monitoring of WBC and neutrophil count is helpful to determine the adverse prognosis of patients with DQ poisoning.

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