白细胞及中性粒细胞对百草枯中毒患者预后的意义

摘要

Objective To study the significance of leukocyte and neutrophil in paraquat poisoning.Methods Totally 139 cases of paraquat poisoning were divided into four groups according to the degree of lung injury:none pulmonary injury group (35 cases),mild pulmonary injury group (26 cases ),moderate pulmonary injury group(18 cases)and severe lung injury group(60 cases);meanwhile they were divided into three groups according to the results of treatment:cure group(86 cases),death within 3 days group(22 cases),the death after 3 days group(31 cases).60 cases of severe lung injury were divided into 3 groups:severe lung injury cure group (8 cases),severe lung injury death within 3 days group(22 cases),the severe lung injury death after 3 days group (30 cases).The relation between peripheral blood leukocyte and neutrophil number with lung injury was observed.Results Leukocyte and neutrophil number in severe lung injury patients were significantly increased [ (9.2±3.0)× 109/L,(9.6±3.6)× 109/L,(10.3±4.7)× 109/L vs (18.6±7.6)× 109/L;(7.1±2.8)× 109/L,(7.5±3.7)× 109/L,(8.0±3.8)× 109/L vs (16.1±6.9)× 109/L,all P＜0.05 ].Leukocyte and neutrophil count in the 2 groups of death were significantly higher than those of the cure group.Leukocyte and neutrophil count of the patients in severe lung injury cure group started to decline and showed significant difference from in two severe lung injury death groups since third day [ (22.0±7.2 )× 109/L vs (16.4±6.5 )× 109/L vs (9.5±4.7)× 109/L;(19.0±6.4)× 109/L vs (14.2±5.6)× 109/L vs (7.8±4.5)× 109/L,all P ＜0.05].Conclusions The more severe lung injury is,the lager number of leukocyte and neutrophils there is. If the patient's white blood cell and neutrophil count decrease rapidly to normal within 3-5 days and remain within the normal range after discontinuation,there is usually a good prognosis.%目的 研究白细胞及中性粒细胞数量在百草枯中毒患者预后判断中的意义.方法 139例百草枯中毒患者根据肺损伤程度分为4组:无肺损伤组(35例)、轻度肺损伤组(26例)、中度肺损伤组(18例)、重度肺损伤组(60例)；根据治疗结果不同分为3组:治愈组(86例)、3d内死亡组(22例)、3d后死亡组(31例).重度肺损伤组60例患者又分为3组,重度肺损伤治愈组(8例)、重度肺损伤3d内死亡组(22例)、重度肺损伤3d后死亡组(30例).统计分析第1、3、5、7、9天各组患者白细胞和中性粒细胞数.结果 中毒后第1天,重度肺损伤组患者白细胞总数及中性粒细胞数升高,与无肺损伤组、轻度肺损伤组和中度肺损伤组患者比较,差异均有统计学意义[白细胞总数:(9.2 ±3.0)×109/L、(9.6±3.6)×109/L、(10.3±4.7)×109/L比(18.6±7.6)×109/L；中性粒细胞数:(7.1±2.8)×109/L、(7.5±3.7)×109/L、(8.0±3.8)×109/L比(16.1±6.9)×109/L,均P＜0.05].3d内死亡组和3d后死亡组患者的白细胞及中性粒细胞数高于治愈组,差异有统计学意义[中毒后第1天:(9.8±3.8)×109/L比(24.0±7.1)×109/L比(16.0±6.2)×109/L,(7.7±3.5)×109/L比(20.9±6.3)×109/L比(13.9±5.7)×109/L；中毒后第3天:(9.6±3.9)×109/L比(22.0±7.2)×109/L比(16.2±6.6)×109/L,(7.5±3.4)×109/L比(19.0±6.4)×109/L比(13.9±5.7)×109/L,均P＜0.05].中毒后第3天,重度肺损伤治愈组患者的白细胞及中性粒细胞数下降,与重度肺损伤3d内死亡组和重度肺损伤3d后死亡组患者比较,差异均有统计学意义[(22.0±7.2)×109/L比(16.4±6.5)×109/L比(9.5±4.7)×109/L;( 19.0±6.4)×109/L比(14.2±5.6)×109/L比(7.8±4.5)×109/L,均P＜0.05].结论 百草枯中毒患者的肺损伤程度越重,白细胞及中性粒细胞数目越多；如果患者的白细胞及中性粒细胞数在3～5d内很快下降至正常范围内,且停药后保持在正常范围内,则可能提示患者预后较好.