急性有机磷农药中毒患者血清心肌酶谱变化

摘要

目的：分析急性有机磷农药中毒( AOPP)患者血清心肌酶变化。方法收集医院收治的AOPP患者120例的临床资料,根据中毒严重程度将患者分为轻、中、重度中毒组,观察3组血清天门冬氨酸氨基转移酶( AST)、乳酸脱氢酶( LDH)、磷酸肌酸激酶( CK)、磷酸肌酸激酶同工酶MB( CKMB)、α-羟丁酸脱氢酶(α-HBDH)浓度、胆碱酯酶活性及急性生理和慢性健康状况评估Ⅱ( APACHEⅡ)评分。根据临床症状体征、心肌酶谱、心电图结果将120例AOPP患者分为中毒性心肌炎组( n =88)和非中毒性心肌炎组( n =32),检测3组血清AST、LDH、CK、CKMB、α-HB-DH浓度、胆碱酯酶活性及APACHEⅡ评分。另选取同期进行体检的健康人60例作为正常组。结果中毒组血清AST、LDH、CK、CKMB、α-HBDH浓度较正常组明显升高,胆碱酯酶活性较正常组明显降低,差异有统计学意义( P <0.05)；且随着中毒程度加重,血清AST、LDH、CK、CKMB、α-HBDH浓度、APACHEⅡ评分逐渐升高,胆碱酯酶活性逐渐降低,差异有统计学意义( P <0.05)。中毒性心肌炎组血清AST、LDH、CK、CKMB、α-HBDH浓度、APACHEⅡ评分较非中毒性心肌炎组明显升高,胆碱酯酶活性较非中毒性心肌炎组明显降低,差异有统计学意义( P <0.05)。 Sperman相关分析显示,AOPP并发中毒性心肌炎患者血清心肌酶与中毒严重程度、APACHEⅡ呈正相关性,与胆碱酯酶浓度呈负相关性( P <0.05)。结论血清心肌酶谱变化是反映AOPP患者中毒严重程度的血清标志物,AOPP并发中毒性心肌炎患者血清心肌酶谱与中毒严重程度、胆碱酯酶活性及APACHEⅡ评分有关。%Objective To observe the changes of serum myocardium enzyme spectrum in patients with acute organophosphorus pesticide poisoning ( AOPP) . Methods The clinical data about 120 patients with AOPP were retrospectively analyzed. According to the severity of poisoning,these patients were divided into mild, moderate and severe poisoning groups. Moreover the 120 patients with AOPP were divided into toxic myocarditis group ( n =88 ) and non-toxic myocarditis group (n=32) according to clinical symptoms and signs, myocardium enzyme spectrum and ECG results. The serum levels of aspartate amino transferase (AST), lactate dehydrogenase (LDH), phosphocreatine kinase (CK), phosphocreatine kinase isoenzyme ( CKMB) and α-hydroxybutyrate dehydrogenase (α-HBDH ) ,cholinesterase activity and APACHEⅡscores were detected in all the groups. Besides the 60 healthy subjects were served as control group. Results As compared with those in control group, the serum levels of AST, LDH, CK, CKMB,α-HBDH in poisoning group were significantly increased, however, the levels of cholinesterase were significantly decreased ( P <0. 05). With the aggravation of poisoning degree,the serum levels of AST,LDH,CK,CKMB,α-HBDH and APACHEⅡscores were gradually increased,but cholinesterase activities were gradually decreased ( P <0. 05). The levels of AST,LDH,CK,CKMB,α-HBDH and APACHEⅡ scores in toxic myocarditis group were significantly increased, however, the cholinesterase activities were significantly decreased,as compared with those in non-toxic myocarditis group ( P <0. 05). Sperman correlation analysis showed that the levels of myocardium enzyme in patients with AOPP complicated by toxic myocarditis were positively correlated to the severity of poisoning and APACHEⅡ scores,however,which were negatively correlated to the cholinesterase activities ( P <0. 05). Conclusion The changes of serum myocardium enzyme spectrum are important serum markers to reflect the severity of AOPP,moreover, the serum myocardium enzyme spectrum is closely correlated to the severity of poisoning, cholinesterase activities and APACHEⅡscores in patients with AOPP complicated by toxic myocarditis.