摘要:
Objective To investigate the value of serum presepsin concentration measurement in the clinical diagnosis and treatment of patients with pesticide poisoning patients.Methods A total of 160 patients with pesticide poisoning were enrolled as study subjects and divided into moderate organophosphate pesticide poisoning group (40 patients),severe organophosphate pesticide poisoning group (40 patients),abamectin pesticide poisoning group (40 patients),and paraquat poisoning group (40 patients).A total of 20 healthy volunteers were enrolled as the control group.All the patients with poisoning received conventional treatment of pesticide poisoning immediately after admission,and serum presepsin concentration was measured on days 1 (within 24 hours after poisoning),3,and 7 of admission,and biochemical and radiological parameters related to the patient' s condition were also examined.The patients with a Presepsin concentration of >800 pg/ml on day 1 of admission were randomly divided into conventional treatment group and ulinastatin treatment group,and the treatment outcome was compared between the two groups.Results Compared with the healthy control group,the groups with pesticide poisoning showed significant increases in serum Presepsin concentrations,with the highest degree of increase on day 1 (P <0.05).The serum Presepsin concentration was positively correlated with alanine aminotransferase,aspartate aminotransferase,creatine kinase,creatine kinase MB,lactate dehydrogenase,serum creatinine,blood urea nitrogen,interleukin-18,and white blood cell count,but negatively correlated with cholinesterase.In the conventional treatment group and ulinastatin treatment group,the overall response rate was 68% and 78.8%,respectively,with a significant difference between the two groups (P<0.05).In 40 patients with paraquat poisoning,32 experienced an increase in serum presepsin concentration,and among these 32 patients,27 (83%) experienced exudation on lung CT.Conclusion Serum Presepsin concentration measurement can assist early diagnosis,evaluation of disease severity,and guidance for clinical medication in patients with pesticide poisoning,especially in those with severe pesticide poisoning and a tendency to multiple organ failure.%目的 研究血清中可溶性CD14亚型(presepsin)SCD14-ST浓度检测对农药中毒患者的临床诊疗意义.方法 选取农药中毒患者160例为研究对象,分为有机磷农药中度中毒组40例,有机磷农药重度中毒组40例,阿维菌素农药中毒组40例,百草枯中毒组40例,以健康志愿者20例为对照组.所有中毒患者放院后即进行农药中毒的常规治疗,并于入院第1天(中毒发生24 h内)、第3天、第7天检测血清中presepsin浓度,以及与病情变化相关的生化指标、影像学等;根据患者入院第1天检测的血清中presepsin浓度选择presepsin大于800 pg/ml的病例,随机分为常规治疗组和乌司他丁治疗组,比较两组治疗效果.结果 与健康对照组比较,各组农药中毒患者的血清中presepsin浓度明显升高,以第1天升高程度最为明显,差异有统计学意义(P<0.05);血清中presepsin浓度与丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)、血肌酐(SCr)、尿素氮(BUN)、白细胞介素-18(IL-18)、白细胞(WBC)呈正相关;与有机磷农药中毒胆碱酯酶活力呈负相关.血清中presepsin浓度>800 pg/ml的常规治疗组总有效率为68%,联合乌司他丁治疗组的总有效率为78.8%,两组治疗有效率的差异有统计学意义(P<0.05).40例百草枯农药中毒患者中,血清中presepsin 浓度明显升高32例,其中27例(83%)肺部CT出现了渗出.结论 检测血清中presepsin浓度对农药中毒患者,尤其是严重的、有进展为多器官功能衰竭趋势的农药中毒患者的早期诊断、病情严重程度评估、指导临床用药均具有潜在意义.