中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
4期
270-273
,共4页
李竞%赵继华%张泉%袁飞%魏路清
李競%趙繼華%張泉%袁飛%魏路清
리경%조계화%장천%원비%위로청
百草枯%中毒%肺%高分辨率CT%磨玻璃影%预后
百草枯%中毒%肺%高分辨率CT%磨玻璃影%預後
백초고%중독%폐%고분변솔CT%마파리영%예후
Paraquat%Poisoning%Lung%High-resolution computed tomography%Ground glass opacity%Prognosis
目的：评价应用高分辨率CT（HRCT）检查肺部磨玻璃影（GGOs）在评估百草枯中毒患者预后中的价值。方法回顾性分析武警后勤学院附属医院2012年1月至2014年8月收治的137例急性百草枯中毒患者的临床与影像学资料。比较不同预后两组患者入院当日血浆百草枯浓度及GGOs相对面积。服毒后至入院10 d内每隔3 d进行一次胸部HRCT检查，对主动脉弓层面、主肺动脉窗层面、左上叶支气管层面、右下肺静脉层面、左侧膈顶层面5个层面的GGOs进行半定量分析。绘制受试者工作特征曲线（ROC），判断各指标对预后评估的价值。结果纳入137例患者中，有45例患者于服毒后28 d内死亡，病死率为32.85%。死亡组血浆百草枯浓度较存活组明显升高（mg/L：7.06±0.67比3.51±0.34，t＝5.280，P＝0.000），入院后3个时间点GGOs相对面积均明显大于存活组〔1～3 d：（32.0±5.0）%比（2.5±0.4）%，t＝7.860，P＝0.000；4～6 d：（45.5±5.7）%比（2.8±0.5）%，t＝12.420，P＝0.000；7～10 d：（68.0±4.8）%比（3.0±0.6）%，t＝23.950，P＝0.000〕。ROC曲线显示，服毒后7～10 d GGOs相对面积判断预后的ROC曲线下面积（AUC）为1.000，能严格区分预后，但时间较晚；服毒后4～6 d GGOs相对面积的AUC为0.979，阈值>12.0%时特异度为96.15%，敏感度为85.19%，阳性预测值为88.46%，阴性预测值为94.94%，可早期判断患者预后；而血浆百草枯浓度对于预后判断相对较差，AUC为0.821，阈值＞1.95 mg/L时特异度为34.52%，敏感度为88.64%，阳性预测值为41.49%，阴性预测值为85.29%。结论应用胸部HRCT评估GGOs相对面积可以预测百草枯中毒患者的预后，且其价值优于血浆百草枯浓度。服毒后4～6 d行HRCT评估GGOs相对面积可早期评价百草枯所致肺损伤，且能指导临床预后评价。
目的：評價應用高分辨率CT（HRCT）檢查肺部磨玻璃影（GGOs）在評估百草枯中毒患者預後中的價值。方法迴顧性分析武警後勤學院附屬醫院2012年1月至2014年8月收治的137例急性百草枯中毒患者的臨床與影像學資料。比較不同預後兩組患者入院噹日血漿百草枯濃度及GGOs相對麵積。服毒後至入院10 d內每隔3 d進行一次胸部HRCT檢查，對主動脈弓層麵、主肺動脈窗層麵、左上葉支氣管層麵、右下肺靜脈層麵、左側膈頂層麵5箇層麵的GGOs進行半定量分析。繪製受試者工作特徵麯線（ROC），判斷各指標對預後評估的價值。結果納入137例患者中，有45例患者于服毒後28 d內死亡，病死率為32.85%。死亡組血漿百草枯濃度較存活組明顯升高（mg/L：7.06±0.67比3.51±0.34，t＝5.280，P＝0.000），入院後3箇時間點GGOs相對麵積均明顯大于存活組〔1～3 d：（32.0±5.0）%比（2.5±0.4）%，t＝7.860，P＝0.000；4～6 d：（45.5±5.7）%比（2.8±0.5）%，t＝12.420，P＝0.000；7～10 d：（68.0±4.8）%比（3.0±0.6）%，t＝23.950，P＝0.000〕。ROC麯線顯示，服毒後7～10 d GGOs相對麵積判斷預後的ROC麯線下麵積（AUC）為1.000，能嚴格區分預後，但時間較晚；服毒後4～6 d GGOs相對麵積的AUC為0.979，閾值>12.0%時特異度為96.15%，敏感度為85.19%，暘性預測值為88.46%，陰性預測值為94.94%，可早期判斷患者預後；而血漿百草枯濃度對于預後判斷相對較差，AUC為0.821，閾值＞1.95 mg/L時特異度為34.52%，敏感度為88.64%，暘性預測值為41.49%，陰性預測值為85.29%。結論應用胸部HRCT評估GGOs相對麵積可以預測百草枯中毒患者的預後，且其價值優于血漿百草枯濃度。服毒後4～6 d行HRCT評估GGOs相對麵積可早期評價百草枯所緻肺損傷，且能指導臨床預後評價。
목적：평개응용고분변솔CT（HRCT）검사폐부마파리영（GGOs）재평고백초고중독환자예후중적개치。방법회고성분석무경후근학원부속의원2012년1월지2014년8월수치적137례급성백초고중독환자적림상여영상학자료。비교불동예후량조환자입원당일혈장백초고농도급GGOs상대면적。복독후지입원10 d내매격3 d진행일차흉부HRCT검사，대주동맥궁층면、주폐동맥창층면、좌상협지기관층면、우하폐정맥층면、좌측격정층면5개층면적GGOs진행반정량분석。회제수시자공작특정곡선（ROC），판단각지표대예후평고적개치。결과납입137례환자중，유45례환자우복독후28 d내사망，병사솔위32.85%。사망조혈장백초고농도교존활조명현승고（mg/L：7.06±0.67비3.51±0.34，t＝5.280，P＝0.000），입원후3개시간점GGOs상대면적균명현대우존활조〔1～3 d：（32.0±5.0）%비（2.5±0.4）%，t＝7.860，P＝0.000；4～6 d：（45.5±5.7）%비（2.8±0.5）%，t＝12.420，P＝0.000；7～10 d：（68.0±4.8）%비（3.0±0.6）%，t＝23.950，P＝0.000〕。ROC곡선현시，복독후7～10 d GGOs상대면적판단예후적ROC곡선하면적（AUC）위1.000，능엄격구분예후，단시간교만；복독후4～6 d GGOs상대면적적AUC위0.979，역치>12.0%시특이도위96.15%，민감도위85.19%，양성예측치위88.46%，음성예측치위94.94%，가조기판단환자예후；이혈장백초고농도대우예후판단상대교차，AUC위0.821，역치＞1.95 mg/L시특이도위34.52%，민감도위88.64%，양성예측치위41.49%，음성예측치위85.29%。결론응용흉부HRCT평고GGOs상대면적가이예측백초고중독환자적예후，차기개치우우혈장백초고농도。복독후4～6 d행HRCT평고GGOs상대면적가조기평개백초고소치폐손상，차능지도림상예후평개。
ObjectiveTo assess the value of the area of ground glass opacities (GGOs) in lungs displayed by high-resolution computed tomography (HRCT) in paraquat (PQ) poisoned patients in evaluating prognosis. Methods Clinical and imaging data of 137 patients with acute PQ poisoning admitted to Affiliated Hospital of the Medical College of Chinese People's Armed Police Forces from January 2012 to August 2014 were analyzed retrospectively. The plasma concentration of PQ on admission and the area of GGOs were compared between two groups. The lung HRCT within 10 days of poisoning was performed every 3 days, and the areas of GGOs were evaluated on five levels, including aortic arch, aortic pulmonary window, left upper lobe bronchial, right inferior pulmonary vein, and left diaphragmatic dome. Receiver operating characteristic curve (ROC) was plotted to evaluate the value of all the parameters for prognosis.Results Among 137 patients, 45 died within 28 days after poisoning, with the mortality rate of 32.85%. The plasma PQ level in the non-survivors was significantly higher than that in the survivors (mg/L:7.06±0.67 vs. 3.51±0.34,t = 5.280,P = 0.000). The areas of GGOs at three time points in the non-survivors were significantly higher than those in the survivors [1-3 days: (32.0±5.0)% vs. (2.5±0.4)%,t = 7.860,P = 0.000;4-6 days: (45.5±5.7)% vs. (2.8±0.5)%,t = 12.420,P = 0.000; 7-10 days: (68.0±4.8)% vs. (3.0±0.6)%, t = 23.950,P = 0.000]. ROC analysis demonstrated that the area under the ROC curve (AUC) of GGOs in 7-10 days was 1.000, which could be used to determine the prognosis, but it was too late for the treatment. The AUC of GGOs in 4-6 days was 0.979, with the threshold of> 12.0%, the specificity of 96.15%, the sensitivity of 85.19%, the positive predictive value of 88.46%, and the negative predictive value of 94.94%, which presented good effect in predicting prognosis in the early stage of acute PQ intoxication. But plasma PQ concentration was relatively poor for determining prognosis, AUC was 0.821, with the threshold of> 1.95 mg/L, the specificity of 34.52%, the sensitivity of 88.64%, the positive predictive value of 41.49%, and the negative predictive value of 85.29%.Conclusions The area of GGOs displayed by HRCT can be used to evaluate the fully developed acute PQ lung injury, and it is superior to plasma PQ concentration. The area of GGOs displayed by HRCT 4-6 days after intoxication can be used for the evaluation of PQ induced pulmonary injury in the early stage and the evaluation of clinical prognosis.
