液相芯片检测细胞因子对急性有机磷农药中毒患者预后的预测价值

余莉婷; 徐勋宏; 蒋文明; 余勇苗

doi:10.16766/j.cnki.issn.1674-4152.003115

液相芯片检测细胞因子对急性有机磷农药中毒患者预后的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.003115

浙江省人民医院淳安分院急诊科，浙江杭州 311700

基金项目:

浙江省医药卫生科技计划项目 2023XY144

详细信息

通讯作者:
余莉婷，E-mail：gaogao142@163.com

中图分类号: R595.4
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出版历程
- 收稿日期: 2023-01-28
- 网络出版日期: 2023-09-13

Prognosis value of liquid chip detection of cytokines in patients with acute organophosphorus pesticide poisoning

Department of Emergency, Chun'an Branch of Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 311700, China

摘要

摘要: 目的通过液相芯片技术检测血清细胞因子，探讨血清细胞因子对急性有机磷农药中毒(AOPP)患者预后的预测价值。方法选取2019年4月—2022年6月浙江省人民医院淳安分院收治的80例中重度AOPP患者作为研究对象，采用液相芯片技术检测相关血清细胞因子，根据预后情况分为存活组(61例)和死亡组(19例)。对比2组一般资料、血清细胞因子水平，绘制ROC曲线评价相关影响因素对预后的预测效能。结果死亡组APACHE Ⅱ评分[(27.89±4.00)分]较存活组[(21.50±2.90)分]高(P < 0.05)；死亡组肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、涎液化糖链抗原-6(KL-6)、转化生长因子-β(TGF-β)、心肌钙蛋白I(cTnI)较存活组高(P < 0.05)；ROC曲线显示，cTnI、IL-6、KL-6、TNF-α、TGF-β预后预测的AUC分别为0.805(95% CI：0.702~0.885)、0.755(95% CI：0.656~0.844)、0.682(95% CI：0.569~0.782)、0.751(95% CI：0.642~0.841)、0.716(95% CI：0.604~0.811)，与APACHE Ⅱ评分的AUC[0.890(95% CI：0.800~0.949)]对比差异无统计意义(P>0.05)。结论液相芯片是一种检测多种细胞因子的有效方法，采用该技术检测的TNF-α、IL-6、KL-6、cTnI、TGF-β1细胞因子对AOPP预后的预测价值高。
- 有机磷农药中毒 /
- 液相芯片技术 /
- 细胞因子 /
- 预后
Abstract: Objective To evaluate the prognostic value of serum cytokines in patients with acute organophosphorus pesticide poisoning (AOPP) by liquid chip technique. Methods A total of 80 patients with moderate to severe AOPP admitted to Chun ' an Branch of Zhejiang Provincial People ' s Hospital from April 2019 to June 2022 were selected as the study subjects. The related serum cytokines were detected by liquid chip technology. According to the prognosis, the patients were divided into survival group (61 cases) and death group (19 cases). General data and serum cytokine levels were compared between the two groups, and ROC curve was drawn to evaluate the prognostic efficacy of related influencing factors. Results APACHE Ⅱ score (27.89±4.00) in death group was higher than that in survival group (21.50±2.90, P < 0.05). The levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, salivary liquiform glycogen-6 (KL-6), transforming growth factor-β (TGF-β) and troponin I (cTnI) in death group were higher than those in survival group (P < 0.05). ROC curve showed that the AUC of cTnI, IL-6, KL-6, TNF-α and TGF-β for prognosis were 0.805 (95% CI: 0.702-0.885), 0.755 (95% CI: 0.656-0.844) and 0.682 (95% CI: 0.569-0.782), 0.751 (95% CI: 0.642-0.841), 0.716 (95% CI: 0.604-0.811), which were no statistical significance compared with the AUC predicted by APACHE Ⅱ score [(0.890, 95% CI: 0.800-0.949), P>0.05]. Conclusion Liquid chip is an effective method to detect a variety of cytokines, and the TNF-α, IL-6, KL-6, cTnI, TGF-β1 cytokines detected by this technology have high prognostic value for AOPP.
- Organophosphorus pesticide poisoning /
- Liquid chip technology /
- Cytokines /
- Prognosis

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图 1 急性有机磷农药中毒患者预后因素预测价值ROC曲线

Figure 1. Predictive value ROC curve of prognostic factors in AOPP patients

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表 1 2组急性有机磷农药中毒患者一般资料比较

Table 1. Comparison of general data of patients with acute organophosphorus pesticide poisoning in 2 groups

项目	死亡组(n=19)	存活组(n=61)	统计量	P值
性别(男性/女性，例)	9/10	34/27	0.408^a	0.523
年龄(x±s，岁)	39.95±6.02	38.88±6.31	0.669^b	0.509
中毒至入院时间(x±s，h)	7.95±1.92	7.93±2.01	0.039^b	0.969
有机磷农药种类[例(%)]			0.230^a	0.891
敌百虫	7(36.84)	20(32.79)
敌敌畏	8(42.11)	25(40.98)
其他	4(21.05)	16(26.23)
中毒程度[例(%)]			0.008^a	0.931
中度	11(57.89)	36(59.02)
重度	8(42.11)	25(40.98)
中毒剂量(x±s，mL)	20.25±5.02	20.01±4.98	0.182^b	0.857
APACHE Ⅱ评分(x±s，分)	27.89±4.00	21.50±2.90	6.455^b	< 0.001
血糖(x±s，mmol/L)	6.79±1.25	6.68±1.37	0.327^b	0.756
入院时收缩压(x±s，mmHg)	110.32±23.02	116.86±23.34	1.078^b	0.290
入院时舒张压(x±s，mmHg)	75.23±16.85	79.68±16.88	1.005^b	0.323
血红蛋白(x±s，g/L)	142.26±18.34	144.02±19.32	0.361^b	0.721
血小板计数(x±s，×10⁹/L)	265.26±42.25	276.38±43.98	0.992^b	0.329
红细胞计数(x±s，×10¹²/L)	4.26±0.42	4.28±0.45	0.178^b	0.860
白细胞计数(x±s，×10⁹/L)	13.25±4.32	13.34±4.29	0.079^b	0.937
注：^a为χ²值，^b为t值。1 mmHg=0.133 kPa。

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表 2 2组急性有机磷农药中毒患者血清细胞因子比较(x ±s)

Table 2. Comparison of serum cytokines in patients with acute organophosphorus pesticide poisoning in 2 groups(x ±s)

组别	例数	TNF-α(pg/mL)	IL-6(pg/mL)	IL-10(pg/mL)	CRP(mg/L)	KL-6(U/mL)	TGF-β(μg/L)	CK-MB(U/L)	cTnI(ng/mL)
死亡组	19	135.89±8.86	95.30±9.51	72.52±9.54	19.92±3.52	93.29±5.08	24.32±1.95	40.22±3.52	0.45±0.04
存活组	61	128.19±9.53	85.15±9.53	70.52±10.27	18.88±3.55	81.97±12.43	20.43±4.45	39.26±3.95	0.38±0.06
t值		3.248	4.060	0.783	1.122	5.739	5.370	1.008	5.849
P值		0.003	< 0.001	0.439	0.271	< 0.001	< 0.001	0.321	< 0.001

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表 3 急性有机磷农药中毒患者预后预测因素的预测价值

Table 3. Predictive value of prognostic factors in AOPP patients

预测变量	AUC	95% CI	特异度(%)	灵敏度(%)	Youden指数	临界值
APACHE Ⅱ评分	0.890	0.800~0.949	88.52	78.95	0.675	24.89
cTnI	0.805	0.702~0.885	75.40	84.20	0.596	0.42
IL-6	0.755	0.656~0.844	83.61	63.16	0.468	93.17
KL-6	0.682	0.569~0.782	65.57	89.47	0.551	87.85
TNF-α	0.751	0.642~0.841	65.57	94.74	0.603	22.04
TGF-β	0.716	0.604~0.811	72.13	63.16	0.353	134.15

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