百草枯中毒24小时内肺部磨玻璃影体积及其早期动态变化的预后价值

发布时间：2018-04-27 08:03

本文选题：百草枯中毒 + 超急性期　；参考：《安徽医科大学》2017年硕士论文

【摘要】：研究一百草枯中毒24小时内肺部磨玻璃影体积的预后价值目的探讨百草枯中毒(PQ)24小时内肺CT磨玻璃影(GGO)体积与患者预后的关系。材料与方法回顾性分析58例百草枯中毒患者的一般资料、中毒24小时内的临床表现、实验室检查结果及CT影像学表现,根据百草枯中毒90天内患者的生存情况分为生存组和死亡组,比较两组患者的上述指标,对其具有显著统计学差异的客观指标采用Logistic回归分析,寻找有独立预后效应的因子,然后进一步采用ROC曲线分析其预测死亡的效能;同时,根据58例患者有无GGO进一步分为GGO组和无GGO组,采用Kaplan-Meier生存曲线分析GGO组和无GGO组的存活率。结果(1)生存组33例,其中男性15例,女性18例,平均年龄为(34.91±10.67)岁,死亡组25例,其中男性8例,女性17例,平均年龄为(38.72±13.97)岁,估计中毒剂量、胸闷有无、Pa O2、Pa CO2、白细胞、谷草转氨酶、肌酐等7个指标存在统计学差异(P0.05),即生存组明显高于死亡组,年龄、性别、食管烧灼感、咽痛、氧饱和度、PH、中性粒细胞、谷丙转氨酶、总胆红素等9个指标无统计学差异(P0.05),即生存组与死亡组之间无明显差异;(2)CT表现对比示:百草枯中毒24小时内GGO例数、GGO体积、GGO体积比及GGO累及肺段数4个指标存在统计学差异(P0.05),无明显异常、肺纹理增多、实变、胸腔积液、扫描时间等5个指标无统计学差异(P0.05)。(3)Logistic回归分析提示,百草枯中毒24小时内GGO体积、血肌酐、Pa O2是判断百草枯中毒预后的独立预后因子(P0.05),Pa CO2、谷草转氨酶、白细胞计数不是判断百草枯中毒预后的独立预后因子(P0.05);(4)ROC曲线示:GGO体积(AUC=0.837)曲线下面积大于血肌酐(AUC=0.832)、Pa O2(AUC=0.739),百草枯中毒24小时内肺部CT的GGO体积(cut-off值为7.62cc3)预测患者死亡的敏感性、特异性和准确性分别为96.97%、68%、74%。(5)GGO组存活率为32.1%,无GGO组则高达80%(P0.05)。结论百草枯中毒24小时内GGO体积、血肌酐、Pa O2均可预测百草枯中毒的预后结局,但GGO体积具有更好的预测效能及敏感性、准确性,即百草枯中毒24小时内GGO有无、体积大小对于判断百草枯中毒预后具有客观的临床指导价值。研究二百草枯中毒肺部磨玻璃影体积早期动态变化的预后价值目的探讨百草枯中毒早期(7天内)肺部CT磨玻璃影体积的动态变化与预后的关系。材料与方法回顾性分析42例百草枯中毒后24小时内、2天、4天及7天完整CT资料的中毒患者的影像学变化,根据百草枯中毒90天内患者的生存情况分为生存组和死亡组,比较两组患者GGO体积动态变化的特点,采用重复测量方差分析对其进行分析、比较,通过ROC曲线分析四个时间点预测死亡的效能。结果生存组30例,死亡组12例,(1)随着时间推移,两组患者肺部CT出现异常征象的人数均未见明显变化;(2)重复测量方差分析的结果示:时间因素有效应(F=13.458,P=0.001),即GGO体积随时间变化而变化,且时间因素与分组因素有交互作用(F=13.436,P=0.001),即各时间点测得的GGO体积随分组改变而改变;组间因素的计算结果表明,分组因素有效应(F=14.024,P=0.001),即生存组与死亡组之间GGO体积总体而言有统计学差异;(3)组间比较中,GGO体积在百草枯中毒2天、4天、7天三个时间点上生存组与死亡组之间有统计学差异(P0.05),在百草枯中毒24小时这一时间点上生存组与死亡组之间无统计学差异(P0.05),即在上述三个时间点生存组GGO体积明显低于死亡组,在百草枯中毒24小时这一时间点上生存组GGO体积与死亡组差别不大;组内比较中,生存组内四个时间点之间没有统计学差异,而死亡组之间各时间点之间是有统计学差异的,即死亡组之间随着时间推移,CT随访显示GGO体积呈现进行性增大的趋势;(4)百草枯中毒24小时、2天、4天、7天的GGO体积曲线下面积分别为0.524、0.741、0.798、0.833,呈现增加趋势,预测死亡的敏感性(33.33%、83.33%、91.67%、91.67%)增加,而特异性(92.86%、64.29%、71.43%、71.43%)降低;结论百草枯中毒早期GGO体积呈现平稳变化提示患者预后良好,呈现快速增加、进展则预示患者结局不良,百草枯中毒早期GGO体积的动态变化对于预测百草枯中毒预后具有准确、客观的判断,对于临床治疗及评估具有良好的指导价值。
[Abstract]:To study the prognostic value of the volume of lung glass shadow within 24 hours of the one hundred paraquat intoxication objective to explore the relationship between the volume of CT ground glass shadow (GGO) and the prognosis of the patients within 24 hours of paraquat poisoning (PQ). Materials and methods reviewed the general data of 58 cases of paraquat poisoning, the clinical manifestations, laboratory results and C in the 24 hours. T imaging findings were divided into survival and death groups according to the survival of paraquat intoxication within 90 days. Compared with the above indicators in the two groups, the objective indicators with significant statistical differences were analyzed by Logistic regression analysis to find the factors that had independent prognostic effects, and then a ROC curve was used to analyze the effect of their prediction of death. At the same time, 58 patients were divided into GGO group and non GGO group without GGO, and the survival rate of GGO and non GGO groups was analyzed by Kaplan-Meier survival curve. Results (1) the survival group was 33 cases, including 15 male and 18 female, with the average age of (34.91 + 10.67) years and 25 in the death group, including 8 men and 17 women, average age of (38.72 + 13.97). 7 indexes of Pa O2, Pa CO2, leukocyte, gluten transaminase and creatinine were statistically different (P0.05), that is, the survival group was significantly higher than the death group, that is, age, sex, esophagus burning sensation, pharynx, oxygen saturation, PH, neutrophils, alanine aminotransferase, total bilirubin, etc. (P0.05), namely, P0.05. There was no significant difference between the storage group and the death group; (2) the CT performance comparison showed that there were 4 indexes of GGO, GGO volume, GGO volume ratio and the number of GGO involved in the lung segment (P0.05), there was no significant difference in lung texture, real change, pleural effusion, scanning time and other 5 indexes (P0.05). (3) Logistic regression. The analysis suggested that GGO volume, serum creatinine and Pa O2 were independent prognostic factors (P0.05) for determining the prognosis of paraquat intoxication in 24 hours, Pa CO2, gluten transaminase, and white blood cell count is not an independent prognostic factor (P0.05) to judge the prognosis of paraquat poisoning; (4) the ROC curve indicated that the area under the GGO volume (AUC=0.837) curve is larger than the serum creatinine (AUC=0.832). Pa O2 (AUC=0.739), the GGO volume of CT in the lung (cut-off value of 7.62cc3) within 24 hours of paraquat poisoning, the sensitivity of the patient's death was predicted, the specificity and accuracy were 96.97%, 68%, 74%. (5) GGO, 32.1%, and 80% (P0.05) in no GGO group. The outcome of the poisoned prognosis, but GGO volume has better predictive efficiency and sensitivity, accuracy, that is, GGO within 24 hours of paraquat poisoning, volume size is of objective clinical guiding value for judging the prognosis of paraquat poisoning. To study the prognostic value of the early dynamic changes of the body accumulation of the lung glass shadow in the two paraquat intoxication The relationship between the dynamic changes in the volume of CT glass shadow in the lung and the prognosis of the early (7 days) lung intoxication. Materials and Methods Retrospective analysis of the imaging changes in the patients with complete CT data within 24 hours, 2 days, 4 days and 7 days after paraquat poisoning and the survival group and the death group according to the survival conditions of the patients with paraquat poisoning within 90 days, compared with the survival and death groups. Compared with the characteristics of the dynamic changes of GGO volume in the two groups, the repeated measurement of variance analysis was used to analyze it. Compared with the ROC curve, the mortality was predicted by four time points. 30 cases in the survival group, 12 cases in the death group, and (1) the number of abnormal signs of pulmonary CT in the two groups of the patients had not changed obviously with the time of time. (2) repeated measurements were carried out. The results of the quantitative variance analysis show that the time factor has effect (F=13.458, P=0.001), that is, the volume of GGO changes with time, and the time factor has interaction with the group factor (F=13.436, P=0.001), that is, the GGO volume measured at each time point changes with the group change, and the results of the intergroup factors show that the group factor has effect (F=14.024, P=0.001). There was a statistical difference between the GGO volume between the survival group and the death group. (3) in the group comparison, there was a statistically significant difference between the survival group and the death group at 2 days, 4 days, 7 days and three time points (P0.05), and there was no statistical difference between the survival group and the death group at the 24 hour point of paraquat poisoning (P0.05). The GGO volume of the survival group at the above three time points was obviously lower than the death group, and the GGO volume in the survival group was not much different from the death group at the time point of 24 hours of paraquat poisoning. There was no statistical difference between the four time points in the survival group, and the difference between the time points between the dead groups was statistically significant, that is, the death group. Over time, CT follow-up showed the trend of progressive enlargement of GGO volume; (4) 24 hours of paraquat poisoning, 2 days, 4 days, and 7 days of GGO volume curves were 0.524,0.741,0.798,0.833, showing an increase in the prediction of death sensitivity (33.33%, 83.33%, 91.67%, 91.67%), while specificity (92.86%, 64.29%, 71.43%, 71.43%) Conclusion the GGO volume in the early stage of paraquat poisoning shows a stable prognosis and a rapid increase in the prognosis. The progress indicates that the patient's outcome is bad. The dynamic changes of the GGO volume in the early stage of paraquat poisoning are accurate and objective for predicting the prognosis of paraquat poisoning and have good guidance price for clinical treatment and evaluation. Value.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R595.4;R816.41

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