Changes Of Levels Of Plasma PTX-3in Patients With Acute Paraquat Poisoning And Its Value

Objection:1. Through detection of levels of pentraxin3,to investigate value of PTX–3for patients with acute paraquat poisoning on disease severity and prognosis.2. Confirm the important role of inflammatory response in acute paraquatpoisoning.3. Providing a new method for the treatment of paraquat poisoning.Methods:Collect58patients with acute paraquat poisoning in emergency ICU of dalianmedical university from March2012to January2014. All patients were carried out theunified therapeutic schedule.Based on whether died during hospitalization,58patientswere divided into survival group and death group; According to their poisoning does,divided into light、medium-duty and fulminanting type.Respectively on admission, thefirst l,2,3days after treatment, blood routine, c-reactive protein, pentraxin3weremeasured in early morning on an empty stomach;Application of statistical methods tocompare:(1) corresponds to point the WBC, CRP, PTX-3level change between thesurvival group and death group (2) corresponds to point the WBC, CRP, PTX-3levelchange during different does group;(3) analysis the WBC, CRP, PTX-3of paraquat topredict the risk of death through the ROC curve.Results:(1) three inflammatory index level change with the severity of disease in paraquatpoisoning patients, the heavier disease, the more intense inflammatory reaction,thehigher inflammation index:①peripheral blood WBC in death group is significantlyhigher than the survival group at the time of admission、 treatment after1day,2daysafter treatment, P <0.05, the difference was statistically significant;At the3days after treatment although peripheral blood WBC in death group is higher than the survivalgroup, but P>0.05, there was no statistically significant difference;②death patients′CRP levels at various time points were significantly higher than the survival group, P <0.05, differences between the two groups have statistical significance.(3) PTX-3levelsis higher in both survival group and death group at various time points than it in serumof patients, PTX-3levels are higher in death group at various time points than thesurvival group, P <0.05, differences between the two groups have statisticalsignificance.(2)The levels of three kinds of inflammation index in patients with acute paraquatpoisoning as the dose increased:①the WBC in light paraquat poisoning on admissionaverage is still in the normal, the WBC level at the time of1,2,3days after treatmenthigher than normal;The WBC count in medium-duty and fulminanting type patients inthe hospital,1,2,3days after treatment were higher than normal.Comparing three setsof peripheral blood leukocytes found: on admission、1、2days after treatment, P <0.05,the difference was statistically significant;Comparison at3days after treatment, P>0.05t，here was no statistically significant difference.②light poisoning patients onadmission and1,3days after treatment CRP mean are within the normal range, thesecond day after the treatment of CRP levels higher than normal; CRP levels inmedium-duty and fulminanting type patients at various time points were higher thannormal;On admission,1,2,3days after treatment, the comparison between three groupP <0.05, the difference was statistically significant.③light, medium-duty, fulminantingtype PTX-3at each time point average levels were higher than normal;Comparisonbetween three groups at various time points P <0.05, the difference was statisticallysignificant.(3) Drawing ROC curve of the WBC, CRP, PTX-3to predict mortality inpatients with paraquat: area under curve for the WBC in1day after the treatment, CRPin1,2,3days after treatment, the PTX-3in1,2,3days after treatment aresignificantly greater than the diagnostic reference line (P <0.05).Three indicators in1day after the treatment are good predictive, at this point the WBC, CRP,PTX-3′s areaunder the curve were0.681,0.701,0.728。According to the ROC curve to determine thethree indexes of evaluation parameters: the cutoff value of the peripheral blood WBC is 14.425or higher, sensitivity and specific degrees are0.634,0.728, Youden index is0.362; the cutoff value of CRP is17.1or higher, sensitivity and specific degrees are0.685,0.707, Youden index is0.392; the cutoff value of PTX–3is8.86or higher,sensitivity and specific degrees are0.677,0.761, Youden index is0.438.Conclusion:1. The inflammatory reaction play an important role in acute paraquat poisoningoccurrence, development process, inflammation index after paraquat poisoning changewith the degree of inflammatory reaction and illness severity.2. The level of WBC, CRP, PTX-3can be reactions as the intensity of bodyinflammatory, especially the early (24hours-48hours) levels can evaluate patientsprognosis.3. Compared with the commonly index used to evaluat prognosis of paraquatpoisoning poisoning such as dosage, clinical time, APACHE Ⅱ score, bloodpurification, the level of WBC, CRP, PTX-3ruled out the subjective factors;4. Compared with the WBC and CRP, predictive of mortality of PTX-3inpatients with paraquat poisoning is higher.