| Objective This research used the method of combination of traditional Chinese and western medicine to treat snake bite and explored the effect of independent risk factors which was related to the prognosis of snake bite patients. To provide evidence for the prior judgement of the prognosis in patients and the standard of clinical diagnosis and treatment.Methods Retrospectively analyzed 232 snake bite patients who admitted in the emergency ward of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from April 2013 to November 2014. The inclusion criteria of participants in this research referenced the international diagnosis standard and score for the combination of Chinese and western medicine to treat snake bite, which was formulated in the 2011 Academic Annual Conference of Traditional Chinese Medicine Surgical Operation.Patients were divided into the improvement group(81 cases) and recovery group(151cases) by the indexes of blood routine, coagulation convention, myocardial enzyme,liver enzymes, renal function and inflammatory biomarkers and scores of symptoms and signs in the last review before patients discharge. Single factor analysis was used to analyze the clinical data of two groups patients. Two independent sample t-test was used for the quantitative data and X2 test was used for the enumeration data. Stepwise logistic regression analysis was used for the risk factors that may affect the prognosis.Those significant risk factors(P < 0.05) included in the logistic regression model.P<0.05 was the criteria for the regression model significant. The receiver-operating characteristic curve(ROC curve) was used for analyzing the value of each independent factor in predicting on the severity and prognosis of snake bite patients.Results1.Improvement group: including 81 cases(44 men, 37 women) whose indexes of serum enzymology review at discharge had not returned to normal or constituted MODS,systemic and local symptoms significantly reduced, wounds almost healed and integral indexes were 30% ~ 89%. The average age of cases in this group was 68.3±9.3 years.Recovery group: including 151 cases(81 men, 70 women) whose indexes of serum enzymology review at discharge were in the normal range, systemic and local symptoms disappeared, wounds healed, the function of injured limb recovered, and integral indexes were 90% or more. The average age of cases in this group was50.4 ± 15.6 years. There was no statistical significance in sex, while significant difference in age(P < 0.01) between two groups.2.Clinical observation indexes: the comparison between improvement group and recovery group of snake bite patients: alanine aminotransferase[(45.6±17.9)U/L vs(38.7±13.4)U/L P ﹤ 0.01], aspartate aminotransferase[(57.1±13.2)U/L vs(46.8±15.8)U/L P ﹥ 0.05],urea nitrogen[(21.4±9.7)mmol/L vs(18.5±11.3)mmol/LP ﹤0.05],serum creatinine[(234.7±132.4)μmol/Lvs(12.4±63.6)μmol/L P ﹥ 0.05],creatine kinase[(368.4±163.5)U/L vs(228.9±136.7)U/L P<0.01],creatine kinase isoenzyme[(23.9±13.4)U/L vs(18.9±5.7)U/L P <0.01], total bilirubin[(15.7±6.6)μmol/L vs(18.9±5.7)μmol/L P﹤0.05],allergic C-reactive protein[(23.7±11.4)mg/L vs(16.67±4.69) mg/L P ﹥0.05], lactate dehydrogenase[(183.4±51.7) U/L vs(134.5±22.1)U/L P ﹥0.05], white blood cell count[(14.9±5.4)×109/L vs(13.7±4.3)×109/L P﹤0.05],prothrombin time[(15.8±3.7)s vs(15.3±2.9)s P ﹥ 0.05],Partial prothrombin time[(41.5±13.7)s vs(39.8±12.1)s P ﹥0.05].3. The results of single factor analysis showed that there were statistical significance in seven indexes between of two groups of patients with snake bite, i.e., age, alanine transaminase, urea nitrogen and creatine kinase, creatine kinase isoenzyme, total bilirubin, and white blood cell count(P < 0.05); while there was no statistical significance in aspartate aminotransferase, serum creatinine, allergic C-reactive protein,lactate dehydrogenase, prothrombin time and partial prothrombin time in the two groups(P > 0.05).4. The analysis of multiple factors related to the prognosis :According to the results of single factor regression analysis, we selected 7 prognostic risk factors(P < 0.05)which may affect the prognostic of patients bitten by poisonous snakes and based on the clinical inspection standard to give them values, and then included them into the logistic regression model. P<0.05 was the standard for the selection of factors in regression model. Age(> 60 years old), ALT(> 50 U/L) and CK-MB(> 24 U/L) were included in the final regression model.5.The area of the prognosis of snake bite risk factors under the ROC curve were as follows: age was 0.895, alanine aminotransferase was 0.842 and creatine kinase isoenzyme was 0.858.6. The prediction efficiency analysis of age, alanine aminotransferase and creatine kinase isoenzyme were as follows: the best cutoff value were 61.4 years old,60 u/L and27 u/L respectively;Sensitivity were 82.7%, 63.0% and 82.7% respectively; specific degree were 95.4%, 84.1% and 95.4% respectively; Youden index were 0.6682, 0.5833 and 0.6829 respectively.ConclusionThe results of single factor analysis showed that aspartate amino transferase, serum creatinine, hypersensitivity, C- reactive protein, lactate dehydrogenase, prothrombin time and partial prothrombin time were not the risk factors for the prognosis of snake bite patients, while age, elevated alanine transaminase, urea nitrogen increased, creatine kinase eleations, creatine kinase isoenzyme increased, higher total bilirubin and increasing white blood cell count were the risk factors for the prognosis of snake bite patients. The results of multivariable logistic regression analysis showed that patients’ age(> 60 years old), alanine aminotransferase(> 50 U/L) and creatine kinase isoenzyme(> 24 U/L) were the independent risk factors for the prognosis of snake bite patients and were included into the regression model. |
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