| Part I The Prognostic Value of Volume of Ground Glass Opacity within 24 Hours in Paraquat PoisoningObjective To investigate the prognostic value of volume of ground glass opacity(GGO)within 24 hours in the cases of paraquat(PQ)poisoning.Materials and Methods Retrospectively,basic information,clinical manifestation,laboratory results and CT imaging data of 58 patients with paraquat poisoning within 24 hours were analyzed.The data was divided into survival group and death group according to the survival of patients within 90 days after poisoning.The above mentioned indicators were compared.Logistic regression analysis is used to search for the significant different independent prognostic factors.Afterwards through ROC curve to evaluate the diagnostic value.Meanwhile,the data was divided into GGO group and non-GGO group according to with or without GGO.Using Kaplan-Meier survival curve to analyse survival rate of GGO group and non-GGO group.Results(1)Research showed that out Of the 58 cases,33 survived which 15 cases of men,18 cases of women,with an average age of(34.91±10.67)and 25 died which 8 cases of men,17 cases of women,with an average age of(38.72±13.97).The estimated amount of PQ ingested,chest stufly,Pa O2,Pa CO2,white blood cell count,aspertate aminotransferase and creatinine of the non-survivors were higher significantly than those of survivors(P < 0.05).Age,gender,burning sensation in the esophagus,pharyngalgia,oxygen saturation,PH,neutrophils,alanine transaminase and total bilirubin were not significant difference(P>0.05).(2)CT findings within 24 hours: cases of GGO,volume of GGO,volume ratio of GGO and number of GGO involving lung segment were significant difference(P<0.05),no obvious abnormality,increase of lung markings,consolidation, hydrothorax,scanning time were not significantly different(P > 0.05).(3)Logistic regression: volume of GGO in 24 hours,serum creatinine,Pa O2 were independent prognostic factors that estimate the prognosis of paraquat poisoning(P < 0.05).Pa CO2,aspertate aminotransferase,white blood cell count is not judge independent prognostic factors in patients with paraquat poisoning prognosis(P > 0.05).(4)ROC curve: the area under the ROC curve for the GGO volume(AUC = 0.837)was larger than that for serum creatinine(AUC = 0.832),Pa O2(AUC = 0.739).The sensitivity,specificity and accuracy of GGO volume(cut-off value=7.62cc3)within 24 hours in predicting death resulting from paraquat poisoning were 96.97%,68% and 74%,respectively.(5)GGO group survival rate was 32.1%,no-GGO group was 80%(P < 0.05).Conclusion The volume of GGO within 24 hours,serum creatinine,Pa O2 can predict the prognosis of paraquat poisoning,but the volume of GGO has better prediction performance,sensitivity and accuracy,The presence or absence of GGO and volume size within 24 hours have significant guidance values in judging prognosis of paraquat poisoning.Part II The Prognostic Value of Early Dynamic Change of Volume of Ground Glass Opacityin Paraquat PoisoningObjective To investigate the prognostic value of early(Within 7 days)dynamic change of GGO volume in the cases of paraquat poisoning.Materials and Methods Retrospectively,CT imaging data of 42 patients with paraquat poisoning were analyzed.Among them,CT imaging follow-up data were integrated,including CT imaging data of24 hours,2nd day,4th day and 7th day.The data were divided into survival group and death group according to the survival of patients within 90 days after poisoning.The characteristics of dynamic change of GGO volume were compared.Repeated ANOVA is used to analyse and compare the difference between two groups.Using ROC curve to analysis the diagnostic performance in four time points.Results Research showed that out Of the 42 cases,30 survived and 12 died.(1)With time going on,the cases of arising abnormal findings were not change between two groups.(2)Repeated ANOVA results:Time factor has effect(F=13.458,P=0.001),as time changes,volume of GGO changes.Meanwhile,time factor has interaction with grouping factor(F=13.436,P=0.001),volume of GGO change with the change of grouping in each time point.Grouping factor has effect(F=14.024,P=0.001),volume of GGO between survival group and death group were significantly different.(3)Comparisons between groups,the volume of GGO in 2nd days,4th days,7th days between the survival group and death group had significant difference(P<0.05),there was no significant difference within 24 hours between two groups(P>0.05),it is mesns that the volume of GGO in survival group was significantly lower than that in death group in 2nd day,4th day,7th day and the volume of GGO in both survival group and death group had no significant difference;Comparisons in groups,there was no significant difference between the survival group in four time points,and there was significant difference between the death group in four time points,it is means that with the time going on,the volume of GGO showed a trend of increasing in death group.(4)ROC curve: the area under the ROC curve for the GGO volume were 0.524,0.741,0.798,0.833 within 24 hours,2nd day,4th day,7th day of paraquat poisoning,respectively.The sensitivity(92.86%,64.29%,71.43%,71.43%)were increased,but the specificity(92.86%,64.29%,71.43%,71.43%)were reduced.Conclusion Early dynamic change of the volume of GGO have accurate and objective effect in judging prognosis of paraquat poisoning and provide significant guidance values for clinical treatment and assessment. |
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