| Objective: Analyzed the correlation between CT manifestations and the concentration of IL-17 and TGF-?1 in blood and serum drug concentration,and provided the basis for clinical diagnosis,treatment and prognosis judgement of paraquat poisoning patients.Methods: Selected 50 patients with paraquat poisoning from January 2013 to January 2018.Analyzed the general data,clinical manifestations,related examinations and CT findings of the patients were retrospectively.After follow-up,the outcomes of all patients were counted and divided into death group and survival group.Determined the serum drug concentration and the concentrations of IL-17 and TGF-?1.Thoracic CT semi-quantitative scoring was performed for the two groups with different CT manifestations.The general data and CT findings of death group and survival group were compared.The results of serum drug concentration,IL-17 and TGF-?1 were compared between death group and survival group.The factors influencing the prognosis of paraquat poisoning were analyzed by multivariate regression analysis.The correlation between serum drug concentration and GGO volume ratio,L-17 and TGF-?1 was analyzed,and the relationship between GGO volume ratio and IL-17 and TGF-?1 was determined by CT semi-quantitative analysis.Result correlation,ROC analysis,CT semi-quantitative analysis and predictive value of IL-17 and TGF-?1 for death caused by paraquat poisoning.Results:1.Comparison of general data between death group and survival group: Among 50 patients with acute paraquat poisoning,27 were in survival group and 23 were in death group.There was no difference in age,sex,clinical manifestation,poisoning time,liver function damage,kidney function damage and leukocytosis between the two groups(P > 0.05),but there was significant difference in moderate dose between the two groups.It was significantly higher than the survival group(P < 0.05).2.Comparing the CT manifestations between the death group and the survival group,the CT signs of the death group included 5 cases of pulmonary texture thickening,4 cases of exudative consolidation,8 cases of ground glass sign,5 cases of interstitial changes,1 case of pleural effusion,1 case of subcutaneous emphysema of mediastinum and 1 case of others.In survival group,there were 6 cases of pulmonary texture thickening,8 cases of exudative consolidation,4 cases of ground glass sign,3 cases of interstitial change,3 cases of pleural effusion,3 cases of subcutaneous emphysema of mediastinum,and 0 cases of other cases.There were no differences between the two groups in the lung texture thickening,exudative consolidation,interstitial change,pleural effusion and subcutaneous emphysema of mediastinum.There were differences in exudative consolidation and ground glass sign between the two groups(P<0.05).Comparisons of GGO manifestations showed that there were significant differences in GGO cases,GGO volume and GGO volume between the two groups(P < 0.05).There were no significant differences in five indicators(P > 0.05),including no abnormality,increased lung texture,pleural effusion and scanning time.3.The results of serum drug concentration,IL-17 and TGF-?1in the death group and the survival group were compared.The serum drug concentration in the death group was(2.525 ±0.541)ug/ml,and that in the survival group was(1.0623 ±0.010)ug/ml(P < 0.05).The serum drug concentration in the dead group was significantly higher than that in the survival group.The concentration of IL-17 in the dead group was(45.65 ±14.54)ug/L,and that in the survival group was(30.61 ±10.51)ug/L(P < 0.05).The concentration of IL-17 in the dead group was significantly higher than that in the survival group.The concentration of TGF-?1 in the dead group was(455.05 ±130.54)ug/L and in the survival group was(305.05±80.50)ug/L,The concentration of TGF-?1 in the dead group was significantly higher than that in the survival group.(P < 0.05)4.Multivariate analysis of prognosis of paraquat poisoning: On the basis of comparison of variance of two groups of single factors,differential serum drug concentration,GGO volume ratio,IL-17 and TGF-?1 were included in stepwise logistic regression analysis.It was found that serum drug concentration,GGO volume ratio,IL-17 and TGF-?1 were independent risk factors affecting the prognosis of paraquat poisoning.5.The correlation between serum drug concentration and GGO volume ratio,L-17 and TGF-?1: The blood drug concentration was positively correlated with GGO volume ratio,t=5.342 P=0.000.Serum drug concentration was positively correlated with L-17 t=3.561,P=0.001,and serum drug concentration was positively correlated with TGF-beta 1,t=-0.775,P=0.042.6.The correlation analysis between GGO volume ratio and IL-17 and TGF-?1 by CT semi-quantitative analysis: GGO volume ratio was positively correlated with IL-17,t=2.342,P=0.03.The volume ratio of GGO was positively correlated with TGF-?1,t=6.319,P=0.00.7.ROC analysis CT semi-quantitative analysis and predictive value of IL-17 and TGF-beta 1 on death of paraquat poisoning: ROC curve analysis showed that IL-17,TGF-beta 1,volume ratio predicted the prognosis of paraquat poisoning.The area under IL curve was 0.952,P< 0.01,the threshold was 1.033,the sensitivity was 0.964,the specificity was 0.911,and the optimum Yoden index was 0.875.The area under the curve of TGF-beta 1 was 0.923,P<0.01,the threshold was 1.033,the sensitivity was 0.778,the specificity was 0811,and the optimum Yoden index was 0.763.The area under ROC curve was 0.915,P < 0.01,the threshold was 1.033,the sensitivity was 0.778,the specificity was 0811,and the optimum Yoden index was 0.763.Conclusion:1.The volume of ground glass sign on CT is directly proportional to the factors reflecting alveolar inflammation and fibrosis,and is proportional to the concentration of serum drug.The higher the concentration of serum drug,the more serious the alveolar inflammation and fibrosis,the larger the volume of ground glass sign on CT.2.The plasma levels of IL-17 and TGF-beta 1 were directly proportional to the serum drug concentration.The higher the serum drug concentration was,the higher the serum IL-17 and TGF-beta 1 concentrations were.3.The volume of ground glass sign on CT and the plasma levels of IL-17 and TGF-?1 can be used as prognostic judgements of poisoning,providing a new index for correctly judging the prognosis of paraquat poisoning. |
PDF Full Text Request