Effect of lung and kidney injury sequence on prognosis in patients with paraquat poisoning

doi:10.3877/cma.j.issn.2095-9133.2019.06.007

Abstract

Abstract:

Objective

To investigate the effect of lung and kidney injury sequence on prognosis in patients with paraquat poisoning.

Methods

A total of 175 cases of paraquat poisoning admitted to the emergency department of the First Affiliated Hospital of Nanchang University from October 2010 to August 2018 were analyzed retrospectively, including 60 males and 115 females, aged 14-79 years, with an average age of (36.55±16.13)years. The 175 cases of paraquat poisoning were divided into 3 groups according to the sequence of lung and kidney injury. Renal injury was prior to lung injury group(Group A, 68 cases), lung injury was prior to kidney injury group (Group B, 42 cases), and lung and kidney damage group (group C, 65 cases). The data between each group were recorded, including dose of poisoning, the time from poisoning to gastric lavage, the time from poisoning to admission, age, gender, the time from poisoning to lung damage, and the time from poisoning to kidney damage, to compare the prognosis of patients with improvement or death.

Results

There was no statistically significant difference between the three groups in terms of the time from taking poison to gastric lavage, the time from taking poison to admission, and gender (P>0.05). There were statistically significant differences in the dose and age (P<0.01). However, there was no correlation of age on prognosis (P>0.05), while there was a correlation of dose on prognosis (P<0.001). The prognosis of group A was better than that of group B, and the difference is statistically significant (χ²=8.32, P<0.01); the prognosis of group B was better than that of group C, and the difference was statistically significant (χ²=21.04, P< 0.001).

Conclusion

The order of lung and kidney injury sequence has an impact on the prognosis: patients with simultaneous lung and kidney damage have the worst prognosis; the prognosis of the patient with kidney damage prior to lung damage is better than that of the patient with lung damage prior to kidney damage. The dose of poisoning also has good value for the prognosis.

Key words: Prognosis, lung injury, kidney injury, paraquat poisoning

Cuijun Huang, Congyang Zhou, Xingwen Ye. Effect of lung and kidney injury sequence on prognosis in patients with paraquat poisoning[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2019, 05(06): 344-347.

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References 16

1	中国医师协会急诊医师分会．急性百草枯中毒诊治专家共识[J]．中国急救医学，2013，33(6): 484-489.
2	Dinis-Oliveira RJ, Duarte JA, Sánchez-Navarro A, et al.Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment[J]. Crit Rev Toxicol, 2008, 38(1): 13-71.
3	Mccarthy S, Somayajulu M, Sikorska M, et a1.Paraquat induces oxidative stress and neuronal cell death；neuroprotection by water-soluble coenzyme Q10[J]. Toxicol Appl Pharmacol, 2004, 201(1): 21-31.
4	Meng XX, Wang RL, Gao S, et al.Effect of ulinastatin on paraquat-induced-oxidative stress in human type II alveolar epi-thelial cells[J]. World J Emerg Med, 2013, 4(2): 133-137.
5	Li SP, Han JY, Sun P, et al.Effect of SP-A/B in lipoic acid on acute paraquat poison- ing[J]. World J Emerg Med, 2014, 5(1): 57-62.
6	Weng CH, Hu CC, Lin JL, et al.Predictors of acute respiratory distress syndrome in patients with paraquat intoxication[J]. PLoS ONE, 2013；8(12): e82695.
7	冷俊岭，邹晓东，李扬，等．大剂量敌草快中毒患者1例报告[J/CD]．中华卫生应急电子杂志，2017, 3(5): 67-68.
8	Jones AL, Elton R, Flanagan R. Multiple logistic regression analysis of plasma paraquat concentrations as predictor of outcome in 375 cases of paraquat poisoning[J]. QJM, 1999, 92(10): 573-578.
9	Feng MX, Li YN, Ruan WS, et al.Predictive value of the maximum serum creatinine value and growth rate in acute paraquat poisoning patients[J]. Sci Rep, 2018, 8(1): 11587.
10	张志坚，周从阳，彭礼波，等．内质网应激与氧化应激在百草枯致大鼠肺纤维化中的作用及沙苑子总黄酮的影响[J]．中华急诊医学杂志，2014，23(9): 998-1001.
11	周从阳，张志坚，罗雅娟，等．乌司他丁对百草枯染毒大鼠肺组织热休克蛋白70和NF-κB的影响[J]．中华劳动卫生职业病杂志，2011，29(4): 280-283.
12	Dinis—Oliveira RJ, de Pinho PG, Santos L, et al.Postmortem analyses unveil the poor efficacy of decontamination, anti—inflammatory and immunosuppressive therapies in paraquat human intoxications[J]. PloS One, 2009, 4(9): e7149.
13	Kim SJ, Gil HW, Yang JO, et al.The clinical features of acute kidney injury in patients with acute paraquat intoxication[J]. Nephrol Dial Transplant, 2009, 24(4): 1226-1232.
14	Patschan D, Patschan S, Muller GA.Inflammation and microvasculopathy in renal ischemia reperfusion injury[J]. J Transplant, 2012, 2012: 764154.
15	赵波，菅向东，张忠臣，等．百草枯染毒大鼠组织中毒物含量与脏器损伤的关系[J]．中华劳动卫生职业病杂志，2010，28(3): 220-223.
16	DinisOliveira RJ, Duarte JA, SánchezNavarro A, et al.Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment[J]. Crit Rev Toxicol, 2008, 38(1): 1371.

组别	例数	性别(男/女)	年龄(岁，±s)	服毒量(mL，±s)	洗胃时间(min，±s)	入院时间(h，±s)	服毒至肺损伤时间(d，±s)	服毒至肾损伤时间(d，±s)
A组	68	21/47	30.79±13.11	36.88±48.72	92.09±104.50	16.82±23.02	4.43±2.08	2.01±1.19
B组	42	16/26	41.67±17.76	35.05±33.91	69.29±66.46	12.86±16.78	2.19±1.81	3.26±1.88
C组	65	23/42	39.28±16.30	67.31±56.98	82.31±130.02	14.94±233.75	1.69±0.82	1.69±0.82

组别	例数	性别(男/女)	年龄(岁，±s)	服毒量(mL，±s)	洗胃时间(min，±s)	入院时间(h，±s)	服毒至肺损伤时间(d，±s)	服毒至肾损伤时间(d，±s)
A组	68	21/47	30.79±13.11	36.88±48.72	92.09±104.50	16.82±23.02	4.43±2.08	2.01±1.19
B组	42	16/26	41.67±17.76	35.05±33.91	69.29±66.46	12.86±16.78	2.19±1.81	3.26±1.88
C组	65	23/42	39.28±16.30	67.31±56.98	82.31±130.02	14.94±233.75	1.69±0.82	1.69±0.82

组别	例数	性别(男/女)	年龄[岁，M(P25，P75)]	服毒量[mL，M(P25，P75)]	服毒至洗胃时间[min，M(P25，P75)]	服毒至入院时间[h，M(P25，P75)]
A组	68	21/47	26.0(20.0，40.7)	20.0(10.0，40.0)	60.0(30.0，90.0)	7.0(4.0，14.5)
B组	42	16/26	38.5(28.0，53.2)	20.0(10.0，50.0)	60.0(30.0，60.0)	6.5(4.7，12.0)
C组	65	23/42	38.0(25.0，51.5)	50.0(20.0，100.0)	60.0(30.0，60.0)	6.0(4.0，9.5)
H/χ²值	?	0.39	12.65	16.80	0.46	1.05
P值	?	>0.05	<0.01	<0.01	>0.05	>0.05

组别	例数	性别(男/女)	年龄[岁，M(P25，P75)]	服毒量[mL，M(P25，P75)]	服毒至洗胃时间[min，M(P25，P75)]	服毒至入院时间[h，M(P25，P75)]
A组	68	21/47	26.0(20.0，40.7)	20.0(10.0，40.0)	60.0(30.0，90.0)	7.0(4.0，14.5)
B组	42	16/26	38.5(28.0，53.2)	20.0(10.0，50.0)	60.0(30.0，60.0)	6.5(4.7，12.0)
C组	65	23/42	38.0(25.0，51.5)	50.0(20.0，100.0)	60.0(30.0，60.0)	6.0(4.0，9.5)
H/χ²值	?	0.39	12.65	16.80	0.46	1.05
P值	?	>0.05	<0.01	<0.01	>0.05	>0.05

变量	P值	OR值	95%可信区间
服毒量	<0.001	1.04	1.02～1.06
年龄	>0.05	/	/

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