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目的探讨急性杀虫脒中毒(ACP)与心、肝、肾损伤的关系。方法对66例ACP患者血清肌钙蛋白Ⅰ(CTnⅠ)、肌酸激酶同工酶(CK-MB)和肝、肾功能进行动态检测,且动态观察心电图;并与30例健康体检者(对照组)血清检测指标、心电图比较。结果 ACP患者中毒后3～72 h各时点血清CTnⅠ、CK-MB值明显高于对照组(P<0.001);重度中毒组各时点CTnⅠ、CK-MB值明显高于轻、中度中毒组(P<0.001);72 h时点CTnⅠ略有下降[(1.90±0.50)μg/L],而CK-MB明显下降[(89.43±24.47)U/L]。重度中毒组心电图异常率(91.67%)明显高于轻、中度中毒组(46.67%,P<0.001),轻、中度中毒组心电图异常率明显高于对照组(13.33%,P<0.01)。重度中毒组肝、肾功能异常率明显高于轻、中度中毒组和对照组(P<0.05或P<0.01)。结论 ACP可损伤心肌细胞和肝、肾功能,且中毒程度越深损伤越严重。ACP患者CTnⅠ和CK-MB检测、心电图检查对心肌损伤具有重要临床意义,CTnⅠ的诊断价值可能优于CK-MB。
Objective To investigate the relationship between acute chlordimeform poisoning (ACP) and heart, liver and kidney damage. Methods Serum levels of CTn Ⅰ, CK-MB, liver and kidney were measured dynamically in 66 patients with ACP. Electrocardiogram (ECG) was dynamically observed in 30 patients with ACP. Serum detection index, ECG comparison. Results Serum levels of CTnⅠ and CK-MB in ACP patients at 3 ~ 72 h after poisoning were significantly higher than those in control group (P <0.001). CTnⅠ and CK-MB values at each time point in severe poisoning group were significantly higher than those in mild and moderate poisoning (P <0.001). At 72 h, CTn I slightly decreased (1.90 ± 0.50 μg / L) and CK-MB decreased significantly (89.43 ± 24.47 U / L). The abnormal rate of electrocardiogram (91.67%) in severe poisoning group was significantly higher than that in mild and moderate poisoning group (46.67%, P <0.001), and the abnormal rate of electrocardiogram in mild and moderate poisoning group was significantly higher than that in control group (13.33%, P <0.01) . Severe poisoning group liver and kidney dysfunction was significantly higher than the light and moderate poisoning group and the control group (P <0.05 or P <0.01). Conclusion ACP can damage myocardial cells and liver and kidney function, and the more severe the degree of poisoning is, the more severe the injury is. CTnI and CK-MB detection of ACP patients, ECG examination of myocardial injury has important clinical significance, CTnI diagnostic value may be superior to CK-MB.