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目的探讨急性杀虫双中毒(ABP)程度与心、肝、肾损伤的关系。方法 67例ABP患者分为轻、中度中毒组(32例)和重度中毒组(35例)。所有患者于入院后第3、7、24、48、72小时进行血清肌钙蛋白I(CTnI)和肌酸激酶同工酶(CK-MB)检测;于入院后第3、24、48小时进行肝、肾功能检测。轻、中度中毒组每8h,重度中毒组每4h检查1次心电图,共3d。结果与30例健康者(对照组)的血清检测指标以及心电图进行比较,ABP患者中毒后3～72h各时点的血清CTnI以及CK-MB值明显高于对照组(P<0.05或P<0.01),重度中毒组各时点的CTnI以及CK-MB值明显高于轻、中度中毒组(P<0.01)。第72小时时点CTnI值略有下降[(0.14±0.04)μg/L],而CK-MB值明显下降[(35.43±10.44)U/L]。重度中毒组心电图异常率(28.57%)明显高于轻、中度中毒组(9.38%)(P<0.01),轻、中度中毒组心电图异常率与对照组比较,差异均无统计学意义(P>0.05)。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 ABP可损伤心肌细胞以及肝、肾功能,且中毒程度越深损伤越重。ABP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 insecticidal double poisoning (ABP) and heart, liver and kidney damage. Methods 67 patients with ABP were divided into mild and moderate poisoning group (32 cases) and severe poisoning group (35 cases). All patients were detected on the 3rd, 7th, 24th, 48th and 72th hour after admission. CTnI and CK-MB were detected at 3, 24, 48 hours after admission Liver and kidney function tests. Light and moderate poisoning group every 8h, severe poisoning group check ECG every 4h, a total of 3d. Results Serum CTnI and CK-MB in serum of 3 healthy volunteers (control group) and CK-MB at 3 ~ 72h post-poisoning were significantly higher than those of control group (P <0.05 or P <0.01) ). The CTnI and CK-MB of severe poisoning group were significantly higher than those of mild and moderate poisoning group (P <0.01). The CTnI value decreased slightly at the 72nd hour ([(0.14 ± 0.04) μg / L], while the CK-MB value decreased obviously [(35.43 ± 10.44) U / L]. The abnormal rate of electrocardiogram (28.57%) in severe poisoning group was significantly higher than that of mild poisoning group (9.38%) (P <0.01), and there was no significant difference between the mild and moderate poisoning group P> 0.05). 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 ABP can damage myocardial cells and liver and kidney function, and the deeper the degree of poisoning, the more severe injury. CTnI and CK-MB detection in patients with ABP, ECG examination of myocardial injury has important clinical significance, CTnI diagnostic value may be superior to CK-MB.