硒对百草枯中毒患者肺纤维化的影响
| 作者: |
1邹振武,
1李德忠,
1王齐兵
1 恩施土家族苗族自治州中心医院西医部急诊中心，湖北 恩施 445000 |
| 通讯: |
李德忠
Email: 344890540@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.11.021 |
摘要
目的：探讨硒酵母片治疗百草枯(paraquat，PQ)中毒患者肺纤维化的临床疗效。方法：选择2014年10月至2018年3月恩施土家族苗族自治州中心医院西医部急诊中心收治的PQ中毒患者106例，依据随机数字法将所选患者分为对照组53例和治疗组53例。对照组采用2014年PQ中毒救治齐鲁方案(QL)的规范化临床路径治疗方法，连用14 d。治疗组在对照组基础上加用硒酵母片(selenious yeast tablets，SYT)治疗，连用14 d。随后比较两组患者入院时口服PQ剂量、APACHE II评分及服毒至入院时间，随后采用双抗体夹心ELISA监测两组第1，3，5，7，14天血清中KL-6，IL-8水平；并采用高分辨率CT对两组第1，3，5，7，14天的肺纤维化进展程度进行评分。结果：对照组与治疗组在口服PQ剂量、APACHE II评分以及服毒至入院时间方面差异无统计学意义(P>0.05)。两组在病死率上差异无统计学意义(P>0.05)，但在生存时间上治疗组与对照组比较差异具有统计学意义(P<0.05)。治疗组血清中KL-6，IL-8水平均显著低于同期对照组(P<0.05)。高分辨率CT结果显示，治疗组患者肺纤维化程度较对照组明显减轻(P<0.05)。结论：硒酵母片能够降低血清中KL-6，IL-8的水平，进而延缓PQ中毒患者肺纤维化的进展，但并未改变PQ患者的生存及预后。
关键词：
硒；百草枯中毒；肺纤维化；预后
Clinical study on the effect of selenium on pulmonary fibrosis in patients with paraquat poisoning
CorrespondingAuthor: LI Dezhong Email: 344890540@qq.com
DOI: 10.3978/j.issn.2095-6959.2019.11.021
Abstract
Objective: To investigate the clinical efficacy of Selenious Yeast Tablets (SYT) in the treatment of pulmonary fibrosis in patients with paraquat (PQ) poisoning. Methods: A total of 106 patients with PQ poisoning were treated in the emergency center of the Western Medicine Department of the Enshi Tujia and Miao Autonomous Prefecture of Enshi in October 2014. The selected patients were divided into 53 cases in the control group and 53 in the treatment group according to the random number method. The control group adopted the standardized clinical pathway treatment method of PQ poisoning in 2014, Qilu scheme, for 14 days. The treatment group was treated with Selenious Yeast Tablets for 14 days on the basis of the control group. Then the oral PQ dose, APACHE II score and the time of hospitalization were compared between the two groups. Then the serum KL-6 and IL-8 levels were monitored by double antibody sandwich ELISA in the two groups of patients on 1st, 3rd, 5th, 7th and 14th days. High resolution CT was used to score the progression of pulmonary fibrosis in two groups of patients 1st, 3rd, 5th, 7th and 14th days. Results: There was no significant difference between the control group and the treatment group in terms of oral PQ dose, APACHE II score, and the time from taking poison to admission time (P>0.05). There was no significant difference in the mortality rate between the two groups (P>0.05), but the difference in the survival time between the treatment group and the control group was statistically significant (P<0.05). The serum KL-6 and IL-8 levels in the treatment group were significantly lower than those in the control group (P<0.05). High resolution CT results showed that the degree of pulmonary fibrosis in the treatment group was significantly lower than that in the control group (P<0.05). Conclusion: Selenious Yeast Tablets can reduce the level of KL-6 and IL-8 in serum, and postpone the progression of pulmonary fibrosis in patients with PQ poisoning, but it does not change the survival and prognosis of PQ patients.
Keywords：
selenium; paraquat poisoning; pulmonary fibrosis; prognosis