降鈣素原對急性一氧化碳中毒預后判斷的臨床意義

摘要：目的 觀察血清降鈣素原（procalcitonin， PCT）對急性一氧化碳（ carbon monoxide CO ）中毒遲發型腦病的早期診斷價值。方法 選取我院2014年1月～2016年3月收治的134例急性一氧化碳中毒患者，按血碳氧血紅蛋白分10%～20%輕度中毒（A組）38例，血碳氧血紅蛋白在20%～40%的中度中毒患者（B組）80例，血碳氧血紅蛋白在40%～50%的重度中毒患者（（C組））16例，同期選擇健康體檢者30例作為陰性對照組。采用日常生活能力量表（Activity of Daily Living Scale，ADL）與簡易智力狀態檢查量表（Mini-Mental stalteemination，MMSE）檢查患者神經功能與智力。觀察三組患者血白細胞、中性粒細胞、白介素2（IL-2）、白介素6（IL-6）、白介素10（IL-10）。血清降鈣素（PCT）的水平，分析輕、中、重度急性一氧化碳中毒遲發型腦病患者與IL-2、IL-6、IL-10、PCT相關性。結果 三組神經功能與智力評分結果有非常顯著的統計學差異，神經功能與智力的分數值隨著中毒程度的加重而顯著降低（P<0.01）。三組白細胞總數、中性粒細胞、IL-2、IL-6、IL-10、PCT水平均與正常水平比有差異，但隨著中毒程度的加重，IL-2、IL-6明顯降低，白細胞、中性粒細胞、IL-10、PCT明顯升高，三組除中性粒細胞沒有統計學差異外，其它均有統計學差異（P<0.01）。IL-2、IL-6、IL-10與遲發型腦病的相關性沒有統計學差異（P>0.05），PCT與遲發型腦病的相關性有非常顯著的統計學差異（P<0.01）。結論 輕、中、重度急性一氧化碳中毒遲發型腦病患者與PCT有極其顯著的相關性，擬可以作為早期判斷一氧化碳中毒遲發型腦病發生的指標。

關鍵詞：急性一氧化碳中毒；遲發型腦病；血清降鈣素原

Abstract：Objective To investigate early diagnosis of serum procalcitonin （procalcitonin， PCT） on delayed encephalopathy with acute carbon monoxide （CO） poisoning.Methods 134 patients with acute carbon monoxide poisoning from January 2014 ～March 2016 in our hospital were divided into 38 cases mild poisoning （A group）in 10% -20% carboxyhemoglobin of blood， 80 cases moderate poisoning （group B）in 20% -40% carboxyhemoglobin of the blood， 16 cases severe poisoning （（group C））in 40% to 50% carboxyhemoglobin of the blood of. 30 cases of healthy people was as a negative control group during the same period . neurological and intelligence of Patients were examined by Activity of Daily Living Scale（ADL） and the Mini-Mental State Examination （MMSE）. The level of white blood cell， neutrophils， IL-2， IL-6， IL-10， PCT were observed and analyzed in patients of 3 groups. The relevance of patients with delayed encephalopathy of mild， moderate， severe acute carbon monoxide poisoning was analyzed with IL-2， IL-6， IL-10， PCT .Results Neurological and mental score in the three groups had very significant statistical difference， neurological and mental point value was significantly decreased with the severity of poisoning （P<0.01）. WBC， neutrophils， IL-2， IL-6， IL-10， PCT were different with normal thatlevel， IL-2， IL-6 was significantly reduced， leukocytes， neutrophils， IL-10， PCT were increased significantly with the severity of poisoning， in addition to the neutrophils was not statistically significant（P> 0.05）， other were statistically significant （P<0.01）.The correlation between delayed encephalopathy and IL-2， IL-6， IL-10 were not statistically significant （P> 0.05）， correlation between PCT and delayed encephalopathy had a very statistically significant difference （P<0.01）. Conclusion The patients with delayed encephalopathy of mild， moderate， severe acute carbon monoxide poisoning and PCT have extremely significant correlation.This seems to be used as early indicators for delayed encephalopathy of carbon monoxide poisoning.

Key words：Acute carbon monoxide poisoning；Delayed encephalopathy；Serum calcitonin

一氧化碳（ carbon monoxide ，CO ）中毒是急診最常見的毒性氣體損傷導致的疾病之一[1]。約13%～50%重度CO 中毒昏迷患者經2～60 d潛伏期后（假愈期），出現以癡呆、精神和錐體外系癥狀為主的腦功能障礙（稱之為急性一氧化碳中毒遲發性腦病）[2-3]。……