| Background and objectiveParaquat poisoning is one of the emergency department common disease, which has a high fatality rate because of no specific antidote. With the progress of the disease, ultimately it may death with systemic inflammatory response syndrome and multiple organ dysfunction failure. The research reported that the incidence of systemic inflammatory response in paraquat poisoning is 92.13%, multiple organ failure was 84.16%.Recently more and more researchers believe that inflammatory reaponse plays an important role in paraquat poisoning with the further research. And a study finds that the body is in the stage of diffuse inflammation 7 hours after poisoning.Therefore it has become an important direction that inhibiting inflammatory reaction. Recently the clinical prognosis of paraquat poisoning mainly depend on the concentration of plasma paraquat, oral doses, etc. Due to the limitation of technical conditions and hospitals conditions, the determination of plasma concentration can not go well in many hospitals;Oral doses can not get the true results because of the influence of the subjective description and tending to appear vomiting after absorption, etc. So it is important to find out the predictive value,operation feasibility of objective variables.Serum procalcitonin(PCT) is inflammatory mediator with a hormone and cytokine regulating function. At present most studies confirmed the diagnostic value in infectious diseases, such as sepsis, and which is gradually noticed by people in non-infectious diseases. A large number of studies both at home and abroad have identified that plasma PCT were increased in early in SIRS caused by infectious disease or noninfectious disease. Ma wenbo and his team have found that the PCT level is higher in Organophosphorus pesticide poisoning, the heavier illness, poor prognosis. However, few studies have confirmed that the PCT and the prognosis of paraquat poisoning. Through early prediction experiment found that the degree of PCT in patients with paraquat poisoning is associated with adverse outcome and prognosis. In this paper, through the study of the dynamic of serum PCT and other inflammatory factors in order to investigate the significance of PCT and other inflammatory factors in paraquat poisoning and comfirm the role of inflammatory response in paraquat poisoning. MethodsThe clinical data of 64 patients with acute paraquat intoxication admitted to emergency department of the first affiliated hospital of Zhengzhou university were collected during the period from 2013 March to 2014 March were divided into two groups according to whether died during hospitalization(give up treatment as a death group): the death group and the survival group, three groups according to poisoning dose: light poisoning(LP),moderate poisoning(MP),heavy poisoning(HP),and three groups according to the early of serum PCT: normal group, low level group, high level group. Age, gender, poisoning doses, time elapsed from poisoning to admission, time elapsed from poisoning to gastrolavage were measured. And on the 1st day,the 3rd day and the 5th day after poisoning, serum PCT were detected. And record the C-reactive protein, white blood cell count, lactic acid level at the same time, assess organic function and APACHEII scores. To investigate the relationship between PCT and other inflammatory makers and the prognosis of patients with paraquat poisoning. Results1. PCT and other inflammatory makers at different time points were compared between death group and survival group in paraquat poisoning: Serum PCT,CRP, lactic acid levels of the death group obviously higher than survival group in the 1st day,the 3rd day and the 5th day after poisoning, the difference was statistically significant.There was no obvious difference on white blood count in the 1st day between the two groups, but in the 3rd day and the 5th day, there was obvious difference.2. PCT and other inflammatory makers at different time points were compared between LP,MP and HP groups : ①The levels of PCT was still in normal range in the 1st day in LP group,others were significantly increased at different time points, There were statistical differences in PCT levels at different time points in three groups; ②The levels of CRP were increased at different time points except for the 1st day, the 5st day in LP group,the 1st day in MP group, there were statistical differences at different time points in three groups; ③The white blood count were in normal range in the 1st day in LP and MP group, others were increased,there were not statistically difference between the three groups in the 1st day, there was not statistically difference between LP group and MP group in the 5st day; ④The levels of lactic acid were increased at different time points except for the 1st day and the 5st day in LP group, there were not statistically difference between LP group and MP group in three days.3. The relationship between the early PCT and the incidence of MODS: The higher the concentration of serum PCT, the earlier and the greater the risk of developing MODS. The incidence of MODS in high level group was higher at different time points than the other groups, there were statistically difference between the three groups.4. According to the correlation analysis, the early PCT was obviously related to poisoning doses, APACHEII scores, CRP, LAC, Cr, serum amylase. Conclusion can be got that the higher of the early PCT concentration, the more severe poisoning, the greater risk of Multiple organ dysfunction. Conclusions1. The level of inflammatory makers of PCT, CRP, WBC, LAC changes with the severity of poisoning,which can reflect the level of inflammatory conditions;2. The higher of the early PCT levels is, the more severe the disease is, it can be used as a reliable marker of predicting multiple organ function failure;3. The level of CRP,WBC,LAC can be used as auxiliary indicators for reflecting state of illness and evaluating prognosis. |
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