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中华危重症医学杂志(电子版) ›› 2021, Vol. 14 ›› Issue (04): 275 -280. doi: 10.3877/cma.j.issn.1674-6880.2021.04.003

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蜂蛰伤严重程度相关因素的评估与分析
汪旭 1, 张劲松 2 , ( ), 唐宁 1, 蒋静涵 3, 王淦楠 2, 娄爽 2, 周锋 1, 谢正伟 1   
  1. 1. 241001 安徽芜湖,皖南医学院第一附属医院急诊重症医学科
    2. 241001 安徽芜湖,皖南医学院第一附属医院全科医学科
    3. 210029 南京,江苏省人民医院急诊重症医学科
  • 收稿日期:2020-12-09 出版日期:2021-08-31
  • 通信作者: 张劲松

Assessment and analysis of risk factors for severity of wasp sting

Xu Wang 1, Jinsong Zhang 2 , ( ), Ning Tang 1, Jinghan Jiang 3, Gannan Wang 2, Shuang Lou 2, Feng Zhou 1, Zhengwei Xie 1   

  1. 1. Department of Emergency Intensive Care Unit,
    2. Department of Emergency Intensive Care Unit, Jiangsu Province Hospital, Nanjing 210029, China
    3. Department of General Practice, the First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
  • Received:2020-12-09 Published:2021-08-31
  • Corresponding author: Jinsong Zhang
目的

探讨影响蜂蛰伤患者病情严重程度的临床相关因素。

方法

回顾性分析2016年1月至2020年8月皖南医学院第一附属医院急诊科收治的73例蜂蛰伤患者,根据患者住院期间序贯器官衰竭估计评分变化值(ΔSOFA)将患者分为ΔSOFA评分≥ 2分组(33例)和ΔSOFA评分< 2分组(40例)。比较两组患者的一般资料、临床症状、实验室指标及预后情况等,采用多因素Logistic回归模型分析蜂蛰伤严重程度的相关影响因素,并采用受试者工作特征(ROC)曲线分析其预测价值。

结果

ΔSOFA评分≥ 2分组和ΔSOFA评分< 2分组患者年龄[(62 ± 12)岁vs.(44 ± 20)岁,t = 4.563,P < 0.001]、蜇伤蜂种(χ2 = 33.277,P < 0.001)、肉眼血尿(19/33 vs. 1/40,χ2= 24.875,P < 0.001)、皮疹(6/33 vs. 17/40,χ2= 4.995,P= 0.026)、肌酸激酶[4 297 (1 427,11 871)U/L vs. 180(124,405)U/L,H= 5.012,P < 0.001]、总胆红素[46(26,124)μmol/L vs. 11(8,17)μmol/L,H= 6.140,P < 0.001]、红细胞计数[(3.6 ± 0.9)× 1012/L vs.(4.4 ± 0.8)× 1012/L,t= 3.967,P < 0.001]、血小板计数[(151 ± 70)× 109/L vs.(203 ± 72)× 109/L,t= 3.141,P= 0.002]、白细胞计数[(19 ± 8)× 109/L vs.(13 ± 5)× 109/L,t= 3.431,P= 0.001]、肌酐[126(78,261)μmol/L vs. 64(52,75)μmol/L,H= 4.805,P < 0.001]、胱抑素C[1.5(1.0,2.1)mg/L vs. 0.9(0.8,1.1)mg/L,H= 4.753,P < 0.001]和活化部分凝血酶原时间[44.8(26.9,81.9)s vs. 26.1(22.9,29.5)s,H= 3.668,P < 0.001]比较,差异均有统计学意义。多因素Logistic回归分析结果显示,蜇伤蜂种[比值比(OR)= 83.532,95%置信区间(CI)(1.516,4 601.326),P= 0.031]和总胆红素[OR= 1.092,95% CI(1.003,1.190),P= 0.043]为影响蜂蛰伤后ΔSOFA评分的独立危险因素。ROC曲线分析结果显示,蜇伤蜂种[曲线下面积(AUC)= 0.839,95%CI(0.738,0.940),P < 0.001]和总胆红素[AUC= 0.920,95%CI(0.859,0.980),P < 0.001]均对蜂蛰伤严重程度具有预测价值。ΔSOFA评分≥ 2分组患者的住院时间显著高于ΔSOFA评分< 2分组[11.0(4.0,24.5)d vs. 2.5(2.0,3.0)d,H= 5.056,P < 0.001]。

结论

蜇伤蜂种和总胆红素对蜂蛰伤严重程度具有预测价值,早期识别有助于评估患者病情严重程度并及时进行临床干预。

Objective

To explore the clinically relevant factors affecting the severity of wasp sting.

Methods

A total of 73 wasp sting patients admitted to the Department of Emergency Medicine of the First Affiliated Hospital of Wannan Medical College from January 2016 to August 2020 were retrospectively analyzed. According to the change of sequential organ failure assessment during hospitalization (ΔSOFA), patients were divided into a ΔSOFA score ≥ 2 group(n= 33) and a ΔSOFA score < 2 group (n= 40). The general data, clinical symptoms, laboratory indicators and prognosis were compared between the two groups. A multi-factor Logistic regression model was used to analyze factors affecting the severity of wasp sting. A receiver operating characteristic (ROC) curve was used to analyze their predictive value.

Results

The age [(62 ± 12) years vs. (44 ± 20) years, t= 4.563, P < 0.001], stinging wasp species (χ2= 33.277, P < 0.001), gross hematuria (19/33 vs. 1/40, χ2= 24.875, P < 0.001), rash (6/33 vs. 17/40, χ2= 4.995, P= 0.026), creatine kinase [4 297 (1 427, 11 871) U/L vs. 180 (124, 405) U/L, H= 5.012, P < 0.001], total bilirubin [46 (26, 124) μmol/L vs. 11 (8, 17) μmol/L, H= 6.140, P < 0.001], erythrocyte count [(3.6 ± 0.9) × 1012/L vs. (4.4 ± 0.8) × 1012/L, t= 3.967, P < 0.001], platelet count [(151 ± 70) × 109/L vs. (203 ± 72) × 109/L, t= 3.141, P= 0.002], leukocyte count [(19 ± 8) × 109/L vs. (13 ± 5) × 109/L, t= 3.431, P= 0.001], creatinine [126 (78, 261) μmol/L vs. 64 (52, 75) μmol/L, H= 4.805, P < 0.001], cystatin C [1.5 (1.0, 2.1) mg/L vs. 0.9 (0.8, 1.1) mg/L, H= 4.753, P < 0.001] and activated partial thromboplastin time [44.8 (26.9, 81.9) s vs. 26.1 (22.9, 29.5) s, H= 3.668, P < 0.001] all showed significant differences between the ΔSOFA score ≥ 2 group and the ΔSOFA score < 2 group. Multi-factor Logistic regression analysis showed that stinging wasp species [odds ratio (OR)= 83.532, 95% confidence interval (CI) (1.516, 4 601.326), P= 0.031] and total bilirubin [OR= 1.092, 95%CI (1.003, 1.190), P= 0.043)] were independent factors affecting the ΔSOFA after wasp sting. ROC curve analysis showed that stinging wasp species [area under the curve (AUC)= 0.839, 95%CI (0.738, 0.940), P < 0.001] and total bilirubin [AUC= 0.920, 95%CI (0.859, 0.980), P < 0.001] had predictive value for the severity of wasp sting. The hospitalization stay of patients in the ΔSOFA score ≥ 2 group was significantly higher than that of the ΔSOFA score < 2 group [11.0 (4.0, 24.5) d vs. 2.5 (2.0, 3.0) d, H= 5.056, P < 0.001].

Conclusion

Stinging wasp species and total bilirubin have predictive value for the severity of wasp sting, and their early identification can help assess the severity and conduct timely clinical intervention for patients.

表1 两组蜂蛰伤患者临床资料比较[MP25P75)]
表2 Logistic回归分析影响蜂蛰伤患者ΔSOFA评分的危险因素
图1 蜇伤蜂种、总胆红素对蜂蛰伤后患者ΔSOFA评分≥ 2分的ROC曲线分析
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