| 占一姗，朱友荣.儿童毒蘑菇中毒病例及死亡危险因素分析[J].实用中西医结合临床,2023,23(1):5-9,61 |
| 儿童毒蘑菇中毒病例及死亡危险因素分析 |
| Analysis of the Clinical Characteristics and Risk Factors of Death of Children Mushroom Poisoning |
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| DOI： |
| 中文关键词: 毒蘑菇中毒 儿童 危险因素 预后 |
| 英文关键词: Poisonous mushrooms Children Risk factors for death Prognosis |
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| 中文摘要: |
| 目的：探讨儿童毒蘑菇中毒的临床特征和死亡相关危险因素。方法：回顾性分析江西省儿童医院2011年1月至2021年6月因食入毒蘑菇中毒收住院98例患儿的临床资料，并将考虑致死性毒菇中毒的病例47例分为存活组和死亡组，比较一般资料及实验室指标差异，多因素Logistic回归分析筛选死亡危险因素和受试者工作特征曲线确定其阈值。结果：（1）98例毒蘑菇中毒来自57个家庭，其中男56例，女42例；年龄最大15岁1个月，最小1岁7个月；98例中急性肝损型41例，胃肠炎型57例；死亡18例，均为肝损型，治愈80例，死亡率为18.37%，6月份死亡患儿最多（占总死亡的88.89%）。（2）根据专家指南共识评分98例毒蘑菇中毒患儿中有47例考虑致死性毒蘑菇中毒，其中存活29例，死亡18例。存活组与死亡组患儿年龄、住院天数、小儿危重症评分、脑病症状出现时间比较，差异有统计学意义（P＜0.05）；入院后丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原、乳酸（LA）、血浆氨、血清肌酸激酶同工酶（CK-MB）、总胆红素、白蛋白、血尿素氮、血肌酐等指标的最高值与血糖的最低值比较，差异均有统计学意义（P＜0.05）。（3）多因素Logistic回归分析结果显示：ALT是死亡的独立危险因素，年龄比较虽然差异有统计学意义但非独立危险因素。受试者工作特征曲线分析显示，ALT预测食入毒菇中毒患儿死亡的曲线下面积为0.862（95%CI 0.755~0.969，P＜0.001），阈值为4 342.500 U/L，敏感度为77.80%，特异度为86.20%。结论：食入毒蘑菇中毒患儿死亡病例均为急性肝损型，单因素分析患儿年龄、住院天数、小儿危重症评分、ALT等与患儿死亡有关，其中ALT为预测毒蘑菇中毒患儿死亡的独立危险因素。 |
| 英文摘要: |
| Objective: To explore the clinical characteristics and death-related risk factors of mushroom poisoning in children. Methods: A retrospective analysis the clinical data of 98 children admitted to Jiangxi Children's Hospital from January 2011 to June 2021 due to poisoning caused by ingested poisonous mushroom was retrospectively analyzed. A total of 47 cases of lethal mushroom poisoning were divided into the survival group and the death group. The differences in general data and laboratory indicators were compared. Multivariate Logistic regression analysis was used to screen the risk factors of death and the receiver operating characteristic curve to determine them threshold. Results:(1) 98 cases of mushroom poisoning came from 57 families, including 56 males and 42 females; the oldest was 15 years and 1 month, and the youngest was 1 year and 7 months. Among the 98 cases, 41 cases were acute liver damage, 57 cases of gastrointestinal inflammatory type; 18 cases death, all are type of liver damage, 80 cases were cured, and the mortality rate was 18.37%. The children died most in June (88.89% of the total deaths); (2) 98 cases of poisonous mushroom were scored according to the consensus of expert guidelines ,47 cases were considered fatal mushroom poisoning. Among them, 29 survived and 18 died. There were statistically significant differences in age, hospitalization days, pediatric critical illness score, and encephalopathy between the survival group and the death group (P＜0.05); after admission to the hospital, laboratory
indicators have the highest values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, lactic acid (LA),plasma ammonia, creatine kinase-MB (CK-MB), total bilirubin, albumin and the lowest blood glucose, and the differences in values were statistically significant (P＜0.05); (3) Multivariate Logistic regression analysis showed that ALT is an independent risk factor for death, although the difference in age is statistically significant, it is not an independent risk factor. The receiver operating characteristic curve analysis showed that the area under the curve for ALT to predict the death of children with poisoned mushroom poisoning was 0.862 (95%CI 0.755~0.969, P＜0.001), the threshold was 4 342.500 U/L, the sensitivity was 77.80%, and it was specific degree 86.20%. Conclusion: The deaths of children with mushroom poisoning by ingestion are all acute liver damage. The univariate analysis of children's age, length of hospitalization, pediatric critical illness score, ALT are related to the death of children, and ALT is the independent risk factors of children with mushroom poisoning. |
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