急性一氧化碳中毒后早期心肌损伤的危险因素及预后分析
目的:探讨急性一氧化碳中毒(acute carbon monoxide poisoning，ACOP) 患者发生早期心肌损伤的危险因素及心肌损伤对预后的影响。方法:选取2020年1月至2024年11月在常德市第一人民医院神经内科治疗的ACOP患者176例，其中男80例，女96例。根据中毒后72h内CK-MB最高值，将患者分为早期心肌损伤组（CK-MB≥75 U/L，n=32例）和非早期心肌损伤组（CK-MB<75 U/L，n=144例）。收集并比较两组临床资料，应用二元Logistic多因素回归模型探讨ACOP患者并发早期心肌损伤的独立影响因素，并进一步通过绘制受试者工作特征（ROC）曲线分析其危险因素对早期心肌损伤的预测效能。结果:两组患者性别、年龄、基础疾病（高血压、糖尿病、冠心病、脑卒中）、个人史（吸烟、饮酒）差异均无统计学意义(P>0.05)。早期心肌损伤组NLR、MLR、ALT、AST、BUN、CRP水平均高于非早期心肌损伤组，差异有统计学意义(P＜0.05)。进一步进行多因素logistic 回归分析结果显示，AST、CRP是ACOP患者发生早期心肌损伤的独立危险因素（P<0. 05）。联合诊断ROC曲线显示AST联合CRP预测ACOP患者早期心肌损伤的敏感度为78.1％，特异度为93.1％，AUC为0.931。早期心肌损伤组患者DEACMP发生率明显高于非早期心肌损伤组（χ?2=19.055，P＜0.01）。结论:AST、CRP 是ACOP患者发生早期心肌损伤的独立危险因素。AST联合CRP对ACOP患者早期心肌损伤具有一定的预测价值。早期心肌损伤组患者DEACMP发生率更高，提示心肌损伤与患者不良预后密切相关。
Objective:To explore the risk factors of early myocardial injury in patients with acute carbon monoxide poisoning (ACOP) and the effect of myocardial injury on prognosis. Methods:176 patients with ACOP treated in the Department of Neurology of the First Peoples Hospital of Changde City from January 2020 to November 2024 were selected, of which 80 were male and 96 were female. According to the highest value of CK-MB within 72h after poisoning, the patients were divided into the early myocardial injury group (CK-MB≥75 U/L, n=32 cases) and the non-early myocardial injury group (CK-MB<75 U/L, n=144 cases). The clinical data of the two groups were collected and compared, and a binary logistic multifactor regression model was applied to explore the independent influencing factors of ACOP patients with concurrent early myocardial injury, and the predictive efficacy of the risk factors for early myocardial injury was further analysed by plotting the subjects work characteristics (ROC) curves. Results:The differences in gender, age, underlying diseases (hypertension, diabetes mellitus, coronary heart disease, stroke), and personal history (smoking, alcohol consumption) between the two groups were not statistically significant (P>0.05). The levels of NLR, MLR, ALT, AST, BUN, and CRP were higher in the early myocardial injury group than in the non-early myocardial injury group, and the differences were statistically significant (P < 0.05). Further multifactorial logistic regression analysis showed that AST and CRP were independent risk factors for early myocardial injury in ACOP patients (P<0. 05). The combined diagnostic ROC curve showed that the sensitivity of AST combined with CRP in predicting early myocardial injury in patients with ACOP was 78.1%, the specificity was 93.1%, and the AUC was 0.931. The incidence of DEACMP in patients with early myocardial injury group was significantly higher than that in patients with non-early myocardial injury group (χ 2=19.055, P<0.01). Conclusion:AST and CRP are independent risk factors for early myocardial injury in ACOP patients, and AST combined with CRP has a certain predictive value for early myocardial injury in ACOP patients. The incidence of DEACMP was higher in the early myocardial injury group, suggesting that myocardial injury is closely related to the poor prognosis of patients.
钟怡、刘鉴仪、刘艳、高云春、金玲
医学研究方法临床医学
急性一氧化碳中毒早期心肌损伤天冬氨酸转氨酶C反应蛋白
acute carbon monoxide poisoningearly myocardial injuryaspartate aminotransferase-reactive protein
钟怡,刘鉴仪,刘艳,高云春,金玲.急性一氧化碳中毒后早期心肌损伤的危险因素及预后分析[EB/OL].(2025-03-23)[2025-08-16].https://www.biomedrxiv.org.cn/article/doi/bmr.202504.00060.点此复制
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