王蕾, 姜岱山, 张毅, 沈君华, 陈振华, 贾寒雨, 朱保锋. 血清指标的联合检测对重症中暑的诊断意义：附70例重症中暑患者的临床资料分析[J]. 职业卫生与应急救援, 2022, 40(2): 180-186. DOI: 10.16369/j.oher.issn.1007-1326.2022.02.011
引用本文: 王蕾, 姜岱山, 张毅, 沈君华, 陈振华, 贾寒雨, 朱保锋. 血清指标的联合检测对重症中暑的诊断意义：附70例重症中暑患者的临床资料分析[J]. 职业卫生与应急救援, 2022, 40(2): 180-186. DOI: 10.16369/j.oher.issn.1007-1326.2022.02.011
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WANG Lei, JIANG Daishan, ZHANG Yi, SHEN Junhua, CHEN Zhenhua, JIA Hanyu, ZHU Baofeng. Diagnostic significance of combined detection of serum indexes in severe heatstroke: a clinical analysis of 70 patients with severe heatstroke[J]. Occupational Health and Emergency Rescue, 2022, 40(2): 180-186. DOI: 10.16369/j.oher.issn.1007-1326.2022.02.011
Citation: WANG Lei, JIANG Daishan, ZHANG Yi, SHEN Junhua, CHEN Zhenhua, JIA Hanyu, ZHU Baofeng. Diagnostic significance of combined detection of serum indexes in severe heatstroke: a clinical analysis of 70 patients with severe heatstroke[J]. Occupational Health and Emergency Rescue, 2022, 40(2): 180-186. DOI: 10.16369/j.oher.issn.1007-1326.2022.02.011
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血清指标的联合检测对重症中暑的诊断意义：附70例重症中暑患者的临床资料分析

Diagnostic significance of combined detection of serum indexes in severe heatstroke: a clinical analysis of 70 patients with severe heatstroke

    摘要
  • 摘要:
      目的  通过分析重症中暑患者的临床特征，探讨热射病（heat stroke，HS）辅助诊断的早期敏感临床指标，以期及早干预病情。
      方法  选择南通大学第二附属医院收治的70例重症中暑住院患者为研究对象，根据患者中暑的严重程度，分为热痉挛与热衰竭组（n = 28）、劳力型热射病（exertional heat stroke，EHS）组（n = 24）、经典型热射病（classic heat stroke，CHS）组（n = 18）。记录患者的一般资料及入院24 h的临床检验指标，比较各组患者临床指标的差异，进一步绘制热痉挛与热衰竭组和HS组的受试者工作特征曲线（ROC）。
      结果  70例患者中男性46例，女性24例；平均年龄（65.72 ± 16.64）岁。最高体温（39.66 ± 1.08）℃，住院时间（15.58 ± 14.49）d。61例病情好转，9例死亡。3组患者入院24 h内多项临床指标差异有统计学意义（P < 0.05）。其中：EHS组及CHS组的体温高于热痉挛与热衰竭组（P < 0.05），但EHS组、CHS组的体温差异无统计学意义（P > 0.05）；EHS组的D-二聚体（DD）、降钙素原（PCT）高于热痉挛与热衰竭组、CHS组（P < 0.05）；EHS组的血小板（PLT）、超敏C反应蛋白（CRP）、血钠（Na）、静脉血糖（GLU）、APACHEⅡ低于热痉挛与热衰竭组、CHS组（P < 0.05），PLT的降低最为显著；CHS组糖化血红蛋白（HbA1C）高于热痉挛与热衰竭组、EHS组（均P < 0.05）。各指标在热痉挛与热衰竭组、HS组患者间的受试者工作特征曲线显示：各指标均无法同时达到较高的特异度和敏感度；而串联DD、PCT、PLT三者后的AUC上升至0.838（95% CI：0.731 ~ 0.916），敏感度为71.43%，特异度为85.71%，该联合指标的诊断效能高于任何单一指标。
      结论  PLT的显著下降、PCT和DD的增高可能是HS的早期敏感指标，三者联合检测可作为HS早期诊断以及病情危重的参考依据。

     

    Abstract:
      Objective  The clinical characteristics of patients with severe heatstroke was analyzed to explore the early sensitive clinical indicators for auxiliary diagnosis of heat stroke (HS), in order to intervene these cases as soon as possible.
      Methods  Totally 70 hospitalized patients with severe heatstroke in the Second Affiliated Hospital of Nantong University were studied and their general data and clinical test indexes within 24 hours after admission were collected. According to the severity of heatstroke, they were divided into heat spasm and heat failure group(n = 28), exertional heat stroke(EHS) group(n = 24) and classic heat stroke (CHS) group (n = 18). The differences of clinical indexes of patients in different groups were compared, and the receiver operating characteristic curve (ROC)of heat spasm and heat failure group and HS group was further drawn.
      Results  Among the 70 patients, there were 46 males and 24 females with average age of (65.72 ± 16.64)years old. The maximum temperature of these patients was (39.66 ± 1.08)℃. The hospitalization time was (15.58 ± 14.49) days with dying of 9 cases. There was significant difference of multiple clinical indexes among these three groups (P < 0.05). The body temperature of EHS group and CHS group was higher than that of heat spasm and heat failure group(P < 0.05), but there was no significant difference between EHS group and CHS group(P > 0.05). D-dimer(DD), Procalcitonin(PCT) and Apache Ⅱ in EHS group were higher than those in heat spasm, heat failure and CHS group (P < 0.05). The levels of Platelet (PLT), high-sensitivity C-reactive protein (CRP), blood sodium (Na), blood glucose (Glu) in EHS group were lower than those in heat spasm and heat failure and CHS group (P < 0.05). HbA1C in CHS group was higher than that in heat spasm, heat failure and EHS group(P < 0.05). The receiver operating characteristic curves of individual index in these 3 groups showed that each index could not simultaneously achieve high specificity and sensitivity. The AUC of combined DD, PCT and PLT in series increased to 0.838 (95% CI 0.731 - 0.916), with a sensitivity of 71.43% and a specificity of 85.71%. The diagnostic efficiency of the combined index was higher than any single index.
      Conclusions  The significant decrease of PLT and the increase of PCT and DD may be the early sensitive indexes of HS. The combined detection of these serum indicators can be used as a reference for the early diagnosis and prediction of critical condition of HS.

     

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