小儿蜂蜇伤中毒后致急性肾损伤的相关因素分析

doi:10.3969/j.issn.1671-7171.2023.09.021

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摘要【目的】探讨小儿蜂蜇伤中毒后致急性肾损伤(AKI)的相关影响因素。【方法】回顾性分析在本院接受治疗的120例蜂蜇伤中毒患儿的临床资料,根据患儿是否存在AKI分为AKI组(n=46)和非AKI组(n=74)。收集并比较两组患儿一般资料、蜇伤至入院时间等各项信息及入院时红细胞(RBC)计数、白细胞(WBC)计数、血红蛋白(Hb)、血钾离子(K⁺)、血钙离子(Ca²⁺)、二氧化碳结合力(CO₂CP)、尿素氮(BUN)、血肌酐(Scr)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、丙氨酸氨基转氨酶(ALT)、天冬氨酸转氨酶(AST)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)等各项指标。使用受试者工作特征(ROC)曲线分析相关指标对小儿蜂蜇伤中毒后AKI发生的预测价值,将有差异的单因素纳入Logistic模型,行量化赋值,分析小儿蜂蜇伤中毒后AKI发生的危险因素。【结果】 AKI组蜇伤至入院时间、WBC计数、K⁺、Scr、CK-MB、CK、LDH、ALT、AST水平均显著高于非AKI组,且差异有统计学意义(P<0.05)。经ROC分析,蜇伤至入院时间、WBC计数、K⁺、Scr、CK-MB、CK、LDH、ALT、AST预测小儿蜂蜇伤中毒后AKI的曲线下面积分别为0.943、0.876、0.845、0.947、0.875、0.920、0.906、0.919、0.956(均P<0.05)。经多因素Logistic回归分析证实,蜇伤至入院时间≥11.245 h、WBC计数≥14.095×10⁹/L、K⁺≥5.5 mmol/L、Scr≥129.490 μmol/L、CK-MB≥50.130 U/L、CK≥371.410 U/L、LDH≥470.135 U/L、ALT≥83.745 U/L、AST≥96.195 U/L是小儿蜂蜇伤中毒后发生AKI的危险因素。【结论】小儿蜂蜇伤中毒后发生AKI与蜇伤至入院时间、WBC计数、K⁺、Scr、CK-MB、CK、LDH、ALT、AST密切相关,临床应予以关注。

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	罗明海
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关键词 ：咬伤和蜇伤, 蜂, 急性肾损伤/并发症, 影响因素分析

Abstract：【Objective】To explore the influencing factors of acute kidney injury (AKI) in children after bee sting poisoning.【Methods】A retrospective analysis of clinical data from 120 children with bee sting poisoning was conducted. According to the presence or absence of AKI,they were divided into the AKI group (n=46) and non-AKI group (n=74). General information,such as the time from sting to admission and the blood tests at admission including red blood cells (RBC),white blood cells (WBC),hemoglobin (Hb),potassium ions (K⁺),calcium ions (Ca²⁺),carbon dioxide combining power (CO₂CP),blood urea nitrogen (BUN),serum creatinine (Scr),creatine kinase isoenzyme (CK-MB),creatine kinase (CK),lactate dehydrogenase (LDH),alanine aminotransferase (ALT),aspartate aminotransferase (AST),prothrombin time (PT),activated partial thromboplastin time (APTT),were collected and compared between the two groups. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of these indicators for AKI after bee sting poisoning in children. The single factors with differences were incorporated into the logistic model to quantify and identify the risk factors for AKI after bee sting poisoning in children.【Results】The time from sting to admission and levels of WBC,K⁺,Scr,CK-MB,CK,LDH,ALT,and AST in the AKI group were significantly higher than those in the non-AKI group with statistical significance (P<0.05). ROC analysis showed that the areas under the curve of time from sting to admission,WBC、K⁺,Scr,CK-MB,CK,LDH,ALT,and AST for predicting AKI after bee sting poisoning in children were 0.943,0.876,0.845,0.947,0.875,0.920,0.906,0.919,and 0.956,respectively (all P<0.05). Multivariate logistic regression analysis confirmed that time from sting to admission ≥11.245 h,WBC≥14.095×10⁹/L,K⁺≥5.5 mmol/L,Scr≥129.490 μmol/L,CK-MB≥50.130 U/L,CK≥371.410 U/L,LDH≥470.135 U/L,ALT≥83.745 U/L,AST≥96.195 U/L were risk factors for AKI after bee sting poisoning in children.【Conclusion】The occurrence of AKI in children after bee sting poisoning is closely related to the time from sting to admission,WBC,K⁺,Scr,CK-MB,CK,LDH,ALT,and AST. Those indicators should be paid attention to in clinical practice.

Key words： Bites and Stings Bees Acute Kidney Injury/CO Root Cause Analysis

收稿日期: 2022-08-18

中图分类号:

R646.5

通讯作者: *E-mail:zssgeili@163.com

引用本文:

罗明海, 段武琼, 李聪, 张森山. 小儿蜂蜇伤中毒后致急性肾损伤的相关因素分析[J]. 医学临床研究, 2023, 40(9): 1357-1360.
LUO Minghai, DUAN Wuqiong, LI Cong, et al. Analysis of Factors Related to Acute Kidney Injury after Bee Sting Poisoning in Children. JOURNAL OF CLINICAL RESEARCH, 2023, 40(9): 1357-1360.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.09.021 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I9/1357

[1] 李莉,夏羽茜,李馨欣,等. 蜂蛰伤发病机制的研究进展[J].海南医学,2018,29(20):2940-2942.
[2] WITHARANA RA,DISSANAYAKE A,KARUNARATNE I,et al. A rare case of micro-angiopathic hemolytic anemia due to envenoming by giant asian honey bee (apis dorsata)[J].Wilderness Environ Med,2021,32(3):340-343.
[3] 冯云霞,张学鹏,陈硕,等. 蜂蜇伤患者血清降钙素原水平及其预测急性肾损伤的价值[J].中国急救医学,2020,40(7):610-613.
[4] FLISER D,LAVILLE M,COVIC A,et al. A European Renal Best Practice (ERBP) position statement on the Kid-ney Disease Improving Global Outcomes (KDIGO) clinical prac-tice guidelines on acute kidney injury:part 1: definitions,conser-vative management and contrast-induced nephropathy[J].NephrolDial Transplant,2012,27(12):4263-4272.
[5] 中国毒理学会中毒与救治专业委员会,中华医学会湖北省急诊医学分会,湖北省中毒与职业病联盟,等. 胡蜂螫伤规范化诊治中国专家共识[J].中华危重病急救医学,2018,30(9):819-823.
[6] HUGHES R L. A fatal case of acute renal failure from envenoming syndrome after massive bee attack: a case report and literature review[J].Am J Forensic Med Pathol,2019,40(1):52-57.
[7] TOLEDO LFM,MORRE DCBC,CAIXETA DMDL,et al. Multiple bee stings,multiple organs involved: a case report[J].Rev Soc Bras Med Trop,2018,51(4):560-562.
[8] CHEN T H,LIAO W T,CHEN C S,et al. An Envenoming Syndrome from Massive Vespa Stings Induces Multiple Organ Failure[J].Insects,2020,11(4):219.
[9] 席秋萍,陈宗英,方文燕,等. 蜂蛰伤中毒致急性肾损伤的相关危险因素调查[J].中华劳动卫生职业病杂志,2018,36(2):92-94.
[10] 张琼,王彩凤,梁哲. 黄蜂蛰伤临床特点及急性肾损伤的危险因素分析[J].现代泌尿外科杂志,2019,24(11):944-947.
[11] SRISUWAEN P,SRISUMA S,SRIAPHA C,et al. Clinical effects and factors associated with adverse clinical outcomes of hymenopteran stings treated in a Thai Poison Centre: a retrospective cross-sectional study[J].Clin Toxicol (Phila),2022,60(2):168-174.
[12] 李大欢,王天中,潘萌,等. 肌酸激酶同工酶与中毒严重程度评分对胡蜂蜇伤患者预后的预测价值研究[J].中华危重病急救医学,2021,33(1):105-108.
[13] VIKRANT S,JARYAL A,GUPTA D,et al. Parashar A.Epidemiology and outcome of acute kidney injury due to venomous animals from a subtropical region of India[J].Clin Toxicol (Phila), 2019,57(4):240-245.
[14] 刘蓉芝,胡庆,唐勇. CVVH联合HP对蜂蛰伤致多器官功能障碍综合征患者心肌酶和肝肾功能水平的影响[J].中南医学科学杂志,2020,48(1):93-96.