[CT manifestations and prognosis of acute paraquat induced lung injury]
- PMID: 32306680
- DOI: 10.3760/cma.j.issn.1001-9391.2020.02.014
[CT manifestations and prognosis of acute paraquat induced lung injury]
Abstract
Objective: To investigate the CT features of lung injury induced by paraquat poisoning and its relationship with prognosis, and to provide reference for the judgment of the condition and prognosis of paraquat poisoning. Methods: 146 cases of paraquat poisoning patients were treated in the Third People's Hospital of Xuzhou City from January 2013 to April 2016. The cases were divided into mild group, moderate-severe group and fulminant group according to the concentration of paraquat in urine. The clinical data and CT imaging findings were analyzed and reconstructed in three-dimensional reconstruction. The extent of the lesion was observed and the relationship between CT and prognosis was explored. Results: Paraquat lung injury has many manifestations on CT images, and it's performance can be intersecting at the same time. Early lesions lighter cases, late CT imaging lesions can be completely absorbed or residual fibrosis, the prognosis was good; the early lesion was pulmonary consolidation, pleural effusion cases, the late CT image was usually pleural thickening and bronchiectasis, the prognosis was relatively good; early lesions were large patches of ground glass opacity cases, finally, pulmonary fibrosis was common, the mortality rate of 56.57%. There were significant differences in the extent of lung injury between different groups (P<0.001) , and the difference in mortality was statistically significant when the lung injury was different (P<0.001) . Multivariate stepwise Logistic regression analysis showed that ground-glass opacity (OR value=2.013) , interstitial lung fibrosis (OR=3.779) and mediastinal emphysema (OR=33.118) were risk factors for death of lung injury caused by paraquat poisoning (P<0.05) . Conclusion: There were many manifestations on CT images of paraquat lung injury, and the manifestations of paraquat lung injury can be intersecting at the same time. The pulmonary manifestations and outcomes of different paraquat types were different. The CT manifestations of lung injury in paraquat poisoning were mainly exudative changes at early stage, and can be gradually absorbed or evolved into interstitial changes at later stage. The cumulative damage range can be used as a reference for evaluating the prognosis. Ground-glass opacity, interstitial pulmonary fibrosis and mediastinal emphysema are the risk factors for death of lung injury caused by paraquat poisoning.
目的： 探讨百草枯中毒肺损伤的CT影像表现特点及其与预后的关系，为百草枯中毒病情及预后的判断提供参考依据。 方法： 将2013年1月~2016年4月徐州市肿瘤医院中毒职业病科收治的146例百草枯中毒患者按照尿中百草枯浓度结合口服剂量及实验室检查分为轻型组、中重型组、暴发型组，各组患者分别有12、99、35例。对其临床资料及CT影像表现进行分析并进行三维立体重建，使用容积测量软件进行肺损伤范围测定，计算肺损伤的累计损伤范围占全肺的百分比（%）。根据肺损伤的累计损伤范围占全肺比将患者分为<25%、25%~50%、51%~75%、>75% 4组。两组间率的比较用χ(2)检验或Fisher确切概率法，多个率的比较采用Kruskal-Wallis检验。危险因素分析用多元逐步logistic回归分析。 结果： 百草枯肺损伤CT影像上存在多种表现，且其表现可交叉同时存在。早期表现病变较轻的病例，后期CT表现病变可完全吸收或残留少许纤维化，预后好；早期表现为肺实变、胸腔积液的病例，后期CT表现一般为吸收后胸膜增厚及支气管扩张为主，预后也相对较好；早期表现为大片状磨玻璃影的病例，转归则以肺间质纤维化多见。与轻型组比较，中重型组、暴发型组患者累计损伤范围更大，差异有统计学意义（P<0.01），与中重型组比较，暴发型组患者累计损伤范围更大，差异有统计学意义（P<0.01）。PQ中毒肺损伤各组累计损伤范围的病死率有差异，差异有统计学意义（P<0.01）。采用多元逐步Logistic回归分析，结果显示磨玻璃影（OR=2.013）、肺间质纤维化（OR=3.779）、纵膈气肿（OR=33.118）是百草枯中毒肺损伤死亡的危险因素（P<0.05）。 结论： 不同分型的百草枯中毒肺部表现及转归不同。累计损伤范围可作为评价预后的参考。.
Keywords: CT imaging; Lung injury; Paraquat; Prognosis.
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