McConnell R, Cedillo L, Keifer M, Palomo M R
Division of Occupational and Environmental Medicine, Mount Sinai School of Medicine, New York.
J Occup Med. 1992 Jan;34(1):34-7.
A serious limitation to the diagnosis of mild organophosphate poisoning and to the preventive screening of organophosphate-exposed workers has been the large interindividual variability in erythrocyte cholinesterase. This makes it necessary to obtain a pre-exposure baseline measurement of enzyme activity as a basis for evaluating subsequent declines. To evaluate a new battery-operated colorimetric erythrocyte cholinesterase kit, 23 workers at a Mexican pesticide formulation plant were examined. All workers had normal cholinesterase, and exposed and unexposed workers were found to have similar mean cholinesterase levels. Although erythrocyte cholinesterase was found to have a coefficient of variation of 12% (similar to that reported in previous studies), hemoglobin-adjusted erythrocyte cholinesterase had a markedly reduced coefficient of variation (7.4%). The 90% confidence interval (24.9-31.7 IU/g hemoglobin) resulted in a lower normal limit that is 78% of the upper limit. Even if a pre-exposure baseline were high normal but unknown at the time of examination, the supervising clinician can be confident that any person with a normal result will be no less than 78% of baseline. The kit is moderately priced, easy to use in the field setting, and the low variability to the assay should allow improvement in diagnosis, screening, and in the epidemiologic evaluation of exposure.
红细胞胆碱酯酶存在较大的个体间差异，这严重限制了轻度有机磷中毒的诊断以及对接触有机磷工人的预防性筛查。因此，有必要在接触前获取酶活性的基线测量值，作为评估后续下降情况的基础。为评估一种新的电池供电比色法红细胞胆碱酯酶检测试剂盒，对墨西哥一家农药制剂厂的23名工人进行了检查。所有工人的胆碱酯酶均正常，发现接触和未接触工人的平均胆碱酯酶水平相似。虽然红细胞胆碱酯酶的变异系数为12%（与先前研究报告的相似），但血红蛋白校正后的红细胞胆碱酯酶变异系数明显降低（7.4%）。90%置信区间（24.9 - 31.7 IU/g血红蛋白）得出的正常下限是上限的78%。即使接触前基线处于高正常范围但在检查时未知，监督临床医生也可以确信，任何结果正常的人其胆碱酯酶水平至少是基线的78%。该试剂盒价格适中，便于在现场使用，且检测变异度低，应能改善诊断、筛查以及接触的流行病学评估。
