Aygun Dursun, Erenler Ali Kemal, Karatas Aydin Deniz, Baydin Ahmet
Department of Emergency Medicine, Ondokuz Mayis University, School of Medicine, Samsun, Turkey.
Basic Clin Pharmacol Toxicol. 2007 Mar;100(3):201-4. doi: 10.1111/j.1742-7843.2007.00042.x.
Following acute organophosphate poisoning, intermediate syndrome essentially relates to the impairment of neuromuscular transmission due to prolonged inhibition of acetylcholinesterase activity at the muscle end-plate. However, the role of muscle injury in the development of intermedicate syndrome is not clear. The aim of this study was to determine whether the initial serum levels of the muscle enzymes can predict the subsequent development of intermediate syndrome. We reviewed the files of 47 adult patients with organophosphate poisoning between April 2003 and February 2006. The muscle enzymes were obtained within first 24 hr from each patient. Among the patients, 17% (n = 8) had severe poisoning and 83% (n = 39) mild poisoning. In 10 patients (21%), intermediate syndrome was observed. Of the patients with severe poisoning, 63% (n = 5) developed subsequent intermediate syndrome; among those with mild poisoning, 13% (n = 5) developed intermediate syndrome. There was no significant difference in initial serum levels of creatine kinase and aspartate aminotransferase between the patients with severe poisoning and mild poisoning, and there was no difference in initial serum levels of creatine kinase and aspartate aminotransferase between the patients with and without intermediate syndrome. The serum levels of the muscle enzymes measured within the first 24 hr may not predict the subsequent development of intermediate syndrome.
急性有机磷中毒后，中间综合征主要与肌肉终板处乙酰胆碱酯酶活性长期受抑制导致的神经肌肉传递障碍有关。然而，肌肉损伤在中间综合征发生过程中的作用尚不清楚。本研究的目的是确定肌肉酶的初始血清水平是否能够预测中间综合征的后续发生情况。我们回顾了2003年4月至2006年2月期间47例成年有机磷中毒患者的病历。在每位患者的最初24小时内检测肌肉酶水平。这些患者中，17%（n = 8）为重度中毒，83%（n = 39）为轻度中毒。10例患者（21%）出现了中间综合征。在重度中毒患者中，63%（n = 5）随后发生了中间综合征；在轻度中毒患者中，13%（n = 5）发生了中间综合征。重度中毒患者与轻度中毒患者的肌酸激酶和天冬氨酸转氨酶初始血清水平无显著差异，发生中间综合征的患者与未发生中间综合征的患者的肌酸激酶和天冬氨酸转氨酶初始血清水平也无差异。在最初24小时内检测的肌肉酶血清水平可能无法预测中间综合征的后续发生情况。
