Wilks Martin F, Fernando Ravindra, Ariyananda P L, Eddleston Michael, Berry David J, Tomenson John A, Buckley Nicholas A, Jayamanne Shaluka, Gunnell David, Dawson Andrew
Syngenta Crop Protection AG, Basel, Switzerland.
PLoS Med. 2008 Feb;5(2):e49. doi: 10.1371/journal.pmed.0050049.
Pesticide ingestion is a common method of self-harm in the rural developing world. In an attempt to reduce the high case fatality seen with the herbicide paraquat, a novel formulation (INTEON) has been developed containing an increased emetic concentration, a purgative, and an alginate that forms a gel under the acid conditions of the stomach, potentially slowing the absorption of paraquat and giving the emetic more time to be effective. We compared the outcome of paraquat self-poisoning with the standard formulation against the new INTEON formulation following its introduction into Sri Lanka.
Clinical data were prospectively collected on 586 patients with paraquat ingestion presenting to nine large hospitals across Sri Lanka with survival to 3 mo as the primary outcome. The identity of the formulation ingested after October 2004 was confirmed by assay of blood or urine samples for a marker compound present in INTEON. The proportion of known survivors increased from 76/297 with the standard formulation to 103/289 with INTEON ingestion, and estimated 3-mo survival improved from 27.1% to 36.7% (difference 9.5%; 95% confidence interval [CI] 2.0%-17.1%; p = 0.002, log rank test). Cox proportional hazards regression analyses showed an approximately 2-fold reduction in toxicity for INTEON compared to standard formulation. A higher proportion of patients ingesting INTEON vomited within 15 min (38% with the original formulation to 55% with INTEON, p < 0.001). Median survival time increased from 2.3 d (95% CI 1.2-3.4 d) with the standard formulation to 6.9 d (95% CI 3.3-10.7 d) with INTEON ingestion (p = 0.002, log rank test); however, in patients who did not survive there was a comparatively smaller increase in median time to death from 0.9 d (interquartile range [IQR] 0.5-3.4) to 1.5 d (IQR 0.5-5.5); p = 0.02.
The survey has shown that INTEON technology significantly reduces the mortality of patients following paraquat ingestion and increases survival time, most likely by reducing absorption.
在农村发展中地区，吞食农药是一种常见的自杀方式。为降低除草剂百草枯导致的高病死率，已研发出一种新型制剂（INTEON），其催吐剂浓度更高，含有泻药和一种在胃酸条件下形成凝胶的藻酸盐，这可能会减缓百草枯的吸收，使催吐剂有更多时间发挥作用。在INTEON制剂引入斯里兰卡后，我们比较了其与标准制剂用于百草枯自服中毒的效果。
前瞻性收集了斯里兰卡9家大型医院收治的586例百草枯中毒患者的临床数据，以存活至3个月作为主要结局。通过检测血液或尿液样本中INTEON所含标记化合物来确认2004年10月后所服制剂的类型。已知幸存者的比例从服用标准制剂的76/297增加到服用INTEON制剂的103/289，估计3个月生存率从27.1%提高到36.7%（差异9.5%；95%置信区间[CI]2.0%-17.1%；p = 0.002，对数秩检验）。Cox比例风险回归分析显示，与标准制剂相比，INTEON的毒性降低了约2倍。服用INTEON制剂的患者中，更高比例的人在15分钟内呕吐（原制剂组为38%，INTEON制剂组为55%，p < 0.001）。中位生存时间从服用标准制剂的2.3天（95%CI 1.2 - 3.4天）增加到服用INTEON制剂的6.9天（95%CI 3.3 - 10.7天）（p = 0.002，对数秩检验）；然而，在未存活的患者中，中位死亡时间的增加相对较小，从0.9天（四分位间距[IQR]0.5 - 3.4）增加到1.5天（IQR 0.5 - 5.5）；p = 0.02。
该研究表明，INTEON技术显著降低了百草枯中毒患者的死亡率，并延长了生存时间，很可能是通过减少吸收实现的。
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