Eddleston M, Eyer P, Worek F, Sheriff M H Rezvi, Buckley N A
Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, and Clinical Pharmacology Unit, University of Edinburgh, UK.
QJM. 2008 Jun;101(6):467-74. doi: 10.1093/qjmed/hcn026. Epub 2008 Mar 28.
The usefulness of a low butyrylcholinesterase (BuChE) activity on admission for predicting severity in acute organophosphorus (OP) insecticide poisoning has long been debated. Previous studies have been confounded by the inclusion of multiple insecticides with differing inhibitory kinetics.
We aimed to assess the usefulness of admission BuChE activity, together with plasma OP concentration, for predicting death with two specific organophosphorus insecticides.
A prospective cohort of self-poisoned patients.
We prospectively studied 91 and 208 patients with proven dimethoate or chlorpyrifos self-poisoning treated using a standard protocol. Plasma butyrylcholinesterase activity and OP concentration were measured on admission and clinical outcomes recorded.
The usefulness of a plasma BuChE activity <600 mU/ml on admission varied markedly--while highly sensitive in chlorpyrifos poisoning (sensitivity 11/11 deaths; 100%, 95% CI 71.5-100), its specificity was only 17.7% (12.6-23.7). In contrast, while poorly sensitive for deaths in dimethoate poisoning [12/25 patients; 48%, (27.9-68.7)] it was reasonably specific [86.4% (75.7-93.6)]. A high OP concentration on admission was associated with worse outcome; however, a clear threshold concentration was only present for dimethoate poisoning.
Plasma BuChE activity on admission can provide useful information; however, it must be interpreted carefully. It can only be used to predict death when the insecticide ingested is known and its sensitivity and specificity for that insecticide has been studied. Plasma concentration of some OP insecticides predicts outcome. The development of rapid bedside tests for OP detection may aid early assessment of severity.
入院时低丁酰胆碱酯酶（BuChE）活性对预测急性有机磷（OP）杀虫剂中毒严重程度的作用长期以来一直存在争议。既往研究因纳入了多种具有不同抑制动力学的杀虫剂而受到混淆。
我们旨在评估入院时的BuChE活性以及血浆OP浓度对预测两种特定有机磷杀虫剂中毒所致死亡的作用。
一项针对自我中毒患者的前瞻性队列研究。
我们前瞻性地研究了91例和208例经证实为乐果或毒死蜱自我中毒且采用标准方案治疗的患者。入院时测定血浆丁酰胆碱酯酶活性和OP浓度，并记录临床结局。
入院时血浆BuChE活性<600 mU/ml的作用差异显著——在毒死蜱中毒中敏感性很高（11例死亡中有11例；100%，95%可信区间71.5 - 100），但其特异性仅为17.7%（12.6 - 23.7）。相比之下，在乐果中毒导致死亡方面敏感性较差[25例患者中有12例；48%，（27.9 - 68.7）]，但特异性较高[86.4%（75.7 - 93.6）]。入院时高OP浓度与更差的结局相关；然而，仅在乐果中毒中有明确的阈值浓度。
入院时血浆BuChE活性可提供有用信息；然而，必须谨慎解读。只有在已知摄入的杀虫剂且已研究其对该杀虫剂的敏感性和特异性时，它才能用于预测死亡。某些OP杀虫剂的血浆浓度可预测结局。开发用于OP检测的快速床旁检测方法可能有助于早期评估严重程度。
