急性经口中毒成人中含草甘膦除草剂的临床毒理学的前瞻性观察性研究。
A prospective observational study of the clinical toxicology of glyphosate-containing herbicides in adults with acute self-poisoning.
机构信息
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
出版信息
Clin Toxicol (Phila). 2010 Feb;48(2):129-36. doi: 10.3109/15563650903476491.
CONTEXT
The case fatality from acute poisoning with glyphosate-containing herbicides is approximately 7.7% from the available studies but these have major limitations. Large prospective studies of patients with self-poisoning from known formulations who present to primary or secondary hospitals are needed to better describe the outcome from acute poisoning with glyphosate-containing herbicides. Furthermore, the clinical utility of the glyphosate plasma concentration for predicting clinical outcomes and guiding treatment has not been determined.
OBJECTIVE
To describe the clinical outcomes, dose-response, and glyphosate kinetics following self-poisoning with glyphosate-containing herbicides.
METHODS
This prospective observational case series was conducted in two hospitals in Sri Lanka between 2002 and 2007. We included patients with a history of acute poisoning. Clinical observations were recorded until discharge or death. During a specified time period, we collected admission (n = 216, including five deaths) and serial (n = 26) blood samples in patients. Severity of poisoning was graded using simple clinical criteria.
RESULTS
Six hundred one patients were identified; the majority ingested a concentrated formulation (36%, w/v glyphosate). Twenty-seven percent were asymptomatic, 63.7% had minor poisoning, and 5.5% of patients had moderate to severe poisoning. There were 19 deaths (case fatality 3.2%) with a median time to death of 20 h. Gastrointestinal symptoms, respiratory distress, hypotension, altered level of consciousness, and oliguria were observed in fatal cases. Death was strongly associated with greater age, larger ingestions, and high plasma glyphosate concentrations on admission (>734 microg/mL). The apparent elimination half-life of glyphosate was 3.1 h (95% CI = 2.7-3.6 h).
CONCLUSIONS
Despite treatment in rural hospitals with limited resources, the mortality was 3.2%, which is lower than that reported in previous case series. More research is required to define the mechanism of toxicity, better predict the small group at risk of death, and find effective treatments.
背景
现有研究表明，含草甘膦除草剂急性中毒的病死率约为 7.7%，但这些研究存在较大局限性。需要对来自已知配方的自行服毒并到一级或二级医院就诊的大量患者进行前瞻性研究，以更好地描述含草甘膦除草剂急性中毒的结局。此外，尚未确定草甘膦血浆浓度对预测临床结局和指导治疗的临床实用性。
目的
描述含草甘膦除草剂急性中毒后的临床结局、剂量反应和草甘膦动力学。
方法
本前瞻性观察性病例系列研究于 2002 年至 2007 年在斯里兰卡的两家医院进行。我们纳入了有急性中毒史的患者。记录了临床观察结果，直至出院或死亡。在特定时间段内，我们收集了入院时（n=216，包括 5 例死亡）和连续时（n=26）患者的血样。使用简单的临床标准对中毒严重程度进行分级。
结果
共确定了 601 例患者；大多数患者摄入了浓缩制剂（36%w/v 草甘膦）。27%的患者无症状，63.7%的患者轻度中毒，5.5%的患者中度至重度中毒。共有 19 例死亡（病死率 3.2%），中位死亡时间为 20 小时。致命病例中观察到胃肠道症状、呼吸窘迫、低血压、意识改变和少尿。死亡与年龄较大、摄入量大和入院时高血浆草甘膦浓度（>734μg/mL）密切相关。草甘膦的表观消除半衰期为 3.1 小时（95%CI=2.7-3.6 小时）。
结论
尽管在资源有限的农村医院进行了治疗，但死亡率为 3.2%，低于以往病例系列报告的死亡率。需要进一步研究以确定毒性机制，更好地预测死亡风险较小的人群，并寻找有效的治疗方法。
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