Kariyone Kazuko, Shimatani Yoshimi, Kurihara Toshikazu, Nagao Takehiko, Fujita Yoshika, Uesugi Masayoshi
Clinical Laboratory, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Ota-ku, Tokyo 145-0063, Japan.
Rinsho Byori. 2010 Oct;58(10):972-8.
Cholinergic crisis is an adverse effect of an anticholinesterase agent, which is one of the cholinergic agents. Cholinergic crisis may induce serious conditions such as breathing difficulties. Cholinergic crisis is often diagnosed by an abnormally low level of serum cholinesterase (ChE). However, ChE value is not an appropriate indicator of cholinergic crisis since it has a high inter-individual variation, even though its intra-individual variation is low. Therefore, an indicator with less inter-individual variation capable of preventing the risk of cholinergic crisis was investigated. The results of correlation test between ChE and serum albumin (Alb) showed a strong positive correlation; r = 0.778 in BCG method(Bromo cresol green method) and r = 0.766 in the BCP-improved method for Alb. In addition, the variations of Alb values are much lower than the drastic depression of ChE values in cholinergic crisis. Thus, it is considered that the ratio of ChE and Alb (ChE/Alb) can be a useful indicator of cholinergic crisis. As a result of ROC (Receiver operating characteristic) analysis, the ratios of ChE and Alb values using the BCG method (ChE/Alb (BCG)) were 20.7, 87.0, 156.8 for the Cutoff value, Likelihood ratio and Odds ratio respectively. When using the BCP-improved method for Alb, the ratios of ChE and Alb (ChE/Alb(BCP improved)) were 25.0, 93.7, 180.1 for the Cutoff value, Likelihood ratio and Odds ratio respectively. The ChE/Alb ratio appears to be an excellent indicator of cholinergic crisis diagnosis since it shows a high likelihood ratio as well as a high odds ratio.
胆碱能危象是抗胆碱酯酶药物的一种不良反应，抗胆碱酯酶药物是胆碱能药物之一。胆碱能危象可能诱发严重状况，如呼吸困难。胆碱能危象常通过血清胆碱酯酶（ChE）水平异常降低来诊断。然而，ChE值并非胆碱能危象的合适指标，因为尽管其个体内变异较低，但个体间变异很大。因此，研究了一种个体间变异较小、能够预防胆碱能危象风险的指标。ChE与血清白蛋白（Alb）的相关性测试结果显示出强正相关；在BCG法（溴甲酚绿法）中r = 0.778，在Alb的BCP改良法中r = 0.766。此外，在胆碱能危象中，Alb值的变异远低于ChE值的急剧下降。因此，认为ChE与Alb的比值（ChE/Alb）可作为胆碱能危象的有用指标。ROC（受试者工作特征）分析结果显示，使用BCG法时ChE与Alb值的比值（ChE/Alb（BCG）），临界值、似然比和比值比分别为20.7、87.0、156.8。当使用Alb的BCP改良法时，ChE与Alb的比值（ChE/Alb（BCP改良）），临界值、似然比和比值比分别为25.0、93.7、180.1。ChE/Alb比值似乎是胆碱能危象诊断的优秀指标，因为它显示出高似然比和高比值比。
