Ghannoum Marc, Hoffman Robert S, Mowry James B, Lavergne Valery
Department of Nephrology, Verdun Hospital, University of Montreal, Montreal, Quebec, Canada.
Semin Dial. 2014 Jul-Aug;27(4):395-401. doi: 10.1111/sdi.12237. Epub 2014 Apr 9.
Morbidity and mortality from toxic alcohols like ethylene glycol and methanol remain prevalent worldwide. The introduction of fomepizole, a potent blocker of alcohol dehydrogenase, has modified current practice over the last 15 years. The aim of the study was to describe the characteristics of toxic alcohol poisoning reported to US poison centers, the trends in the incidence of antidote use and hemodialysis treatment, as well as the related mortality. A retrospective study of all electronic entries from the AAPCC National Poison Data System database, from the years 2000 to 2013 was reviewed. When considering all exposures, the great majority of patients had a benign outcome. Major effects (e.g., life threatening) occurred in 2.1% and 4.9% of methanol and ethylene glycol cases, respectively. Mortality rates were similar for both toxic alcohols, approximately 0.6%. When only considering ingestions reported to healthcare facilities, a major effect was reported in 9.5% and 20.5%, and the mortality rate was 2.9% and 2.4% for methanol and ethylene glycol exposures, respectively, and remained constant over time. The use of fomepizole increased statistically over the study period while that of ethanol decreased, until it became proportionally negligible by 2012-2013. The use of hemodialysis significantly decreased in "Early" ethylene glycol exposures during the study period. Similar to other reports, it appears that the use of fomepizole has largely supplanted ethanol as the antidote of choice in toxic alcohol exposures and may decrease the requirements for hemodialysis in patients poisoned with ethylene glycol who have no acidosis and normal kidney function.
像乙二醇和甲醇这类有毒醇类导致的发病率和死亡率在全球范围内仍然普遍存在。在过去15年里，强效酒精脱氢酶阻滞剂甲吡唑的引入改变了当前的治疗方法。本研究的目的是描述向美国中毒控制中心报告的有毒醇类中毒的特征、解毒剂使用和血液透析治疗的发病率趋势以及相关死亡率。对2000年至2013年美国毒物控制中心协作计划（AAPCC）国家中毒数据系统数据库中的所有电子记录进行了回顾性研究。在考虑所有暴露情况时，绝大多数患者预后良好。甲醇和乙二醇中毒病例分别有2.1%和4.9%出现了严重后果（如危及生命）。两种有毒醇类的死亡率相似，约为0.6%。仅考虑向医疗机构报告的摄入情况时，甲醇和乙二醇暴露分别有9.5%和20.5%报告出现严重后果，死亡率分别为2.9%和2.4%，且随时间保持稳定。在研究期间，甲吡唑的使用量在统计学上有所增加，而乙醇的使用量则下降，到2012 - 2013年其比例可忽略不计。在研究期间，“早期”乙二醇暴露患者的血液透析使用量显著下降。与其他报告类似，甲吡唑的使用似乎已在很大程度上取代乙醇，成为有毒醇类暴露的首选解毒剂，并且可能减少对无酸中毒且肾功能正常的乙二醇中毒患者的血液透析需求。
