Agarwal Avinash, Robo Roto, Jain Nirdesh, Gutch Manish, Consil Shuchi, Kumar Sukriti
Department of Medicine, King George's Medical University, India.
Department of Endocrinology, LLRM Medical College, Meerut, India.
Indian J Crit Care Med. 2014 Oct;18(10):666-71. doi: 10.4103/0972-5229.142176.
The primary objective of this study was to determine the serum level of antioxidant enzymes and to correlate them with outcome in patients of aluminum phosphide (ALP) poisoning and, secondly, to evaluate the effect of N-acetylcysteine (NAC) given along with supportive treatment of ALP poisoning.
We conducted a cohort study in patients of ALP poisoning hospitalized at a tertiary care center of North India. The treatment group and control group were enrolled during the study period of 1 year from May 2011 to April 2012.
Oxidative stress was evaluated in each subject by estimating the serum levels of the enzymes, viz. catalase, superoxide dismutase (SOD) and glutathione reductase (GR). The treatment group comprised of patients who were given NAC in addition to supportive treatment (magnesium sulfate and vasopressors, if required), while in the control group, only supportive treatment was instituted. The primary endpoint of the study was the survival of the patients.
The baseline catalase (P = 0.008) and SOD (P < 0.01) levels were higher among survivors than non-survivors. Of the total patients in the study, 31 (67.4%) expired and 15 (32.6%) survived. Among those who expired, the mean duration of survival was 2.92 ± 0.40 days in the test group and 1.82 ± 0.33 days in the control group (P = 0.043).
This study suggests that the baseline level of catalase and SOD have reduced in ALP poisoning, but baseline GR level has not suppressed but is rather increasing with due time, and more so in the treatment group. NAC along with supportive treatment may have improved survival in ALP poisoning.
本研究的主要目的是测定磷化铝（ALP）中毒患者血清抗氧化酶水平，并将其与患者预后进行相关性分析；其次，评估在ALP中毒的支持治疗基础上加用N - 乙酰半胱氨酸（NAC）的效果。
我们在印度北部一家三级医疗中心对住院的ALP中毒患者进行了一项队列研究。治疗组和对照组在2011年5月至2012年4月的1年研究期间入组。
通过测定过氧化氢酶、超氧化物歧化酶（SOD）和谷胱甘肽还原酶（GR）的血清水平，评估每位受试者的氧化应激情况。治疗组患者除接受支持治疗（必要时使用硫酸镁和血管加压药）外，还给予NAC，而对照组仅进行支持治疗。本研究的主要终点是患者的生存情况。
幸存者的基线过氧化氢酶（P = 0.008）和SOD（P < 0.01）水平高于非幸存者。在本研究的所有患者中，31例（67.4%）死亡，15例（32.6%）存活。在死亡患者中，试验组的平均生存时间为2.92 ± 0.40天，对照组为1.82 ± 0.33天（P = 0.043）。
本研究表明，ALP中毒时过氧化氢酶和SOD的基线水平降低，但基线GR水平未受抑制，反而随时间推移而升高，治疗组更为明显。NAC联合支持治疗可能改善了ALP中毒患者的生存率。
