Lim Yun-Ping, Lin Cheng-Li, Hung Dong-Zong, Ma Wei-Chih, Lin Yen-Ning, Kao Chia-Hung
From the Department of Pharmacy (Y-PL, D-ZH, W-CM, Y-NL), College of Pharmacy, China Medical University; Department of Emergency (Y-PL, D-ZH), Toxicology Center; Management Office for Health Data (C-LL), China Medical University Hospital; College of Medicine (C-LL); Graduate Institute of Clinical Medical Science and School of Medicine (C-HK), College of Medicine, China Medical University; and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan.
Medicine (Baltimore). 2015 Jan;94(1):e341. doi: 10.1097/MD.0000000000000341.
Organophosphate (OP) poisoning is a critical cause of morbidity and mortality worldwide. We conducted a nationwide longitudinal cohort study to investigate the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) among patients admitted with OP intoxication.We identified patients with OP intoxication by using the Taiwan National Health Insurance Research Database and enrolled 9223 patients who were hospitalized for OP intoxication between 2000 and 2011. OP intoxication was diagnosed based on a clinical assessment and serum acetylcholinesterase levels at the time of hospital admission. Each patient in the OP intoxication cohort was randomly frequency matched with 4 patients without OP intoxication based on their age, sex, and index year (36,892 patients as control cohort), and all patients were observed from the index date until the appearance of a DVT or a PTE event, or until December 31, 2011. We analyzed the risks of DVT and PTE by using Cox proportional hazards regression models that included the demographic variables of sex, age, and comorbidities (eg, hypertension, diabetes, cerebral vascular disease, heart failure, all cancer types, and lower leg fracture or surgery).The results revealed a significantly increased risk of developing DVT among patients with OP poisoning (adjusted hazard ratio [HR] = 1.55; 95% confidence interval [CI] = 1.03-2.34) but not PTE (adjusted HR = 1.44; 95% CI = 0.83-2.52). Among the patients without comorbidities, the OP poisoning patients compared with controls had a higher adjusted HR of 2.12 (95% CI = 1.21-3.71) for DVT.The results of this nationwide cohort study indicate that the risk of developing DVT is markedly higher in patients with OP intoxication compared with that of the general population.
有机磷中毒是全球发病和死亡的一个关键原因。我们开展了一项全国性纵向队列研究，以调查有机磷中毒入院患者中深静脉血栓形成（DVT）和肺血栓栓塞（PTE）的发生情况。我们通过台湾全民健康保险研究数据库识别出有机磷中毒患者，并纳入了2000年至2011年间因有机磷中毒住院的9223名患者。有机磷中毒根据入院时的临床评估和血清乙酰胆碱酯酶水平进行诊断。有机磷中毒队列中的每位患者根据其年龄、性别和索引年份与4名无有机磷中毒患者进行随机频率匹配（36892名患者作为对照队列），所有患者从索引日期开始观察，直至出现DVT或PTE事件，或直至2011年12月31日。我们使用Cox比例风险回归模型分析DVT和PTE的风险，该模型纳入了性别、年龄和合并症（如高血压、糖尿病、脑血管疾病、心力衰竭、所有癌症类型以及小腿骨折或手术）等人口统计学变量。结果显示，有机磷中毒患者发生DVT的风险显著增加（调整后风险比[HR]=1.55；95%置信区间[CI]=1.03 - 2.34），但PTE风险未增加（调整后HR = 1.44；95% CI = 0.83 - 2.52）。在无合并症的患者中，有机磷中毒患者发生DVT的调整后HR为2.12（95% CI = 1.21 - 3.71），高于对照组。这项全国性队列研究的结果表明，与普通人群相比，有机磷中毒患者发生DVT的风险明显更高。
