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依达拉奉治疗百草枯中毒的临床特征及预后的回顾性研究

Retrospective study of clinical features and prognosis of edaravone in the treatment of paraquat poisoning.

作者信息

Yi Ren, Zhizhou Yang, Zhaorui Sun, Wei Zhang, Xin Chen, Shinan Nie

机构信息

Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China.

出版信息

Medicine (Baltimore). 2019 May;98(19):e15441. doi: 10.1097/MD.0000000000015441.

Abstract

To observe whether edaravone can protect organs and inhibit pulmonary fibrosis in patients with paraquat poisoning and to provide a method for clinical intervention for paraquat poisoning.Forty-four cases of paraquat poisoning were collected from March 2011 to December 2017 in our hospital. Eighteen cases from March 2011 to November 2013 did not receive edaravone treatment and were considered the control group, and 26 cases from January 2014 to December 2017 were treated with edaravone and were considered the observation group. Injuries to the central nervous system, heart, liver, kidney, and digestive system were evaluated on at 24 hours, 3 days, and 7 days after hospitalization. The expression of serum inflammatory factors (interleukin [IL]-6, IL-10, tumor necrosis factor-α [TNF-α]) and oxidative stress correlation (superoxide dismutase [SOD] and malondialdehyde [MDA]) were assayed at 24 hours, 3 days, and 7 days after being hospitalized. After 7, 14, and 30 days, the changes in pathological lung characteristics in the 2 groups were assessed, and survival rates were calculated.Edaravone significantly increased the serum levels of SOD and obviously markedly reduce the serum levels of IL-6, IL-10, TNF-α, and MDA in patients poisoned with paraquat (P < .05). Edaravone significantly protected the liver (P = .021), cardiovascular (P = .031), and renal (P = .028) organs of patients from paraquat poisoning-induced injury after 7 days but had no significant protection or improvement on respiratory and digestive tract damage. Edaravone delayed the occurrence of pulmonary fibrosis and increase the survival time of patients at 7 and 14 days (P < .05). However, the 1-month follow-up found that edaravone did not reduce pulmonary fibrosis (77.8% vs 73.1%, P = .615) and did not increase the survival rate of the patients (61.1% vs 65.3%, P = .853).Edaravone is beneficial for protecting the kidneys and liver from paraquat poisoning through reducing oxidative stress and inhibiting inflammatory response. It can also inhibit the pulmonary fibrosis process and prolong the survival time of the patients. However, no significant improvements were seen in the probability of pulmonary fibrosis and the survival rate.

摘要

观察依达拉奉能否保护百草枯中毒患者的器官并抑制肺纤维化,为百草枯中毒的临床干预提供方法。收集我院2011年3月至2017年12月收治的44例百草枯中毒患者。2011年3月至2013年11月的18例患者未接受依达拉奉治疗,作为对照组;2014年1月至2017年12月的26例患者接受依达拉奉治疗,作为观察组。在患者住院后24小时、3天和7天评估其对中枢神经系统、心脏、肝脏、肾脏和消化系统的损伤情况。在住院后24小时、3天和7天检测血清炎症因子(白细胞介素[IL]-6、IL-10、肿瘤坏死因子-α[TNF-α])的表达及氧化应激相关指标(超氧化物歧化酶[SOD]和丙二醛[MDA])。在7天、14天和30天后,评估两组患者肺部病理特征的变化,并计算生存率。依达拉奉可显著提高百草枯中毒患者血清SOD水平,明显降低血清IL-6、IL-10、TNF-α和MDA水平(P<0.05)。依达拉奉在7天后可显著保护百草枯中毒患者的肝脏(P=0.021)、心血管(P=0.031)和肾脏(P=0.028)器官免受损伤,但对呼吸道和消化道损伤无明显保护或改善作用。依达拉奉可延缓肺纤维化的发生,并增加患者在7天和14天的生存时间(P<0.05)。然而,1个月的随访发现,依达拉奉并未减轻肺纤维化(77.8%对73.1%,P=0.615),也未提高患者的生存率(61.1%对65.3%,P=0.853)。依达拉奉通过减轻氧化应激和抑制炎症反应,有利于保护百草枯中毒患者的肾脏和肝脏。它还可以抑制肺纤维化进程,延长患者的生存时间。然而,在肺纤维化发生率和生存率方面未见明显改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/303e/6531030/006b44b9d1a6/medi-98-e15441-g002.jpg

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