Wille Timo, Djordjević Snezana, Worek Franz, Thiermann Horst, Vučinić Slavica
Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany
Military Medical Academy, National Poison Control Center, Belgrade, Serbia.
BMJ Mil Health. 2020 Apr;166(2):99-102. doi: 10.1136/jramc-2019-001310. Epub 2020 Feb 20.
Recent uses of nerve agents underline the need of early diagnosis as trigger to react (initiating medical countermeasures, avoiding cross-contamination). As organophosphorus (OP) pesticide poisoning exerts the same pathomechanism, that is, inhibition of the pivotal enzyme acetylcholinesterase (AChE), a portable cholinesterase (ChE) test kit was applied in an emergency room for rapid diagnosis of OP poisoning. OP nerve agents or pesticides result in the inhibition of AChE. As AChE is also expressed on erythrocytes, patient samples are easily available. However, in most clinics only determination of plasma butyrylcholinesterase (BChE) is established which lacks a pathophysiological correlate, shows higher variability in the population and behaves different regarding inhibition by OP and reactivation by oximes. The ChE test kit helped to diagnose atypical cases of OP poisoning, for example, missing of typical muscarinic symptoms, and resulted in administration of pralidoxime, the oxime used in Serbia. The ChE test kit also allows an initial assessment whether an oxime therapy is successful. In one case report, AChE activity increased after oxime administration indicating therapeutic success whereas BChE activity did not. With only BChE at hand, this therapeutic effect would have been missed. As inhibition of AChE or BChE activity is determined, the CE-certified device is a global diagnostic tool for all ChE inhibitors including carbamates which might also be misused as chemical weapon. The ChE test kit is a helpful point-of-care device for the diagnosis of ChE inhibitor poisoning. Its small size and easy menu-driven use advocate procurement where nerve agent and OP pesticide exposure are possible.
近期神经毒剂的使用凸显了早期诊断作为应对触发因素的必要性（启动医学应对措施，避免交叉污染）。由于有机磷（OP）农药中毒具有相同的发病机制，即关键酶乙酰胆碱酯酶（AChE）受到抑制，因此在急诊室应用了一种便携式胆碱酯酶（ChE）检测试剂盒，用于快速诊断OP中毒。OP神经毒剂或农药会导致AChE受到抑制。由于AChE也在红细胞上表达，患者样本很容易获取。然而，在大多数诊所中，仅开展血浆丁酰胆碱酯酶（BChE）的检测，这缺乏病理生理学相关性，在人群中显示出较高的变异性，并且在OP抑制和肟类药物复活方面表现不同。ChE检测试剂盒有助于诊断OP中毒的非典型病例，例如，缺乏典型的毒蕈碱样症状，并导致使用了塞尔维亚使用的肟类药物解磷定。ChE检测试剂盒还可以对肟类药物治疗是否成功进行初步评估。在一份病例报告中，肟类药物给药后AChE活性增加表明治疗成功，而BChE活性未增加。如果仅检测BChE，这种治疗效果就会被遗漏。由于测定了AChE或BChE活性的抑制情况，该CE认证设备是一种针对所有ChE抑制剂（包括可能被滥用为化学武器的氨基甲酸酯类）的全球诊断工具。ChE检测试剂盒是诊断ChE抑制剂中毒的一种有用的床旁检测设备。其体积小且操作菜单简单，建议在可能接触神经毒剂和OP农药的地方采购。
