Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
Clin Toxicol (Phila). 2020 Nov;58(11):1015-1022. doi: 10.1080/15563650.2020.1784428. Epub 2020 Jul 1.
Amatoxin leads to the majority of deaths by mushroom poisoning around the world. Amatoxin causes gastrointestinal disturbances and multiple organ dysfunction, including liver and renal failure. As a potential treatment for amatoxin poisoning, -acetylcysteine (NAC) has been used for decades but its benefit is still unproven. We undertook a systematic review to evaluate the performance and safety of -acetylcysteine on patients suffering amatoxin intoxication. We searched Pubmed, EMBASE, CENTRAL and SinoMed databases, from inception to August 31, 2019. Articles were eligible if there were five or more patients with amatoxin poisoning and -acetylcysteine was included in the therapeutic regimen. Mortality rate including liver transplant cases (MRLTi) was the primary outcome. Mortality rate not including liver transplant cases, liver and renal function, clinical complications, as well as any adverse reactions to intravenous NAC were secondary outcomes. Thirteen studies with a total of 506 patients were included. The MRLTi of amatoxin-poisoning patients with NAC treatment was 11% (57/506), and a MRLTe of 7.9% (40/506) and a liver transplantation rate of 4.3% (22/506). Transaminase concentrations generally peaked around 3 days after ingestion, prothrombin time/International Normalized Ratio (PT/INR) generally worsened during the first 3-4 days after ingestion before returning to normal four to 7 days after ingestion, and Factor V levels normalized in about 4-5 days after ingestion in patients treated with NAC. Renal failure was reported in 3% (3/101) and acute kidney injury was reported in 19% (5/27). Gastrointestinal bleeding occurred in 21% (15/71). Anaphylactoid reactions were the principle adverse reaction to NAC treatment in amatoxin-poisoning patients with an incidence of 5% (4/73). NAC treatment combined with other therapies appears to be beneficial and safe in patients with amatoxin poisoning. Until further data emerge, it is reasonable to use NAC in addition to other treatments for amatoxin poisoning.
鹅膏蕈碱是导致全球大多数蘑菇中毒死亡的主要原因。鹅膏蕈碱可引起胃肠道紊乱和多器官功能障碍，包括肝肾功能衰竭。-乙酰半胱氨酸（NAC）作为一种潜在的鹅膏蕈碱中毒治疗方法已应用了数十年，但疗效仍未得到证实。我们进行了一项系统评价，以评估 -乙酰半胱氨酸对鹅膏蕈碱中毒患者的疗效和安全性。我们检索了 Pubmed、EMBASE、CENTRAL 和 SinoMed 数据库，检索时间从建库至 2019 年 8 月 31 日。如果有 5 例或 5 例以上鹅膏蕈碱中毒患者，且治疗方案中包含 -乙酰半胱氨酸，则纳入研究。主要结局为包括肝移植病例的死亡率（MRLTi）。次要结局为不包括肝移植病例的死亡率、肝肾功能、临床并发症以及静脉内 NAC 的任何不良反应。共纳入 13 项研究，总计 506 例患者。NAC 治疗的鹅膏蕈碱中毒患者的 MRLTi 为 11%（57/506），MRLTe 为 7.9%（40/506），肝移植率为 4.3%（22/506）。转氨酶浓度一般在摄入后 3 天左右达到峰值，凝血酶原时间/国际标准化比值（PT/INR）一般在摄入后 3-4 天内恶化，然后在摄入后 4-7 天内恢复正常，而接受 NAC 治疗的患者的因子 V 水平在摄入后约 4-5 天内恢复正常。有 3%（3/101）的患者报告发生肾衰竭，19%（5/27）的患者报告发生急性肾损伤。有 21%（15/71）的患者发生胃肠道出血。过敏样反应是鹅膏蕈碱中毒患者接受 NAC 治疗的主要不良反应，发生率为 5%（4/73）。NAC 联合其他疗法治疗鹅膏蕈碱中毒似乎是有益且安全的。在获得更多数据之前，在其他治疗的基础上联合 NAC 治疗鹅膏蕈碱中毒是合理的。
