Toxicology Clinical Department, University Hospital, Jagiellonian University Medical College, 31-008 Kraków, Poland.
Institute of Health, State Higher Vocational School, 33-320 Nowy Sącz, Poland.
Int J Mol Sci. 2023 Jun 28;24(13):10784. doi: 10.3390/ijms241310784.
In conventional clinical toxicology practice, the blood level of carboxyhemoglobin is a biomarker of carbon monoxide (CO) poisoning but does not correspond to the complete clinical picture and the severity of the poisoning. Taking into account articles suggesting the relationship between oxidative stress parameters and CO poisoning, it seems reasonable to consider this topic more broadly, including experimental biochemical data (oxidative stress parameters) and patients poisoned with CO. This article aimed to critically assess oxidative-stress-related parameters as potential biomarkers to evaluate the severity of CO poisoning and their possible role in the decision to treat. The critically set parameters were antioxidative, including catalase, 2,2-diphenyl-1-picryl-hydrazyl, glutathione, thiol and carbonyl groups. Our preliminary studies involved patients ( = 82) admitted to the Toxicology Clinical Department of the University Hospital of Jagiellonian University Medical College (Kraków, Poland) during 2015-2020. The poisoning was diagnosed based on medical history, clinical symptoms, and carboxyhemoglobin blood level. Blood samples for carboxyhemoglobin and antioxidative parameters were collected immediately after admission to the emergency department. To evaluate the severity of the poisoning, the Pach scale was applied. The final analysis included a significant decrease in catalase activity and a reduction in glutathione level in all poisoned patients based on the severity of the Pach scale: I°-III° compared to the control group. It follows from the experimental data that the poisoned patients had a significant increase in level due to thiol groups and the 2,2-diphenyl-1-picryl-hydrazyl radical, with no significant differences according to the severity of poisoning. The catalase-to-glutathione and thiol-to-glutathione ratios showed the most important differences between the poisoned patients and the control group, with a significant increase in the poisoned group. The ratios did not differentiate the severity of the poisoning. The carbonyl level was highest in the control group compared to the poisoned group but was not statistically significant. Our critical assessment shows that using oxidative-stress-related parameters to evaluate the severity of CO poisoning, the outcome, and treatment options is challenging.
在传统的临床毒理学实践中，血液中碳氧血红蛋白的水平是一氧化碳（CO）中毒的生物标志物，但与完整的临床情况和中毒的严重程度并不对应。考虑到一些文章表明氧化应激参数与 CO 中毒之间存在关系，因此似乎有理由更广泛地考虑这个问题，包括实验生化数据（氧化应激参数）和 CO 中毒的患者。本文旨在批判性地评估与氧化应激相关的参数作为评估 CO 中毒严重程度的潜在生物标志物，并探讨其在治疗决策中的可能作用。本文批判性地设定了抗氧化参数，包括过氧化氢酶、2,2-二苯基-1-苦肼基、谷胱甘肽、硫醇和羰基。我们的初步研究涉及 2015 年至 2020 年期间在雅盖隆大学医学院毒理学临床科就诊的患者（=82）。根据病史、临床症状和血液中碳氧血红蛋白水平诊断中毒。在急诊科就诊时立即采集血液样本用于检测碳氧血红蛋白和抗氧化参数。应用 Pach 量表评估中毒的严重程度。根据 Pach 量表的严重程度（I°-III°），对所有中毒患者进行了分析，发现过氧化氢酶活性显著降低，谷胱甘肽水平降低。根据实验数据，中毒患者的巯基和 2,2-二苯基-1-苦肼基自由基水平显著升高，与中毒严重程度无关。过氧化氢酶/谷胱甘肽和硫醇/谷胱甘肽比值在中毒患者和对照组之间表现出最重要的差异，中毒组显著升高。这些比值并不能区分中毒的严重程度。与中毒组相比，对照组的羰基水平最高，但无统计学差异。我们的批判性评估表明，使用与氧化应激相关的参数来评估 CO 中毒的严重程度、结果和治疗选择具有挑战性。
