Wu Yi-Jan, Chang Shu-Sen, Chen Hsien-Yi, Tsai Kai-Fan, Lee Wen-Chin, Wang I-Kuan, Lee Chern-Horng, Chen Chao-Yu, Liu Shou-Hsuan, Weng Cheng-Hao, Huang Wen-Hung, Hsu Ching-Wei, Yen Tzung-Hai
Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan.
College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Int J Gen Med. 2023 Oct 26;16:4795-4804. doi: 10.2147/IJGM.S432861. eCollection 2023.
There is an overall paucity of data regarding the human toxicity of chlorpyrifos and cypermethrin pesticide mixture. Both organophosphate and pyrethroid insecticides are metabolized by carboxylesterases. Thus, its pesticide combination, organophosphates may boost the toxicity of pyrethroids via inhibited its detoxification by carboxylesterases. This study examined the clinical course, laboratory tests, and outcomes of patients with chlorpyrifos, cypermethrin or their pesticide mixture poisoning, and to determine what association, if any, might exist between these findings.
Between 2000 and 2021, 121 patients poisoned with chlorpyrifos, cypermethrin, or their pesticide mixture were treated at Chang Gung Memorial Hospital. Patients were categorized as chlorpyrifos (n=82), cypermethrin (n=27) or chlorpyrifos and cypermethrin (n=12) groups. Demographic, clinical, laboratory and mortality data were collected for analysis.
The patients experienced a broad range of clinical symptoms, including aspiration pneumonia (44.6%), salivation (42.5%), acute respiratory failure (41.3%), acute kidney injury (13.9%), seizures (7.5%), hypotension (2.6%), etc. Leukocytosis (12,700±6600 /uL) and elevated serum C-reactive protein level (36.8±50.4 mg/L) were common. The acute respiratory failure rate was 41.3%, comprising 48.8% in chlorpyrifos, 11.1% in cypermethrin as well as 58.3% in chlorpyrifos and cypermethrin poisoning. Patients with chlorpyrifos and cypermethrin pesticide mixture poisoning suffered higher rates of acute respiratory failure (P=0.001) and salivation (P=0.001), but lower Glasgow Coma Scale score (P=0.011) and serum cholinesterase level (P<0.001) than other groups. A total of 17 (14.0%) patients expired. The mortality rate was 14.0%, including 17.1% in chlorpyrifos, 3.7% in cypermethrin as well as 16.7% in chlorpyrifos and cypermethrin poisoning. No significant differences in mortality rate were noted (P=0.214).
Chlorpyrifos pesticide accounted for the major toxicity of the pesticide mixture. While the data show a higher rate of respiratory failure in the chlorpyrifos and cypermethrin pesticide mixture group than others, other measures of toxicity such as mortality and length of stay were not increased.
关于毒死蜱和氯氰菊酯农药混合物对人体毒性的数据总体较少。有机磷酸酯类和拟除虫菊酯类杀虫剂均由羧酸酯酶代谢。因此，其农药组合中，有机磷酸酯类可能通过抑制羧酸酯酶对拟除虫菊酯类的解毒作用而增强其毒性。本研究调查了毒死蜱、氯氰菊酯或其农药混合物中毒患者的临床病程、实验室检查及预后，并确定这些结果之间可能存在的关联（若有的话）。
2000年至2021年期间，长庚纪念医院收治了121例因毒死蜱、氯氰菊酯或其农药混合物中毒的患者。患者被分为毒死蜱组（n = 82）、氯氰菊酯组（n = 27）或毒死蜱与氯氰菊酯组（n = 12）。收集人口统计学、临床、实验室及死亡率数据进行分析。
患者出现了广泛的临床症状，包括吸入性肺炎（44.6%）、流涎（42.5%）、急性呼吸衰竭（41.3%）、急性肾损伤（13.9%）、癫痫发作（7.5%）、低血压（2.6%）等。白细胞增多（12,700±6600 /μL）和血清C反应蛋白水平升高（36.8±50.4 mg/L）较为常见。急性呼吸衰竭发生率为41.3%，其中毒死蜱中毒患者中占48.8%，氯氰菊酯中毒患者中占11.1%，毒死蜱与氯氰菊酯混合中毒患者中占58.3%。毒死蜱与氯氰菊酯农药混合物中毒患者的急性呼吸衰竭发生率（P = 0.001）和流涎发生率（P = 0.001）较高，但格拉斯哥昏迷量表评分（P = 0.011）和血清胆碱酯酶水平（P < 0.001）低于其他组。共有17例（14.0%）患者死亡。死亡率为14.0%，其中毒死蜱中毒患者中为17.1%，氯氰菊酯中毒患者中为3.7%，毒死蜱与氯氰菊酯混合中毒患者中为16.7%。死亡率无显著差异（P = 0.214）。
毒死蜱农药是该农药混合物毒性的主要来源。虽然数据显示毒死蜱与氯氰菊酯农药混合物组的呼吸衰竭发生率高于其他组，但其他毒性指标如死亡率和住院时间并未增加。
