Ragab Hisham Elsayed, El-Banna Asmaa, Elshaer Noha Selim, Azzaz Omnia
Professor of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University Champollion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria 21521, Egypt.
Assistant Professor of Industrial Medicine and Occupational Health, Department of Community Medicine, Faculty of Medicine, Alexandria University Champollion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria 21521, Egypt.
Toxicol Res (Camb). 2024 Jul 10;13(4):tfae104. doi: 10.1093/toxres/tfae104. eCollection 2024 Aug.
Cholinesterase inhibitors (ChEIs) insecticide poisoning is a serious global health concern that results in hundreds of thousands of fatalities each year. Although inhibition of the cholinesterase enzyme is the main mechanism of ChEI poisoning, oxidative stress is considered the mechanism underlying the related complications. The study aimed to assess the oxidative status of the patients with ChEI insecticide poisoning and the role of L-carnitine as adjuvant therapy in their management. Human studies on the efficacy and safety of L-carnitine in treating insecticide poisoning are limited despite its growing research interest as a safe antioxidant. This prospective study was conducted on eighty patients with acute ChEIs insecticide poisoning admitted to Alexandria Poison Center, Alexandria Main University Hospital, Egypt. Patients were allocated into two equal groups randomly. The L-carnitine (LC) group received the conventional treatment (atropine & toxogonin) and LC and the standard treatment (ST) group received the standard treatment only. Outcome measures were fatality rate, the total administered dose of atropine & toxogonin, length of hospital stay, and the requirement for ICU admission or mechanical ventilation. The study results revealed that malondialdehyde (MDA) significantly decreased in the LC group. Cholinesterase enzyme levels increased significantly after treatment in the LC group than in the ST group. The LC group needed lower dosages of atropine and toxogonin than the ST group. Also, the LC group showed no need for ICU admission or mechanical ventilation. The study concluded that LC can be considered a promising adjuvant antioxidant treatment in acute ChEIs pesticide poisoning.
胆碱酯酶抑制剂（ChEIs）杀虫剂中毒是一个严重的全球健康问题，每年导致数十万人死亡。虽然抑制胆碱酯酶是ChEI中毒的主要机制，但氧化应激被认为是相关并发症的潜在机制。本研究旨在评估ChEI杀虫剂中毒患者的氧化状态以及左旋肉碱作为辅助治疗在其管理中的作用。尽管左旋肉碱作为一种安全的抗氧化剂的研究兴趣日益增加，但关于其治疗杀虫剂中毒的疗效和安全性的人体研究仍然有限。本前瞻性研究对埃及亚历山大主大学医院亚历山大中毒中心收治的80例急性ChEIs杀虫剂中毒患者进行。患者被随机分为两组，每组人数相等。左旋肉碱（LC）组接受常规治疗（阿托品和解磷定）加LC，标准治疗（ST）组仅接受标准治疗。观察指标包括死亡率、阿托品和解磷定的总给药剂量、住院时间以及入住重症监护病房（ICU）或机械通气的需求。研究结果显示，LC组丙二醛（MDA）显著降低。与ST组相比，LC组治疗后胆碱酯酶水平显著升高。LC组所需的阿托品和解磷定剂量低于ST组。此外，LC组无需入住ICU或进行机械通气。该研究得出结论，左旋肉碱可被视为急性ChEIs农药中毒一种有前景的辅助抗氧化治疗方法。
