Pach D
Department of Endocrinology Collegium Medicum Jagiellonian University, Kraków.
Przegl Lek. 1996;53(4):313-23.
The aim of the study was to evaluate the morphological and functional status of the liver in acute, oral cholinesterase inhibitors poisoning using static scintigraphy, hepatography and measurements of chosen enzymes activity. Considering the different clinical picture of cholinesterase inhibitors poisonings in people, it was necessary to estimate the poisoning severity and its dependence on the frequency and intensification of the liver lesion. Under examination there were 37 cholinesterase inhibitors orally poisoned patients, treated at the Department of Toxicology in the years 1992-1995. The examined group comprised 7 women (19%) and 30 men (81%). Organophosphate compounds poisoning was noted in 14 patients, and carbamates poisonings in 23 patients. The reference group comprised 30 healthy men aged 24 to 59 years not exposed to hepatotoxic agents. More than 90% of patients were classified as severe poisoned. Any fatal case was not noted. A differently intensified pathological changes of the liver dependent on age and poisoning severity were found in 97.2% of patients and their frequency was significantly higher than in the control group. Hepatographic picture revealed in 96.6% of cases the liver lesion. Hepatographic picture of the liver was also dependent on poisoning severity. The higher activity of AST, ALT, AP and higher bilirubin concentration in blood were noted in poisoned men compared to the control group. Control scintigraphic examination revealed a considerable improvement in the intensification of the liver scintigraphic picture in 40% of the patients and a higher intensification in 13% of the subjects. In 46.6% of the patients the intensification of scintigraphic changes remained at the same level. Considering arbitrary criteria for the degree of the liver lesion, the improvement in the intensification of hepatographic changes was noted in 42.8% of the patients; the intensification of the liver lesion was not noted even in one case. Analyzing the percentage of the liver lesion for each individual patient, improvement was noted in 92.8% of the examined patients, and the changes with the same level of intensification in 7.2%. Deterioration was not noted at all.
The liver scintigraphy and hepatography combined with biochemical analysis allows to assess the liver condition in acute cholinesterase inhibitors poisoning.
本研究的目的是使用静态闪烁扫描、肝造影和所选酶活性测量来评估急性口服胆碱酯酶抑制剂中毒时肝脏的形态和功能状态。考虑到人群中胆碱酯酶抑制剂中毒的临床表现各异，有必要评估中毒的严重程度及其与肝脏病变频率和加重程度的关系。接受检查的有37例口服胆碱酯酶抑制剂中毒患者，于1992年至1995年在毒理学系接受治疗。受检组包括7名女性（19%）和30名男性（81%）。14例患者为有机磷化合物中毒，23例患者为氨基甲酸盐中毒。参照组包括30名年龄在24至59岁之间未接触肝毒性药物的健康男性。超过90%的患者被归类为重度中毒。未发现任何死亡病例。在97.2%的患者中发现了与年龄和中毒严重程度相关的肝脏不同程度的病理变化，其发生率明显高于对照组。96.6%的病例肝造影显示有肝脏病变。肝脏的肝造影图像也取决于中毒严重程度。与对照组相比，中毒男性血液中AST、ALT、AP活性更高，胆红素浓度更高。对照闪烁扫描检查显示，40%的患者肝脏闪烁扫描图像的强化有显著改善，13%的受试者强化程度更高。46.6%的患者闪烁扫描变化的强化程度保持在同一水平。根据肝脏病变程度的任意标准，42.8%的患者肝造影变化的强化有改善；甚至没有一例发现肝脏病变强化。分析每位患者的肝脏病变百分比，92.8%的受检患者有改善，7.2%的患者强化程度相同。未发现恶化情况。
肝脏闪烁扫描和肝造影结合生化分析可用于评估急性胆碱酯酶抑制剂中毒时的肝脏状况。
