ヒトの自己中毒における有機リン殺虫剤の違い:前向きなコホート研究
Michael Eddleston1, Peter Eyer, Franz Worek
1South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK. eddlestonm@eureka.lk
Lancet (London, England)
|October 26, 2005
まとめ
オルガノリン殺虫剤による中毒は,化合物によって著しく異なります. ダイメトアートとフェンチオンは,動物に対する毒性データに反して,ヒトにおけるクロルピリフォスよりも高い死亡率と挿管率を引き起こす.
科学分野:
- 毒理学 毒理学 毒理学
- クリニカル・メディシン 臨床医学
- 環境衛生 環境衛生 環境衛生
背景:
- オルガノリン (OP) の殺虫剤は広く使用されていますが,OP中毒は通常,均一な状態として扱われます.
- 既存の分類は主に動物の致死量データに依存しており,ヒトへの毒性を誤って表している可能性があります.
- OP中毒の臨床表現と重症度は,異なる化合物によって著しく異なる可能性があります.
研究 の 目的:
- スリランカで自己中毒のために使用される3つの一般的な有機リン殺虫剤 (クロルピリフォス,ジメトアート,フェンチオン) の臨床的特徴と中毒の重度の違いを調査する.
- これらのOP化合物のヒトに対する毒性を比較し,動物に対する毒性データへの依存を異視する.
- 異なるOP中毒の特定の管理プロトコルの開発に情報を提供するために.
主な方法:
- クロルピリフォス,ジメトアート,またはフェンチオンの自己中毒が確認された802人の患者を対象に,3つの病院で行われた前向きな研究.
- 血中コレニステラス活性と殺虫剤濃度の測定により,病原体を確認し,患者の反応を評価する.
- 死亡率および内側頭管内置の必要性を含む臨床結果の体系的な記録.
主要な成果:
- 死亡率は,クロルピリフォス (8.0%) と比較して,ダイメソアート (23.1%) とフェンチオン (16.2%) で著しく高かった.
- ドメソアート (35.2%) とフェンチオン (31.3%) の中毒では,クロルピリフォス (15.0%) 症例よりも,エンドトラケア管注入が頻繁に必要であった.
- ディメソアート中毒は,しばしばショックによる急速な死亡を引き起こし,フェンチオン中毒は,呼吸器の合併症が遅延することを示した. プラリドキシムに対する反応は様々で,ディメトアートとフェンチオンに対する結果はより悪かった.
結論:
- オルガノリン殺虫剤による中毒は単一の存在ではない. 臨床的経過,治療への反応,および結果には大きな違いがある.
- 人間の毒性プロファイルは,動物データと著しく異なる;クロルピリフォスは,ラットに非常に有毒であるが,研究された化合物の中で人間に最も有毒である.
- 特定のオルガノフォスファル殺虫剤に合わせた個別化管理プロトコルは,患者のアウトカムを改善するために不可欠です.
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