人类自我中毒中的有机杀虫剂之间的差异:一项前性队列研究
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
概括
有机杀虫剂中毒因化合物而异. 狄米索酸和芬在人类中比pyrifos引起更高的死亡率和输管率,这与动物毒性数据相反.
科学领域:
- 毒理学 毒理学 毒理学
- 临床医学 临床医学
- 环境健康 环境健康
背景情况:
- 有机 (OP) 杀虫剂被广泛使用,但OP中毒通常被视为一种统一的情况.
- 现有的分类主要依赖于动物致死剂量数据,可能误解人类毒性.
- 在不同的化合物中,OP中毒的临床表现和严重程度可以显著不同.
研究的目的:
- 调查斯里兰卡三种常见的用于自我中毒的有机杀虫剂中临床特征和中毒严重程度的差异:pyrifos, dimethoate 和 fenthion.
- 为了比较这些OP化合物的人类毒性,挑战对动物毒性数据的依赖.
- 为不同的OP中毒事件制定具体的管理协议提供信息.
主要方法:
- 在三家医院对802名患者进行前性研究,证实了pyrifos,dimethoate或fenthion的自我中毒.
- 测量血液中胆酶活性和杀虫剂度,以确认病原体并评估患者的反应.
- 系统记录临床结果,包括死亡率和需要内内管道输入.
主要成果:
- 与pyrifos (8.0%) 相比,Dimethoate (23.1%) 和fenthion (16.2%) 的死亡率显著更高.
- 在二甲酸盐 (35.2%) 和芬 (31.3%) 中毒时,需要内管道输入的频率高于pyrifos (15.0%) 病例.
- 狄米索酸中毒导致了快速死亡,通常是由于休克,而芬中毒显示出延迟的呼吸道并发症. 对普拉利多西姆的反应有所不同,对二甲酸盐和芬的结果较差.
结论:
- 有机杀虫剂中毒不是一个单一的实体;临床过程,治疗反应和结果存在显著差异.
- 人类毒性概况与动物数据明显不同;在研究的化合物中,在老鼠中具有高度毒性的pyrifos在人类中毒性最小.
- 针对特定的有机杀虫剂量身定制的个性化管理协议对于改善患者的治疗结果至关重要.
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