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The Diagnostic Value of Butyrylcholinesterase in Acute Organophosphorus Pesticide Poisoning

Author: XuChou
Tutor: HeYueZhong
School: PLA Military Academy of Medical Sciences
Course: Internal Medicine
Keywords: Organophosphorus pesticide poisoning Acetylcholinesterase Butyrylcholinesterase Diagnostic value
CLC: R595.4
Type: Master's thesis
Year: 2010
Downloads: 71
Quote: 1
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Abstract


Organophosphorus pesticides (OP) poisoning is a clinical and social problems of the world are concerned about. The WHO statistics Every year, millions of OP poisoning cases occur in developing countries such as China, India. Acute organophosphorus pesticide poisoning (acute organophosphorus pesticide poisoning, AOPP) diagnostics rely mainly on the analysis of the patient's history of exposure to typical symptoms of poisoning, signs and biochemical and poison detection. Primary hospitals often do not have the testing equipment and other reasons, not the poison detection as a routine examination indicators. As organophosphate poisons the target enzyme, acetyl cholinesterase (acetylcholinesterase, AChE) activity in the clinical diagnosis and grading of diagnostic criteria. However, since AChE mainly exists at the neuromuscular junction, the the erythrocytes film location, inactivated quickly, cumbersome specimen processing, therefore not easy to actual clinical application. Butyrylcholinesterase (butyrylcholinesterase, BuChE) not OP role of target enzyme, but its mainly present in the plasma (serum) and stable nature, specimens easy to extract, the reproducible detection process is simple, it is often as a diagnosis. However, a large number of clinical work: and BuChE is used as a diagnostic indicator, mechanical apply theoretical AChE standard unreasonable literature has been controversial for its diagnostic value different conclusion. BuChE activity to diagnose and judgment AOPP condition is accurate and reliable urgent emergency department doctors. In our previous related animals OP exposure and human blood in vitro OP exposure experiments. This study on the basis of the work already in our hospital emergency department revenue the AOPP oral patients as research subjects, designed to correct evaluation of BuChE activity on the AOPP the diagnosis and classification diagnostic value. First of all, the determination of the activity of AChE and BuChE range of normal human blood. Then sync comparative analysis of AOPP were BuChE activity in vivo with the current \To further validate the the BuChE clinical value, we further review of 113 cases of AOPP patient records, BuChE activity and its relationship with other key indicators of clinical analysis. Currently, many methods for determination of cholinesterase (ChE) activity and no unified standard, huge numerical gap between the results of various detection methods. ChE especially AChE activity is detected, the required sample handling more complex, and inactivation faster, a lot of problems and challenges brought to the the clinical actual test operation; same time, in the sample collection process, the determination of the clinical factors affect ChE than If the patient during treatment often intake of a variety of pharmaceutical ingredients, these adverse effects to the detection system. After reviewing the literature, we combine on the basis of clinical practice and in line with medical ethics, based the modified Ellman colorimetric establish and optimize the complete set of blood collection for clinical practice operation, to detect the flow of ChE activity. AChE and BuChE activity relationship studies, the ideal AOPP were ChE vitality of its poisoning of the former ChE activity should be done self-control, to calculate the activity, but this is difficult to achieve in the actual study. Therefore, we selected blood samples of healthy young male volunteers to establish the range of normal human whole blood AChE and plasma BuChE vitality which BuChE 15807 ± 3495U / L, 105 ± 33U/Hb in AChE. From April 2009 to September, 21 cases of hospitalized patients with AOPP oral study, including 8 males and 13 females, age (35.6 ± 14.5) years old. Types of pesticides poisoning include: dichlorvos 13 cases, one cases of parathion, omethoate two cases, four cases of phorate, phoxim. Simultaneous monitoring of these patients with newly diagnosed poisoning period AChE and BuChE activity results, analysis of the activity of AChE and BuChE relationship. The results showed that: caused by AOPP patients in vivo activity of AChE and BuChE are subject to the degree of inhibition of the OP, but the two can not be showed a significant linear regression relationship, we analyze the main reasons for individual differences and AChE and BuChE different kinds OP sensitivity. In most cases, BuChE by the degree of inhibition is higher than by the degree of inhibition of the AChE. Statistics found BuChE activity of less than 10%, corresponding to substantially less than 30% of AChE activity; and BuChE activity less than 20% corresponds to the AChE activity is less than 50%. According to the existing classification of AChE in the diagnostic criteria (30% and 50% severe), we recommend: BuChE as standard, can be considered in severe AOPP were designated as BuChE activity in 20% of the normal value and 10 %. 2, in the recovery of the disease process, although the value of the activity of AChE and BuChE differences, but both trends is basically consistent rebound in BuChE activity is often associated with the recovery of AChE activity. Therefore, we believe that BuChE and AChE can be used as indicators to track disease trends, the clinical dynamic monitoring BuChE activity trends prognosis is positive. 3, in the observation phorate dichlorvos poisoning patients found that there is a difference on the different types of OP in the inhibition of AChE and BuChE both specificity. Phorate and other highly toxic pesticides subject to national restrictions on the use or disabled, increasingly rare in the clinical poisoning BuChE as observed indicators for its poisoning patients need to be given special attention, its diagnostic criteria should be more stringent. 4, in the ideal treatment of patients with dichlorvos poisoning recovery process, BuChE activity was linear rebound daily recovery rate of approximately 2.54%. To further validate the clinical value of of BuChE this effect biomarkers, we observed BuChE activity and its relationship with other clinical indicators. Of January 2008 to April 2009, 113 cases admitted AOPP patients were analyzed retrospectively. We found that: 1 inhibition of BuChE activity in patients with OP exposure Shi Miqie Related collected on the history of the case of difficult patients and suspected cases, can provide important clues to the diagnosis, and provide a reference for targeted poison detection. Clinical cases show obvious correlation between the plasma concentration of BuChE activity and AOPP patients body OP pesticides. BuChE activity is still in the downward phase or persistent depression, indicating that the plasma concentration of the patient's body OP pesticides to maintain a high level; the BuChE activity appear picked up only when the the OP plasma concentration drops to a certain range, Therefore, the BuChE activity monitoring can prompt vivo metabolism pesticides. The judgment of the patient's condition, the the BuChE activity trend than the single test results more meaningful. For example, when the BuChE activity bottoming out, although the value of activity is still low, but this trend indicates that the condition has gradually improved, and prompt the patients need to be given a strict observation of the disease, and the timely adjustment of the dose of anticholinergics, or easy atropine poisoning occurred. Therefore, we think that can be based on the activity of BuChE in newly diagnosed disease classification, while observing its dynamic activity curve trend in the course of treatment you need, and timely adjustment of treatment. Better prognosis AOPP patients in the recovery process, BuChE activity linear recovery, daily recovery rate to or greater than 2.5%. 5, we found that medication, often prompted large amount the BuChE activity continued to be less than 5% (mostly highly toxic class), high blood concentration, such AOPP many patients with respiratory failure, the treatment of difficult, long hospital stay, requires a lot of The antitoxic drug to maintain, more complications, higher fatality rate case, and therefore need to be given adequate attention in clinical. In summary, this study is preliminary demonstration of the feasibility of BuChE activity as the AOPP the diagnosis and classification of diagnostic criteria, and to explore its value for the patient's condition and prognosis. The conclusions of this study: BuChE activity as the clinical the AOPP the diagnosis and classification diagnostic criteria, but its standard value is lower than the activity of AChE standards. Which severe poisoning grading standards designated as 20% of the normal BuChE activity, 10%, and the need to combine the comprehensive consideration of the types of pesticides. Condition and prognosis, the dynamic trend of BuChE activity is more instructive than the single detection. BuChE activity is bottoming out, the need to closely observe the patient's condition and timely adjustment of the dose of anticholinergics, to prevent the occurrence of atropine poisoning the BuChE activity day rebound in the range of 2.5% indicates a better prognosis. For the BuChE activity detection results persistent less than 5%, suggesting that patients with high blood concentration, treatment difficulties, complications, mortality higher characteristics, the need to give priority attention.

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CLC: > Medicine, health > Internal Medicine > Systemic disease > Poisoning and chemical damage > Poisoning
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