丙氨酰谷氨酰胺对重度有机磷中毒患者胃肠及神经功能的影响
|
摘要
目的探讨丙氨酰谷氨酰胺对重度有机磷中毒(OP)患者胃肠及神经功能的影响。方法选取2016年6月至2018年6月收治的重度OP患者100例,依据随机数字表法分为丙谷组和常治组,每组50例。常治组给予常规治疗,丙谷组在此基础上给予丙氨酰谷氨酰胺治疗,比较2组胃肠功能[(二胺氧化酶(DAO)、D-乳酸(D-LA)、乳果糖/甘露醇(L/M)等黏膜功能指标和白蛋白(ALB)、前白蛋白(PALB)、总蛋白(TP)等营养指标]、神经功能[神经特异性烯醇化酶(NSE)、S100β蛋白(S100β)等神经损伤指标和感觉神经传导速度(SCV)、运动神经传导速度(MCV)等神经传导指标]和救治效果。结果 2组治疗后DAO、D-LA、L/M、NSE、S100β明显低于治疗前,丙谷组和常治组治疗后ALB、PALB、TP、SCV、MCV明显高于治疗前,丙谷组治疗后DAO、D-LA、L/M、NSE、S100β明显低于常治组,丙谷组治疗后ALB、PALB、TP、SCV、MCV明显高于常治组,差异有统计学意义(P<0.05);丙谷组中毒症状缓解、胆碱酯酶活性恢复、住院时间明显低于常治组,差异均有统计学意义(P<0.05),丙谷组死亡率虽低于常治组,但差异无统计学意义(P>0.05)。结论丙氨酰谷氨酰胺可有效促进重度OP患者胃肠及神经功能恢复,有利于提高患者的救治效果,值得临床推广。
Objective To explore the effects of alanine glutamine on the gastrointestinal and neurological function in patients with severe organophosphorus poisoning(OP).Methods One hundred patients with severe OP, who were treated in our hospital from June 2016 to June 2018, were randomly divided into alanine glutamine group(n=50) and routine treatment group(n=50) according to random number table. The patients in routine treatment group were given conventional treatment. And the patients in alanine glutamine group were treated by alanine glutamine on the basis of routine treatment. The gastrointestinal function[(DAO), D,Dlactic acid(DLA), lactulose/mannitol(L/M), ALB, PALB and TP], neurological function[neurospecific enolase(NSE),S100 beta protein(S100 beta) of the nerve injury fingers and sensory nerve conduction velocity(SCV),motor nerve conduction velocity(MCV) of the nerve conduction indicators and therapeutic effects were compared between the two groups.Results After treatment, the levels of DAO, DLA, L/M and NSE,S100 beta in both groups were significantly lower than those before treatment. And the levels of ALB, PALB, TP, SCV and MCV were significantly higher than those before treatment. Moreover, the levels of DAO, DLA, L/M and NSE and S100 beta in alanine glutamine group were significantly lower than those in routine treatment group, and the levels of ALB, PALB, TP, SCV and MCV were significantly higher than those in routine treatment group(P<0.05). Furthermore, the symptomatic relief of poisoning, the activity recovery of cholinesterase and hospital stay of the patients in alanine glutamine group were significantly lower than those in routine treatment group(P<0.05). In addition, the death rate of the patients in alanine glutamine group was lower than that in routine treatment group,but there was no significant difference between the two groups(P>0.05).Conclusion Alanine glutamine can effectively promote the recovery of gastrointestinal and neurological function in patients with severe OP and improve the curative effects, which is worth using widely in clinical practice.
Objective To explore the effects of alanine glutamine on the gastrointestinal and neurological function in patients with severe organophosphorus poisoning(OP).Methods One hundred patients with severe OP, who were treated in our hospital from June 2016 to June 2018, were randomly divided into alanine glutamine group(n=50) and routine treatment group(n=50) according to random number table. The patients in routine treatment group were given conventional treatment. And the patients in alanine glutamine group were treated by alanine glutamine on the basis of routine treatment. The gastrointestinal function[(DAO), D,Dlactic acid(DLA), lactulose/mannitol(L/M), ALB, PALB and TP], neurological function[neurospecific enolase(NSE),S100 beta protein(S100 beta) of the nerve injury fingers and sensory nerve conduction velocity(SCV),motor nerve conduction velocity(MCV) of the nerve conduction indicators and therapeutic effects were compared between the two groups.Results After treatment, the levels of DAO, DLA, L/M and NSE,S100 beta in both groups were significantly lower than those before treatment. And the levels of ALB, PALB, TP, SCV and MCV were significantly higher than those before treatment. Moreover, the levels of DAO, DLA, L/M and NSE and S100 beta in alanine glutamine group were significantly lower than those in routine treatment group, and the levels of ALB, PALB, TP, SCV and MCV were significantly higher than those in routine treatment group(P<0.05). Furthermore, the symptomatic relief of poisoning, the activity recovery of cholinesterase and hospital stay of the patients in alanine glutamine group were significantly lower than those in routine treatment group(P<0.05). In addition, the death rate of the patients in alanine glutamine group was lower than that in routine treatment group,but there was no significant difference between the two groups(P>0.05).Conclusion Alanine glutamine can effectively promote the recovery of gastrointestinal and neurological function in patients with severe OP and improve the curative effects, which is worth using widely in clinical practice.
引文
1 艾莉.急性有机磷农药中毒两组药物救治的效果观察.中国中西医结合急救杂志,2015,22:408-411.
2 Cntzat VF,Keane KN,Scheinpflug AL,et al.Alanyl-glutamine improves pancreatic 13-cell function following ex vivo inflammatory challenge.J Endocrinology,2015,224:261-271.
3 白海峰,李卫民,田亚军,等.丙氨酰谷氨酰胺对危重有机磷中毒患者免疫功能及神经功能的影响.药物评价研究,2018,41:287-290.
4 陆再英,钟南山主编.内科学.第7版.北京:人民卫生出版社,2008.928.
5 Iyer R,Iken B,Leon A.Developments in alternative treatments for organophosphate poisoning.Toxicol Lett,2015,233:200-206.
6 谢卓洋,荣广成,王立明.血液灌流对老年急性重度有机磷中毒患者脏器的保护作用.解放军预防医学杂志,2016,34:849-850.
7 杨胜,张冬惠,王绍谦,等.胃肠道毒物优化清除对重度急性有机磷农药中毒患者疗效的影响.中国中西医结合急救杂志,2016,23:164-167.
8 Eddleston M,Chowdhury FR.Pharmacological treatment of organophosp- horus insecticide poisoning:the old and the (possible)new.Brit J Clin Pharmacol,2015,81:462.
9 赵立东,刘阳.醒脑静注射液联合氯解磷定治疗有机磷中毒的疗效观察.现代药物与临床,2018,33:596-599.
10 E1-Ebiary AA,Elsharkawy RE,Soliman NA,et al.N-acetylcysteine in acute organophosphorus pesticides poisoning:A randomized,clinical trial.Basic Clin Pharmacol Toxicol,2016,119:222-227.
11 林建聪.丙氨酰谷氨酰胺治疗甲拌磷中毒致胃肠功能衰竭的疗效.西南国防医药,2017,27:1187-1189.
12 Mccormack WP,Hoffman JR,Pruna GJ,et al.Effects of L-alanyl-L-glutamine ingestion on one-hour runperformance.J Am Coil Nutr,2015,34:1-9.
13 常青,陈豆豆,孙虹.两种血液灌流方式治疗急性有机磷中毒的疗效比较及对心肌损伤、血清NSE和CHE水平的影响.广西医科大学学报,2017,34:883-886.
14 Bo L.Therapeutic efficacies of different hemoperfusion frequencies in patients with organophosphate poisoning.Eur Rev Med Pharmacol Sci,2014,18:3521-3523.
15 Wu X,Xie W,Cheng Y,et al.Severity and prognosis of acute organophosphorus pesticide poisoning are indicated by C-reactive protein and copeptin levels and APACItE Ⅱ score.Exp Ther Med,2016,11:806-810.
2 Cntzat VF,Keane KN,Scheinpflug AL,et al.Alanyl-glutamine improves pancreatic 13-cell function following ex vivo inflammatory challenge.J Endocrinology,2015,224:261-271.
3 白海峰,李卫民,田亚军,等.丙氨酰谷氨酰胺对危重有机磷中毒患者免疫功能及神经功能的影响.药物评价研究,2018,41:287-290.
4 陆再英,钟南山主编.内科学.第7版.北京:人民卫生出版社,2008.928.
5 Iyer R,Iken B,Leon A.Developments in alternative treatments for organophosphate poisoning.Toxicol Lett,2015,233:200-206.
6 谢卓洋,荣广成,王立明.血液灌流对老年急性重度有机磷中毒患者脏器的保护作用.解放军预防医学杂志,2016,34:849-850.
7 杨胜,张冬惠,王绍谦,等.胃肠道毒物优化清除对重度急性有机磷农药中毒患者疗效的影响.中国中西医结合急救杂志,2016,23:164-167.
8 Eddleston M,Chowdhury FR.Pharmacological treatment of organophosp- horus insecticide poisoning:the old and the (possible)new.Brit J Clin Pharmacol,2015,81:462.
9 赵立东,刘阳.醒脑静注射液联合氯解磷定治疗有机磷中毒的疗效观察.现代药物与临床,2018,33:596-599.
10 E1-Ebiary AA,Elsharkawy RE,Soliman NA,et al.N-acetylcysteine in acute organophosphorus pesticides poisoning:A randomized,clinical trial.Basic Clin Pharmacol Toxicol,2016,119:222-227.
11 林建聪.丙氨酰谷氨酰胺治疗甲拌磷中毒致胃肠功能衰竭的疗效.西南国防医药,2017,27:1187-1189.
12 Mccormack WP,Hoffman JR,Pruna GJ,et al.Effects of L-alanyl-L-glutamine ingestion on one-hour runperformance.J Am Coil Nutr,2015,34:1-9.
13 常青,陈豆豆,孙虹.两种血液灌流方式治疗急性有机磷中毒的疗效比较及对心肌损伤、血清NSE和CHE水平的影响.广西医科大学学报,2017,34:883-886.
14 Bo L.Therapeutic efficacies of different hemoperfusion frequencies in patients with organophosphate poisoning.Eur Rev Med Pharmacol Sci,2014,18:3521-3523.
15 Wu X,Xie W,Cheng Y,et al.Severity and prognosis of acute organophosphorus pesticide poisoning are indicated by C-reactive protein and copeptin levels and APACItE Ⅱ score.Exp Ther Med,2016,11:806-810.