Paraquat 독성에 미치는 Dicumarol과 Allopurinol의 병합 투여 효과

송명화,정미숙,오순식,박재윤,차종희 조선대학교 1995 The Medical Journal of Chosun University Vol.20 No.1

Despite intensive investigation into paraquat toxicity, neither the final cytotoxic mechanism nor a clinically useful antidote has been discovered. The mechanism of paraquat cytotoxicity is also debatable, but it is generally accepted that a redox reaction occurs between reduced paraquat and molecular oxygen. The intracellular reduction of paraquat occurs by various enzymes, such as DT-diaphorase, xanthine oxidase and glutathione reductase. In present study, we investigated that the effects of allopurinol, a xanthine oxidase inhibitor, and dicumarol, a DT-diaphorase inhibitor, in paraquat-intoxicated rats. The survivals of paraquat-intoxicated rats were increased by allopurinol treatment compared to paraquat-treated control rats , but not effected by dicumarol treatment. The activity of xanthine oxidase in the liver of allopurinol-treated rats was decreased and DT-diaphorase activity in liver of dicumarol treated rats was also decreased compared to normal control rats. The contents of glutathione in liver of paraquat treated rats was decreased but in paraquat+allopurinol treated rats, the decrements of glutathione contents was reduced but in paraquat+dicumarol treated rats, liver glutathione level was not changed compared to paraquat-treated rats. These results suggest that paraquat toxicity maybe reduced by administration of allopurinol but dicumarol did not have such effects .

Paraquat ( Gramoxone (R) ) 중독환자의 임상적 고찰

이재석(Jae Seok Lee),정미경(Mi Kyung Jeong),김태준(Tae Jun Kim),김종봉(Jong Bong Kim),백진기(Jin Ki Paek),최태명(Tai Myoung Choi),양동호(Dong Ho Yang),홍세용(Sae Yong Hong) 대한내과학회 1994 대한내과학회지 Vol.47 No.1

Background: Paraquat, which has been widely used as a herbicide in Korea, is notorious as a potent human poison. Ingestion of the liquid formulation containing 24.5% paraquat (Gramoxone) is associated with serious outcomes. In spite of the decreasing trend of agriculatural populations in Korea, the incidence of paraquat poinsoning is increasing with high mortality. So we reviewed the cases of paraquat poisoning retrospectively. Method: We analysed retrospectively the clinical and laboratory findings of 143 patinets poisoned with paraquat, who were admitted to the departement of Internal Medicine, Soonchunhyang Chun An Hospital from January 1988 to December 1992. Results: 1) Among 143 cases of paraquat poisoning, S4 cases were male and the others were female. The peak incidence was the forth decade (25.9%), and the main aim of ingestion was for suicide. 2) The major clinical symptoms and signs were sore throat (94%), ulceration in oral cavity (92%), and swallowing difficulty (92%). which were developed in most of the cases of ingestion of paraquat. Also half of the cases of paraquat poisoning complained of epigastric pain (57%), dyspnea (52%), and jaundice (34%), 3) On admission, out of 143 paraquat poinsonings 20 cases (14.1%) were featured with anemia, hepatic dysfunction (42%), and acute renal failure (57.3%). 4) The annual incidence of paraquat poisoning was 18.9% (27 cases) in 1988, 20.3% (29 cases) in 1989, 21.7% (31 cases) in 1990, 19.6% (28 cases) in 1991, and 19.6% (28 cases) in 1992. However, there was statistically no significant difference in annual incidence. 5) On the amount nf paraquat ingestion, the cases who ingested but not swallowed the poison was 22 patients (15.2%), who swallowed less than a mouthful of the poison (< 20 cc) are 8 patients (5.6%), who swallowed more than a mouthful of the poison are 69 patients (48. 3%), and who ingested but not estimated the dosage are 36 patients (25.2%). Gastric lavage was done in 128 cases out of the 143 patients (89.5%). Also hemodialysis, ingestion of charcoal and caster oil were tried. However, 70 cases were expired or discharged hopelessly. 6) The survival rate was 16% except for the eight cases of poisoning caused by inhalation of paraquat at work. The main cause of death was respiratory failure. Conclusion: There was statistically no difference in yearly mortality rate caused by acute paraquat poisoning during the recent 5 years. Furthermore, the incidence of paraquat poisoning i. supposed to be not decreased. It is necessary to perform, further clinical study and preventive measures in paraquat poisoning including systemic measurement of blood level of paraquat.

그라목손 (Paraquat) 중독환자에서 혈액여과투석 (Hemodiafilteration) 방법을 중심으로 한 체외 배설치료의 효율성에 관한 연구

윤성철 ( Sung Chul Yoon ),탁우택 ( Woo Taek Tak ),박영아 ( Young A Park ),이종안 ( Jong An Lee ),김종완 ( Jong Wan Kim ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6

목 적 : 파라콰트 중독의 여러 가지 체외치료방식의 효율성을 비교하고 이러한 효율성 비교를 기초로 혈액여과투석의 효율성을 검증하고자 하였다. 방 법 : 준비실험으로 혈장에 파라콰트를 혼합하여 30㎎/mL의 농도로 만든 후 혈액투석(HD), 혈액관류 (HP), 혈액여과 (HF), 혈액여과투석 (HDF), 혈액여과투석관류 (HDFP)를 시행하여 추출을 (estraction ratio), 시간별 혈장내 파라콰트 농도감소 양상 등을 관찰하여 각각의 효율성을 분석하였다. 동물실험은 파라콰트 중독을 시킨 요오크셔 돼지를 대상으로 혈액관류 및 혈액여과투석을 시행하여 추출을, 시간별 혈중 농도의 변화, 주요 장기 파라?트 잔류량 측정 및 병리적 검색을 시행하여 두 체외배설 방식의 효율성을 비교하였다. 결 과 : 파라콰트 농도측정은 분광광도법 (spectrophotometer)과 HPLC로 각각 측정하여 비교한 결과는 혈중인 경우 spectrophotometer=0.9539×(HPLC)+0.0527이었고, 요중 파라콰트의 농도는 spectrophotometer=0.9777×(HPLC)+0.5254로써 분광광도법 측정치나 HPLC에 의한 측정치간에 유의한 차이가 없었다. 각각의 체외배설방법에 의한 혈장내 파라콰트의 제거 휴율성에 관한 관찰에서 파라콰트의 추출을 (E.R.)의 평균값은 HP 0.84, HD 0.81, HDFP는 0.74, HF 0.5, FDF 0.53이었다. 시간별 혈장내 파라콰트 농도의 변화에서 HDFP를 시행한 경우 첫 한시간 동안 혈중 농도의 감소폭이 가장 켰으며 다음은 HP, HD, HDF, HF의 순서였다. HDF는 투석액의 흐름속도를 800mL/hr, 1,600mL/hr로 달리 시행하면서 추출율을 비교하였는데 통계적 유의한 차이는 관찰되지 않았으나 (ㅔ=0.24) 투석액의 흐름속도를 크게 함으로써 시간별 혈장내 파라콰트의 농도가 더 크게 감소되어 관찰되었다. 동물실험에서 HP의 평균 추출율은 0.61이었고 HDF의 평균 추출율은 0.36이었다. 시간별 혈중 파라콰트 농도의 변화는 대조동물에 비해 혈액관류와 혈액여과투석을 시행한 경우 시간경과에 따라 지속적인 농도감소가 관찰되었다. 파라콰트 중독 후 7시간 후 주요 장기의 잔류 파라콰트 농도는 혈관구조인 신장과 심장에서 크게 측정되었으며, HP와 HDF를 시행한 경우 대조동물에 비해서 신장, 폐장, 근육에서 낮은 농도로 측정되었다. 특히 폐장의 경우, HP와 HDF를 시행한 경우 대조동물에 비해서 시장, 폐장, 근육에서 낮은 농도로 측정되었다. 특히 폐장의 경우, HP를 시행한 경우 상대적으로 대조동물보다 파라콰트 잔류 농도가 더 낮았고 병리적 변화의 정도도 적었다. 결 론 : 혈액여과투석은 혈액관류보다는 효율성이 떨어지나 지속적으로 시행할 수 있고 혈중 파라콰트 농도를 지속적으로 낮게 유지하는데는 효율적인 체외배설 치료방식이다. Purpose : We tried to estimate the clinical efficacy of hemodiafiltration in the paraquat poisoning as compared with that of other various extracorporeal extraction treatment. Methods ; We prepared the fresh frozen plasma mixed with paraquat concentrated up to 30 ㎎/L. The experiment was designed to remove paraquat by use of various extracorporeal treatment, such as hemodialysis (HD), hemoperfusion (HP), hemofiltration (HF), hemodia- filtration (HDF), hemodiafiltration & hernoperfusion (HDFP), respectively. The efficacy was analyze on the basis of counting extraction ratio, observing the decreasing concentration of paraquat with the lapse of time. Four pigs (Yorkshire) were prepared and poisoned by paraquat (40 ㎎/㎏) intramuscularly. Two poisoned animals were assigned for hemoperfusion and hemodiafiltration respectively and other two were assigned for the control. We observed extraction ratio, decreasing concentration of paraquat in blood, remained amount of paraquat in major organs, in addition to pathologic change of major organs after sacrifying the animals Results : The mean of extraction ratio is 0.84 0.27 in case of HP, 0,81 10.21 in HD, 0.74 0.40 in HDFP, 0.53 0.24 in HDF, 0.5 0.14 in HF, The extraction ratio of HP & HD & HDFP was significantly higher than that of HDF & HF (p<0.01). The extraction ratio was counted as the difference between the paraquat concentration of inlet and outlet was divided by the concentration of inlet. The slope of paraquat concentration undergoing extracorporeal treatment was the most acutely decreased in the case of HDFP, the less decreased in HP, and sequentially in HD, HDF and HF(the least) in the order of the decrease. The more decreased paraquat concentration in palsma was observed, the higher flow rate of HDF was conducted. The mean of extraction ratio in animal study was 0.61 in HP and 0.36 in HDF. The blood concentration of paraquat was observed to be much lower in case of HP & HDF, as compared with the control animals. The remained concentration of paraquat in major organs, 7 hours later after being poisoned, was observed to be higher in the vascular structure like kidney and heart. However, it was observed to be lower in kidney, lung & muscle, when either of HDF and HP was conducted, than control. Especially, it was much lower in HP and much less pathologic change in HP. HDF is the less effective measure than HP, but is effective as a continuous treatment to make paraquat concentration to be lower as much as it possible. Conclusion: The HDF is the effective measure to keep the blood paraquat level low, even though it is behind the HP in effectiveness.

Paraquat로 처치한 백서에서 Melatonin과 수용성 비타민 E복합 투여가 지질과산화와 생존율에 미치는 영향

김진하 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Objectives : Paraquat, an oxygen radical-generating agent, is a highly toxic compund for humans ans animals. This study was examined the effect of combined treatment of melatonin and Trolox^(®)(water-soluble analogue of α-tocopherol) in lipid peroxidation and mortality after paraquat intoxication in rats. Methods : Paraquat(20mg/kg) was injected i.p. into Spraque-Dawely rats. After the administration of paraquat, rats were treated with melatonin(10mg/kg), Trolox^(®)(100mg/kg), combined melatonin and Trolox^(®). All rats were killed by decapitation 24hours after paraquat administration and then examined the concentration of malonaldehye and 4-hydroxyalkenal (MDA + 4-HAE) as indices of lipid peroxidation in rat lung and liver. In a survival study, continous i.p. infusion of melatonin (50mg/kg/day) for 14 days using Alzet^(®) Osmotic pump (2ML2) and Trolox^(®)(100mg/kg/day) was injected i.p. after paraquat (20mg/kg) poisoning into rats for 14days. Results : Paraquat alone increased MDA + 4-HAE levels in lung, with this increase being reduced by melatonin and Trolox^(®), and also combined treatment with melatonin and Trolox^(®) completely reversed this effect. Paraquat at 20mg/kg did not induced any significant change in liver lipid peroxidation. In a result of survival analysis, percent survival was 100 % (8/8, control), 0 % (0/8, paraquat only), 62.5 % (5/8, paraquat + melatonin), 37.5 % (3/8, paraquat + Trolox^(®)), 75.0 % (6/8, paraquat + melatonin + Trolox^(®)) at 14 days after paraquat intoxication. Conclusions : These results indicate that melatonin and Trolox^(®) protect lipid peroxidation and increase survival time in paraquat intoxicated rats. Combined treatment with melatonin and Trolox^(®) seems to have more survival benefit than single agent treatment in paraquat intoxication.

Paraquat 중독환자의 초기검사로서 sodium dithionite를 이용한 소변내 paraquat검출의 임상적 의의

윤갑준,임경수,이진웅,김영식,이부수,박덕우,김선만,이강현,황성오,안무업 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Background : Mortality from paraquat intoxication depends upon plasma paraquat concentration. To know the severity of paraquat intoxication is important for directing therapeutic modality and predicting prognosis. Sodium dithionite test for urinary paraquat provides an easy and simple method to determine the severity of paraquat intoxication in emergency department. purpose : To determine whether the result urinary paraquat test by sodium dithionite can predict outcome in patients with paraquat intoxication in emergency department. Subjects : 48 patients(male 31, female 17, mean age 37 years) who had exposure to paraquat and presented within 24 hours after exposure. Result : Thirty five patients were positive in paraquat urine test and thirteen patients were negative. Clinical manifestations were more severe in positive patients than in negatives. Complication was much more in positives than in negatives. 28 of 35 patients(80%) in positives and 2 of 13 patients(15%) in negatives died. Conclusion : Positive test for urinary paraquat is associated with high mortality and morbidity from paraquat intoxication, and qualitative test for urinary paraquat by sodium dithionite is an useful method to determine the severity of paraquat intoxication in emergency department.

Dimethyl Sulfoxide가 급성 Paraquat 중독시 폐에 미치는 영향

이종기,신현호,곽정식,손태중 慶北大學校 醫科大學 1995 慶北醫大誌 Vol.36 No.1

목적 : Paraquat 중독으로 폐실질의 손상이 일어날 때 demethyl sulfoxide (DMSO)를 투여하여 hydroxyl기를 제거한 효과를 초미형태학적으로 규명하고자 하였다. 재료 및 방법 : Sprague-Dawley계 흰쥐 수컷에 paraquat 20㎎/㎏ 1회 복강내에 투여한 후 1, 2, 6 및 12일에 그리고 paraquat 20㎎/㎏ 1회 복강내에 투여한 후 DMSO 1.5㎎/㎏를 매일 1회씩 복강내 투여하면서 1, 2, 6 및 12일에 각각 3마리씩 폐를 적출하여 광학 및 전자현미경으로 관찰하였다. 결과 및 결론 : 광학현미경적으로는 Paraquat 투여후 1일 및 2일에서는 간질조직 및 폐포의 부중이 광범위하게 일어났으며 호중구, 림프구 및 대식세포가 침윤되었다. 6일 이후에는 부종의 범위가 감소되었으며 염증세포의 침윤은 지속되었다. 6일 이후에는 부종의 범위가 감소되었으며 염증세포의 침윤은 지속되었다. Paraquat 투여후 DMSO를 투여한 군에서는 1일 및 2일에 간질조직과 폐포의 부종이 일어났으나 그 범위는 paraquat 단독투여군보다 현저히 경감되었다. 6일이후에는 부종이 점차 회복되었다. 전자현미경적으로는 paraquat 투여군에서는 Ⅰ형 및 Ⅱ형 폐포세포, 폐포모세혈관 내피세포의 퇴행성 변화 및 괴사가 광범위하게 일어났으며 6일 이후는 그 범위가 감소되었다. Paraquat 투여후 DMSO를 투여한 군에서는 1일 및 2일에서 paraquat 단독 투여한 군보다 Ⅰ형 및 Ⅱ형 폐포세포와 내피세포의 퇴행성 변화의 정도가 범위가 경하였으며 6일 이후에는 이들 세포의 상해가 빨리 회복되었다. 이상의 성적으로 보아 paraquat 중독시 DMSO의 투여는 hydroxyl기를 제거해줌으로서 Paraquat에 의한 폐상해를 경감시키고 또한 신속한 회복을 유도한다. This study was carried out to investigate the effects of dimethyl sulfoxide (DMSO) on the lung injuries caused by paraquat. Twenty seven Sprague-Dawley rats were divided three groups I three rats of saline injected control group, twelve of paraquat injected one, and twelve of paraquat and DMSO injected one. Paraquat, 20㎎/㎏, was administered intraperitoneally. DMSO, 1.5㎖/㎏. was intraperitoneally administered everyday after paraquat injection of one time. The rats of both groups were scarificed 1, 2, 6 and 12 days after paraquat injection. The lungs were examined by light microscope and electron microscope. Light microscopically, diffuse pulmonary edema with inflammatory infiltration occurred on 1 and 2 days after paraquat injection, These findings were decreased with time. After treatment with DMSO after paraquat injection, pulmonary edema was decreased in severity compared to paraquat injected group. The lesions were recovered rapidly. Electron microscopically, retrograde changes and necrosis of pneumocytes and swelling of endothelium were present in wide areas after 1 and 2 days after paraquat injection. These were recovered focally with time. After treatment with DMSO after paraquat injection, These cellular changes were decreased in degree compared to paraquat injected group. On time the lesions were rapidly recovered. According to the above results, it would be concluded that the DMSO reduced pulmonary injuries induced by paraquat due to scavenger effects on hydroxyl free radicals of DMSO.

Paraquat 투여 생쥐의 각 장기내 paraquat 농도 및 효소활성의 변화

박재윤,김근형 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

In this experiment, the level of paraquat and activities of acetycholinesterase, superoxide dismutase (SOD) and catalase were investigated in various organs of paraquat-treated mice. Paraquat level in various organs were markedly elevated after paraquat treatment, and the peak is reached within 2-4 hrs followed by a gradual decline to near normal levels by 24hrs. In lung, elevation of paraquat level is more predominant and persist for a prolonged period of time. But the paraquat was not detected in braine of paraquat treated mice. The activity of acetylcholinesterase in liver, lung and kidney of mice was significantly decreased by paraquat but unchaged in brain. The activities of SOD and catalase were significantly decreased in liver and lung of mice by paraquat administration. These result suggested that paraquat-induced organ toxicity were correlated with the level of paraquat in each organs, and paraquat would not be transfer the blood-brain barrier.

Paraquat로 처치한 백서에서 Melatonin과 수용성 비타민 E복합 투여가 지질과산화와 생존율에 미치는 영향

김진하 고신대학교(의대) 고신대학교 의과대학 학술지 2006 고신대학교 의과대학 학술지 Vol.21 No.1

Objectives : Paraquat, an oxygen radical-generating agent,is a highly toxic compound for humans and animals. This study was examined the effect of combined treatment of melatonin and Trolox (water-soluble analogue of a ^tocopherol) in lipid peroxidation and mortality after paraquat intoxication in rats. Methods : Paraquat(20mg/kg) was injected i,p. into Spraque-Dawely rats. After the administration of paraquat, rats were treated with mclatonin( 1 Omg/kg) s TroloxK( lOOmg/kg), combined melatonin and Trolox' AH rats were killed by decapitation 24hours after paraquat administration and then examined the concentration of malonaldehye and 4-hydroxyalkenaI (MDA + 4*HAE) as indices of lipid peroxidation in rat lung and liver In a survival study, continous i.p, infusion of melatonin (50mg/kg/day) for 14 days using Alzet Osmotic pump (2ML2) and Trolox (! OOmg/kg/day) was injected after paraquat (20mg/kg) poisoning into rats for 1 days. Results : Paraquat alone increased MDA + 4-HAE levels in lung, with this increase being reduced by melatonin and Trolox \ and also combined treatment with melatonin and Trolox、' completely reversed this effect. Paraquat at 20mg/kg did not induced any significant change in liver lipid peroxidation. In a result of survival analysis,percent survival was 100 % (8/8,control), 0 % (0/8, paraquat only), 62.5 % (5/8, paraquat + melatonin),37.5 % (3/8, paraquat + Trolox^),75.0 % (6/8,paraquat + melatonin + Troloxx) at 14 days after paraquat intoxication. Conclusions : These results indicate that melatonin and Trolox protect lipid peroxidation and increase survival time in paraquat intoxicated rats. Combined treatment with melatonin and Trolox seems to have more survival benefit than single agent treatment in paraquat intoxication.

Paraquat 중독 환자에서 전폐 방사선치료의 효과

이창걸(Chang Geol Lee),김귀언(Gwi Eon Kim),서창옥(Chang Ok Suh) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.4

목적 : 제초제로 사용되는 Paraquat(Gramoxone??)는 10cc미만의 소량복용으로 사망이 가능하여 자살목적 혹은 사고로 복용한 후 응급실로 내원하게 되는데 적극적인 치료방법으로 신장 및 간장에 대한 독성은 가역적으로 회복이 가능하나 폐에 대한 독성은 가장 치명적으로 초기에 폐부종, 폐출혈등의 성인형호흡곤란증후군의 양상을 보이며 더욱 진행하면 폐섬유화를 초래하여 궁극적으로 사망하게 된다. 1984년 Webb등이 폐부종이 진행되는 paraquat중독환자에서 전폐방사선치료를 시행, 폐섬유화로의 진행을 억제하여 생존시킨 예를 보고한 이래 전폐 방사선치료가 paraquat에 의한 폐독성을 방지할 수 있는 가에 대한 연구가 시도되었다. 저자들은 연세의대 치료방사선과에서 paraquat중독으로 전폐방사선치료를 시행받은 환자들을 후향적으로 분석하여 폐섬유화 예방에 대한 효과 및 궁극적으로 생존율 향상에 기여하였는지 보고자 하였다. 방법 : 1987년 6월부터 1993년 8월까지 paraquat중독으로 연세의료원에 내원하여 치료하였던 30명의 환자들을 대상으로 분석하였다. 이 중 14예에서 전폐방사선치료를 시행받았다. 환자들의 특성을 보면 남녀비가 12:18 이었고 3-76세의 연령에서 20-30세사이가 가장 많았고, 자살목적이 22예, 우발적인 사고로 복용한 예가 8예였다. 환자 및 보호자의 진술에 따라, 복용한 양을 소량(<5cc), 한모금(5-50cc) 그리고 과량(>50cc)군으로 세 군으로 나누어 분석하였다. 방사선치료는 응급실에 도착하여 적극적인 치료와 함께 24시간 이 내 시작하였고 방사선량은 10Gy/5ft/1주으로, 전폐를 범위로 폐밀도 보상 없이 전후 2문 대향조사하였다. 3예에서 방사선치료도중 중단하였는데 치료거절(2Gy) 및 사망(2Gy, 6Gy)이 원인이었다. 결과 : 소량복용군에서는 방사선치료와 상관없이 7예 전원이 생존하였고 대조군에서 2예의 경미한 폐부종이 나타났으나 방사선치료군에서는 나타나지 않았다. 한모금 복용군의 경우 15예 전예에서 폐독성이 나타났는데, 대조군에서는 7예중 1예(14%0에서만 회복된 반면 방사선치료군에서는 8예중 4예(50%)에서 폐독성에서 회복되었다. 한모금 복용군에서 음독후 4일이내에 방사선치료를 받은 경우 5예중 4예(80%)에서 폐독성이 회복된 반면 5일 이후에 치료한 3예에서는 전원(100%)이 호흡부전으로 사명하여 차이를 보였다. 4일이내 방사선치료군에서 2Gy 조사 후 치료를 거절한 1예를 제외하면 4예 전원(100%)에서 폐섬유화를 예방할 수 있었다. 과량복용군에서는 방사선치료와 상관없이 8예 전원이 다기관 손상과 함께 호흡부전으로 사명하였는데 방사선치료는 3예 모두 음독2일 이내에 시행되었지만 모두 폐섬유화로 진행되어 사망하였다. 결과 : Paraquat중독으로 궁극적인 사망의 원인이되는 폐섬유화를 방지하기 위한 방법으로 전폐방사선치료는 비록 복용량이 정확하지는 않으나 약 한모금(5-50cc)정도 복용한 경우 paraquat배설을 위한 적극적인 치료와 함께 조기에(적어도 4일 이내에) 시행될 경우 폐섬유화로의 이행을 방지하여 궁극적으로 생존이 가능함을 알 수 있었고, 소량복용의 경우와 과량을 복용한 경우 전폐방사선치료는 필요가 없을 것으로 생각되었다. 향후 음독후 정확한 혈중 paraquat농도를 측정하여 대조군과 비교하여 전폐방사선효과를 규명하는 임상실험이 필요하리라 사료된다. Purpose : To evaluate whether the early pulmonary irradiation can prevent or decrease the pulmonary damage and contribute to improve ultimate survival in paraquat lung. Materials and Methods : From Jun. 1987 to Aug. 1993. thirty patients with paraquat poisoning were evaluated. Fourteen of these patients were received pulmonary irradiation(RT). All of the patients were managed with aggressive supportive treatment such as gastric lavage, forced diuresis, antioxidant agents and antifibrosis agents. Ingested amounts of paraquat were estimated into three groups(A: minimal <about 5cc. B: mouthful 5-50cc. c: large>50cc). Pulmonary irradiation was strated within 24 hours after admission(from day 1 to day 11 after ingestion of paraquat). Both whole lungs were irradiated with AP/PA parallel opposing fields using Co-60 teletherapy machine. A total of 10Gy(2Gy/fr. x 5days) was delivered without correction of lung density. Results : In group A, all patients were alive regardless of pulmonary irradiation and in group C, all of the patients were died due to multi-organ failure, especially pulmonary fibrosis regardless of pulmonary irradiation. However, in group, six of 7 patients(86%) with no RT were died due to respiratory failure, but 4 fo 8 patients with RT were alive and 4 of 5 patients who were received pulmonary irradiation within 4 days after ingestion of paraquat were all alive though radiological pulmonary change. One patient who refused RT after 2Gy died due to pulmonary fibrosis. All 3 patients who were received pulmonary irradiation after 4 days after ingestion were died due to pulmonary fibrosis in spite of recovery from renal and hepatic toxicity Conclusion : It is difficult to find out the effect of pulmonary irradiation on the course of the paraquat lung because the precise plasma and urine paraquat concentration were not available between control and irradiation groups. But early pulmonary irradiation within 4 days after paraquat poisoning with aggresive supportive treatment appears to decrease pulmonary toxicity and contribute survival in patients with mouthful ingestion of paraquat who are destined to have reversible renal and hepatic damage but irreversible pulmonary toxicity.

파라캇 중독 환자에서 파라캇 혈중농도와 조기 예후 예측인자

최원석 ( Won Suk Choi ),김자현 ( Ja Hyun Kim ),이현아 ( Hyun A Lee ),전경홍 ( Kyung Hong Jun ),강명수 ( Myung Soo Kang ),김향 ( Hyang Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5

목적: 파라캇은 전 세계적으로 널리 사용되는 맹독성 제초제로 이에 중독될 경우 급성 신부전 급성 폐부전 및 폐 섬유화를야기 시키는 치명적인 약물이다. 본 연구는 급성 파라캇 중독 환자에서 내원 초기 응급실에서 측정 가능한 검사항목들과 파라캇 혈중 농도와의 상관관계를 알아보고 이를 통해 초기 검사항목이 예후예측에 이용될 수 있는 가능성을 보고자 하였다. 방법: 파라캇 노출 후 24시간 이내 응급실에 내원한 환자 83명을 대상으로 내원 당시 소변 dithionite검사와 혈중 파라캇 농도를 확인하였으며 초기 검사지표로 백혈구 수 및 소변pH와 혈중 AST, ALT, BUN, Creatinine, Glucose, Amy-lase, Ph, PaO2, PaCO2, HCO3, Base excess, Na, K, Cl등을 분석하였다. 생존군과 사망군으로 나누어 소변 dithionite 검사와 혈중 파라캇 농도 SIPP를 비교하였으며, 혈중 파라캇 농도에 따라 4그룹으로 분류하여 각 그룹간 초기 검사지표를 비교 분석하였다. 결과: 평균 파라캇 혈중농도는 생존군에서 1.32±1.72 μg/mL 사망군에서 사망군에서 88.44±81.56μg/mL로 사망군에서 유의하게 높았다. 파라캇 혈중 농도 증가에 따라 4군으로 분류하여 각 그룹의 초기 검사지표를 비교한 결과 WBC, glucose, Cr, pH, HCO3 BE항목에서 파라캇 혈중농도가 낮은 그룹과 높은 그룹사이에 통계적으로 유의한 차이를 보였고 나이와 음독 후 내원 시간에 대한 보정 후에도 WBC, HCO3 BE 항목에서 혈중농도 변화에 따른 증감관계를 보였다. 결론: 파라캇 혈중 농도와 SIPP는 사망군에서 유의하게 높았다. 초기 검사지표 중 파라캇 혈중농도 변화에 따른 유의한 증감관계를 보인 WBC, glucose, Cr, pH, HCO3 BE등은 생존가능성을 예측하는 조기 인자로 볼 수 있겠다. 특히 나이와 시간에 대한 보정 후에도 유의한 상관관계를 보인 WBC, HCO3, BE 항목은 혈중 농도를 대신해 예후 예측에 이용될 수 있을 것으로 생각된다. Purpose: Paraquat is a lethal herbicide and induces acute renal failure, hepatic dysfunction, and progressive respiratory failure. The aims of this study are to investigate the correlation between plasma paraquat concentrations and initial laboratory data at Emergency Medical Center and to investigate whether initial laboratory data is useful for predicting outcomes of paraquat-poisoned patients. Methods: A retrospective analysis by chart review was done on 83 patients who ingested paraquat and who had presented to Emergency center of within 24 hours. Plasma paraquat concentrations, urine dithionite test and initial laboratory parameters including white blood cell count, urine pH, and AST, ALT, BUN, Creatinine, Amylase, Glucose, pH, PaCO2, PaO2, HCO3. Base Excess, Na, K, Cl were obtained at the time of Emergency Center visit. We compared urine dithionite test, plasma paraquat concentrations and Severity Index of Paraquat Pisoning (SSPI) of the survival group to those of the dead group. The patients were divided into four subgroups based on the level of plasma paraquat concentration, their initial laboratory data was compared and analyzed. Results: The mean plasma paraquat concentration in the mortality group was higher than that in the survival group (88.44±81.56 vs. 1.32±1.72 g/mL). Among the initial laboratory data of four subgroups, μ WBC, Glucose, Cr, pH, HCO3, Bass excess were significantly different between the group of low level of plasma paraquat concentration and higher group. ANCOVA analysis revealed that WBC, HCO3, Bass excess correlated with the level of plasma paraquat concentration significantly. Conclusion: The plasma paraquat concentration and SIPP were higher in the mortality group significantly. Initial laboratory data including WBC, Glucose, Cr, pH, HCO3, Bass excess were proven to be significant prognostic factors. Especially WBC, HCO3, Bass excess can be used to predict the outcome of paraquat poisoning.