Full Text:   <1487>

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CLC number: R595.9

On-line Access: 2015-08-04

Received: 2015-04-28

Revision Accepted: 2015-07-22

Crosschecked: 2015-07-24

Cited: 4

Clicked: 3315

Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Yuan-qiang Lu

http://orcid.org/0000-0002-9057-4344

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Journal of Zhejiang University SCIENCE B 2015 Vol.16 No.8 P.720-726

http://doi.org/10.1631/jzus.B1500101


Evaluation of efficacy of resin hemoperfusion in patients with acute 2,4-dinitrophenol poisoning by dynamic monitoring of plasma toxin concentration


Author(s):  Xue-hong Zhao, Jiu-kun Jiang, Yuan-qiang Lu

Affiliation(s):  Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China

Corresponding email(s):   luyuanqiang609@163.com

Key Words:  2, 4-Dinitrophenol, Poisoning, Hemoperfusion, Pharmacokinetics, Therapeutics


Xue-hong Zhao, Jiu-kun Jiang, Yuan-qiang Lu. Evaluation of efficacy of resin hemoperfusion in patients with acute 2,4-dinitrophenol poisoning by dynamic monitoring of plasma toxin concentration[J]. Journal of Zhejiang University Science B, 2015, 16(8): 720-726.

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author="Xue-hong Zhao, Jiu-kun Jiang, Yuan-qiang Lu",
journal="Journal of Zhejiang University Science B",
volume="16",
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pages="720-726",
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publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1500101"
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%T Evaluation of efficacy of resin hemoperfusion in patients with acute 2,4-dinitrophenol poisoning by dynamic monitoring of plasma toxin concentration
%A Xue-hong Zhao
%A Jiu-kun Jiang
%A Yuan-qiang Lu
%J Journal of Zhejiang University SCIENCE B
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%P 720-726
%@ 1673-1581
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%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1500101

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T1 - Evaluation of efficacy of resin hemoperfusion in patients with acute 2,4-dinitrophenol poisoning by dynamic monitoring of plasma toxin concentration
A1 - Xue-hong Zhao
A1 - Jiu-kun Jiang
A1 - Yuan-qiang Lu
J0 - Journal of Zhejiang University Science B
VL - 16
IS - 8
SP - 720
EP - 726
%@ 1673-1581
Y1 - 2015
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1500101


Abstract: 
Objective: The intoxications caused by 2,4-Dinitrophenol (2,4-DNP), even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and explore the clinical value of resin hemoperfusion (HP) in the treatment of patients with acute 2,4-DNP poisoning. Methods: We reported 16 cases of acute 2,4-DNP poisoning through occupational exposure due to ignoring the risk of poisoning. The blood samples were collected from the 14 survivors. According to the different treatments of resin HP, the survivors were divided into routine HP (n=5) and intensive HP (n=9) groups. Ultra high performance liquid chromatography/ tandem mass spectroscopy (UPLC-MS/MS) was used to detect the 2,4-DNP concentration in plasma in this study. Results: The 14 survivors recovered very well after treatment. The initial plasma 2,4-DNP concentrations (C1) of survivors ranged from 0.25 to 41.88 µg/ml (mean (12.56±13.93) µg/ml). A positive correlation existed between initial plasma 2,4-DNP concentration (C1) and temperature. The elimination of 2,4-DNP was slow and persistent, and the total clearance rates of plasma toxin from the 1st to 3rd day (R3), the 3rd to 7th day (R3&#x2013;7), and the 1st to 7th day (R7), were only (53.03±14.04)%, (55.25±10.50)%, and (78.29±10.22)%, respectively. The plasma toxin was cleared up to 25 d after poisoning in most of the patients. The R3, R3&#x2013;7, and R7 in the intensive HP group were all apparently higher than those in the routine HP group, with statistical significance (P<0.05). Simultaneously, the elimination half-life (t1/2) of 2,4-DNP in the intensive HP group was apparently shorter than that in the routine HP group, with statistical significance (P<0.05). Conclusions: The clinicians should be aware of this slow and persistent process in the elimination of plasma 2,4-DNP. Higher initial plasma toxin concentration resulted in a more severe fever for the patient. According to the limited data, longer and more frequent resin HP may accelerate to eliminate the poison.

血液灌流对急性2,4-二硝基苯酚中毒患者的毒物清除疗效评估

目的:本研究通过监测急性2,4-二硝基苯酚中毒患者治疗前后血浆毒物浓度的动态变化,从而探讨血液灌流治疗对急性2,4-二硝基苯酚中毒患者的毒物清除疗效及其临床价值。
创新点:由于急性2,4-二硝基苯酚中毒患者在临床中较为罕见,其相关毒物代谢动力学资料十分缺乏,且尚未有规范的临床救治方案。本研究创新点主要有:(1)对2,4-二硝基苯酚的毒物代谢动力学进行了必需的探讨和研究;(2)为临床上形成规范的救治方案,提供了科学的实践资料。
方法:回顾性分析了16例急性2,4-二硝基苯酚中毒患者的救治经过,其中14例幸存者根据救治中实施树脂-血液灌流治疗的强度和频度差异,分为常规血液灌流组(5例)和强化血液灌流组(9例)。同时,本研究使用超高效液相色谱串联质谱方法对患者救治过程中的血浆毒物浓度进行了动态监测。
结论:14例幸存患者的初始血浆2,4-二硝基苯酚浓度为0.25~41.88 µg/ml不等,且初始血浆毒物浓度与患者体温高低呈正相关。研究发现,机体对于2,4-二硝基苯酚的清除是缓慢而持久的。根据血浆 2,4-二硝基苯酚浓度动态变化计算而得,患者血浆毒物总清除率R3(中毒后第1日至第3日)、R3-7(中毒后第3日至第7日)和R7(中毒后第1日至第7日)分别为(53.03±14.04)%、(55.2±10.50)% 和 (78.29±10.22)%。其中,强化血液灌流组患者的血浆毒物总清除率R3R3-7R7均显著高于常规血液灌流组,差异有统计学意义(P<0.05)。此外,强化血液灌流组患者的 2,4-二硝基苯酚清除半衰期(t1/2)明显短于常规血液灌流组,差异有统计学意义(P<0.05)。因而,本研究显示高强度、高频度地实施血液灌流治疗有利于急性2,4-二硝基苯酚中毒患者清除毒物。

关键词:2,4-二硝基苯酚;中毒;血液灌流;药代动力学;治疗学

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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