| Objective:Paraquat (PQ) originated in the19th century, was only used asa chemical indicator, is widely used in agricultural industry after it wasdiscovered has herbicidal function in1950s. Along with its enter into marketand widely used, PQ poisoning case becomes more and more with a highmortality but no effective antidote. This now is the serious clinical problem ofthe pesticide used countries. PQ poisoning can lead to multiple organ harm,especially for lungs. An early manifestation maybe lung epithelial cell damageand pulmonary hemorrhage or inflammatory cell infiltration, advancedpulmonary fibrosis can lead to respiratory failure which can caused death. Soit is called "Paraquat lung" also and this is the main reason of PQ poisoningdeath. The reason why PQ poisoning cause lung injury is not clear yet, but themechanism includes free radical theory, enzyme imbalance doctrine,mitochondrial losses doctrine. The free radical theory is the main reason. AfterPQ poisoning, the body release large amounts of oxygen free radicals,resulting in the consumption of large quantities of the superoxide dismutase(super oxide dismutase, SOD), reduce its activity, but increase themalondialdehyde (malondial dehyde, MDA) content. The clinical treatment ofPQ poisoning is blood purification treatment which is based on medicaltreatment (including gastric lavage, catharsis, the use of steroids andimmunosuppressive agents, scavenging oxygen free radicals, protecting theorgan). Hemoperfusion (HP), hemoperfusion combined with hemodialysis (HP+HD) can also be a method of blood purification therapy. Effective bloodpurification is a key method. Blood adsorption technology can clear the PQaccumulation and reduce the harm to organ. Then achieve the purpose ofblood purification.The purpose of this study was to investigate that the what the HP treatment for blood purification can do to superoxide dismutase (SOD)activity and malondialdehyde (MDA) contentMethods：Choose30cases from the Paraquat patients who were treatedat emergency department of the Second Hospital of Hebei Medical UniversityThirty from March2012to November2012, including14male patientsand16cases female who had no previous history of lung, liver, kidney andother organs of the underlying disease. Divide them to two groups in random:group A has15cases using (HP+HD treatment); group B using (HP treatmentgroup). A, B two groups have no big difference in age, the amount of poison,poison the first blood purification to time, and for the first time afteradmission poison detection the paraquat concentration. Based on normalmedical comprehensive therapy, HP+HD and HP treatment are used to both thesetwo groups. And poisoning to first blood purification time can not exceeds12hours. HP+HD for3hours, HP treatment for2hours, both have8hoursinterval. HP use HA330resin hemoperfusion device, HD using polysulfonemembrane dialyzers. Extract5ml venous blood before and after bloodpurification treatment, then given the high-speed centrifugation for10minutesat4000r/min, then get the upper serum in EP tube label, and save them at-80℃refrigerator. After all specimens are collected, do unified detection ofSOD activity and MDA content, SOD activity by xanthine oxidase and TBAmethod for MDA content. Using SPSS13.0statistical software for analysis toget a group of SOD activity and MDA content which is described asx±S,and then compared them each group or between A, B group. If the data is inline with the normal distribution and homogeneity of variance, then usingpaired t test. If does not meet the normal distribution or variance arrhythmia,then using the Wilcoxon rank sum test. The groups are compared usingindependent sample t test, Two sets different ways of blood purificationtreatment of patients with PQ poisoning mortality were compared with usingthe chi-square test,P<0.05has statistically significant.Results：1In15patients of group A, after the HP+HD treatment based on medical treatment,7death, mortality rate is46.67%. In group B,8death afterHP treatment with medical treatment, mortality rate is53.33%. By comparing,the two groups have not statistically significant (P>0.05).2For group A, before first HP+HD treatment, serum SOD activity is47.21±6.22U/ml, after treatment it is79.44±6.72U/ml. Has statisticalsignificance (P<0.05). Before the second HP+HD pre-treatment, serumSOD activity is59.44±5.61U/ml, and change to91.18±5.00U/ml aftertreatment, so it has statistically significant (P<0.05). Before the first time HP+HD treatment, MDA content was7.67±0.49nmol/ml, after treatment MDAcontent is5.68±0.46nmol/ml, has statistical significance (P<0.05). Beforethe second HP+HD treatment MDA content is6.65±0.41nmol/ml, andchanges to5.10±0.27nmol/ml after the treatment, so it has statisticalsignificance (P<0.05). A group of paraquat poisoning patients for the first timeHP+HD treatment of SOD activity and the second HP+HD treatment SODactivity was statistically significant(P<0.05);first time HP+HD treatment ofMDA content with second HP+HD before treatment was statisticallysignificant(P<0.05).3For group B, before the first HP treatment, serum SOD activity is45.79±5.54U/ml. And after the treatment, content is75.76±5.27U/ml. This hasstatistical significance (P<0.05). Before the second HP treatment, serum SODactivity is55.91±4.87U/ml; And after the treatment, SOD activity is83.95±9.15U/ml. So this has statistical significance (P<0.05). Before the first HPtreatment, serum MDA content is7.80±0.48nmol/ml, and changes to5.70±0.47nmol/ml after HP treatment. Result has statistical significance (P<0.05).Before the second HP treatment, serum MDA content is6.78±0.41nmol/mland after the treatment MDA content is5.34±0.37nmol/ml. Result hasstatistically significant (P<0.05). Compare the SOD activity before the firstand the second HP treatment, result has statistically significant (P<0.05);Compare the MDA content before the first and the second HP treatment, resulthas statistically significant (P<0.05).4For group A, after the frist HP+HD treatment, SOD activity increases 32.22±2.13U/ml; For group B, this data increases29.97±1.95U/ml after HPtreatment. This has no statistically significant (P>0.05). For group A, theMDA content decreased value1.99±0.12nmol/ml after the first HP+HDtreatment; for group B, this data decreased2.01±0.11μmol/ml. It has nostatistically significant (P>0.05). For group A, after the second HP+HDtreatment, the SOD activity increases31.74±3.37U/ml; but after the secondHP treatment, the SOD activity of group B increases28.04±8.07U/ml whichhas no statistically significant (P>0.05). For group A, after the second HP+HD treatment, MDA content decreased1.55±0.16nmol/ml; But for group B,the MDA content decreases1.44the±0.99nmol/ml after the second HPtreatment. And the result has no statistically significant (P>0.05).Conclusions：1For both groups, after the first and the second HP+HD/HP treatment,the SOD activity increases significantly and cause the decrease of MDA whichmeans the increase of oxygen free radicals is the main reason of organ damageas it leads to peroxidation damage. HP+HD and HP are two effective bloodpurification treatment methods for reducing oxidative damage.2For both A, B two groups, the SOD activity decreased and MDAcontent increases between8hours from after the first blood purification andbefore the second. That means though we do positive blood purificationtreatment, but there are still continuing peroxide damage. And this suggeststhe importance of blood purification treatment.3Compare the increase of SOD activity and decrease of MDA before/after the first and second HP+HD/HP treatment, result has no significantdifference. The two groups showed no statistically significant mortality,Thissuggests that the hemoperfusion treatment play a leading role, buthemoperfusion combined with hemodialysis treatment need moreinvestigation. |
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