Evaluation Of Azithromycin In The Treatment Of Patients With Acute Paraquat Poisoning

Background and ObjectiveParaquat(PQ)is a highly effective quaternary ammonium salt herbicide.Paraquat is very toxic to human body.Acute poisoning caused by accidental taking or self-taking occurs from time to time.It has been reported that the fatality rate is as high as 60%～80%.Lung is the main target organ.Severe victims will develop pulmonary edema and pulmonary hemorrhage within 24 hours,and die of acute respiratory distress syndrome(ARDS)within 1-3 days.Paraquat collects many organs in the whole body at the same time,and a considerable number of patients died of MODS in the early stage.Some patients develop progressive pulmonary interstitial fibrosis within 1-2 weeks after the acute phase,and eventually die of respiratory failure due to pulmonary fibrosis.At present,there is no specific antidote for paraquat poisoning,and the current treatment measures mainly include promoting drug excretion,immunosuppressive agents,glucocorticoids,antioxidants,hemoperfusion,hemofiltration,etc.Azithromycin is a second generation macrolide antibiotic,which is effective in treating cocci,anaerobic bacteria,Legionella,mycoplasma and chlamydia infection.Meanwhile,it is also applied in non-anti-infective therapy,including the treatment of circulatory system,malignant tumor,respiratory system,digestive system and other related diseases.It is reported that macrolide antibiotics can be used prophylactically in PQ poisoning,which can not only prevent infection,but also play a positive role in the prevention and treatment of pulmonary fibrosis.No clinical data analysis has been reported on the visible molecular mechanism of azithromycin in acute PQ poisoning.By comparison with clinical data,this study explores the application of azithromycin treatment for patients with paraquat poisoning.MethodsA retrospective analysis was performed on 344 patients who attended the First Affiliated Hospital of Zhengzhou University due to oral paraquat poisoning from February 2013 to August 2020.Collect patients’ general clinical data,PQ intake,urine PQ concentration,vital signs,and the last PLT,PT,APTT,SCr,TBIL,ALB,CK,PaO2,SaO2 and other test results before discharge.Collect the last chest CT reports within 48 hours of admission and within 30 days(the last report before discharge for the dead patients);statistics on the treatment methods of patients,including gastric lavage,catharsis,hemoperfusion,cyclophosphamide,hormones,azithromycin,etc.At the same time,the patient was followed up by telephone if he died of oral PQ within 30 days after PQ poisoning.The included patients were divided into groups A,B,and C according to oral doses of 5ml-49ml,50ml-99ml,100ml-400ml.The azithromycin group(group a)and the control group(group b)mortality,pulmonary fibrosis,and multiple organ dysfunction syndrome(MODS)occurrence were compared and analyzed in each group.Comparative analysis of relevant laboratory indicators to explore the efficacy of azithromycin in the treatment of acute paraquat poisoning.ResultsA total of 344 patients with acute PQ poisoning were included in this study,including 187 in group A,98 in azithromycin group,and 89 in control group;82 in group B,44 in azithromycin group,and 38 in control group;75 in group C and 44 in azithromycin group Cases,31 cases in the control group.Comparison of baseline data of each group between groups:the difference in the dose of poison in the patients in group A was statistically significant(P=0.043),and the azithromycin group and the control group in the remaining 3 groups were in age,dose of poison,urine PQ concentration,heart rate,respiration,contraction There was no statistically significant difference in pressure(P>0.05).Comparison of the incidence of pulmonary fibrosis:group A:21.4%of group a,47.2%of group b,the difference was statistically significant(P=0.000);group B:group a 43.2%,group b 65.8%,the difference was statistically significant(P=0.041);Group C:52.5%of group a,67.7%of group b,the difference was not statistically significant(P=0.180).Comparison of the incidence of MODS:group A:14.3%in group a,29.2%in group b,the difference is statistically significant(P=0.013);group B:34.1%in group a,60.5%in group b,the difference is statistically significant(P=0.017);A Group:61.4%in group a,71.0%in group b,the difference was not statistically significant(P=0.389).Liver and kidney damage are the most common in patients with acute paraquat poisoning,followed by coagulation system and cardiovascular system dysfunction.Nervous system disorders are less common.The incidence of organ damage in patients in the low and medium-dose poisoning group was significantly lower than that in the control group.Fatality rate comparison:group A:19.4%in group a,23.6%in group b,the difference was not statistically significant(P=0.483);group B:39.5%in group a,60.5%in group b,the difference was statistically significant(P=0.007);Group C:63.6%in group a,71.0%in group b,the difference was not statistically significant(P=0.507).Comparing the last laboratory indicators within 30 days,the difference between total bilirubin in group A and platelets in group C was statistically significant.In the remaining dose groups,the azithromycin group and the control group had differences in PaO2,SaO2,CK,PLT,APTT,SCr,The difference between TBIL and ALB was not statistically significant.Conclusions1.The application of azithromycin in patients with low and medium doses of PQ poisoning can effectively prevent and treat pulmonary fibrosis,reduce the occurrence of MODS,and improve the lung function and quality of life of patients.Clinical treatment may consider adding azithromycin and other macrolide antibiotics.2.High-dose PQ poisoning patients maintain vital signs and promote drug excretion.If necessary,use azithromycin and other macrolide drugs as adjuvant therapy.3.The application of azithromycin can reduce the mortality of patients with moderate-dose PQ poisoning,and the application of azithromycin and other macrolide antibiotics should be given priority.