Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Efficacy of deferoxamine on paraquat poisoning

파라쿼트 중독 환자에서 deferoxamine의 치료 효과

  • Huh, Jin Won (Department of Internal Medicine, Inje University) ;
  • Jegal, Yangjin (Department of Internal Medicine, University of Ulsan) ;
  • Hong, Sang-Bum (Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine) ;
  • Oh, Yeon Mok (Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine) ;
  • Shim, Tae Sun (Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine) ;
  • Lee, Sang Do (Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine) ;
  • Kim, Woo Sung (Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine) ;
  • Kim, Dong Soon (Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine) ;
  • Kim, Won Dong (Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine) ;
  • Koh, Younsuck (Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine)
  • 허진원 (인제대학교 의과대학 내과학교실) ;
  • 제갈양진 (울산대학교 의과대학 내과학교실) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Received : 2006.10.26
  • Accepted : 2007.01.18
  • Published : 2007.02.28
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Abstract

Background: Paraquat is known to induce oxidant injury that results in multiorgan failure and lung fibrosis. Iron has been considered to play a key role in paraquat-induced oxidant lung injury. This study examined the effect of deferoxamine, an iron-chelating agent, in the treatment of paraquat poisoning. Methods: From September, 2001 to April, 2005, 28 patients with paraquat poisoning who were admitted at a medical intensive care unit of a University-affiliated hospital, were enrolled in this study. Sixteen patients were treated according to the paraquat poisoning treatment guidelines and 12 received an intravenous infusion of deferoxamine in addition to the treatment guidelines. Results: There were no differences between the two groups in terms of age, gender, severity of paraquat poisoning, and the time elapsed from ingestion to presentation at hospital. There was no difference in overall mortality between the two groups but the incidence of respiratory failure in the deferoxamine group was higher than in the conventional group(4/7 versus 0/9, p=0.019). Conclusion: Deferoxamine seems to have no clinical benefit compared with the conventional treatment.

연구배경: 파라쿼트 중독은 다발성 장기부전과 폐섬유화를 유발하여 높은 사망률을 초래한다. 폐섬유화의 약화를 위해 여러 종류의 면역억제제가 사용되었으나 그 치료효과는 다양하다. 철은 파라쿼트로 유발된 산화 스트레스에 의한 폐손상에 중요한 역할은 한다. 본 연구는 파라쿼트 중독의 치료시 철 킬레이트 제제인 deferoxamine의 효과를 보고자 시행되었다. 방 법: 2001년 10월부터 2005년 4월까지 파라쿼트 중독으로 내과계중환자실에 입원한 37명 중 28명이 본 연구에 포함되었다. 환자들은 서울아산병원의 파라쿼트 치료 프로토콜에 따라서 치료되었다. 이 중 12명이 추가로 deferoxamine 투여군으로 무작위 분류되었다. 결 과: 두 군간의 성별, 나이, 파라쿼트 중독의 정도, 섭취 후 병원까지의 도착 시간 등은 유의한 차이를 보이지 않았다. 파라쿼트 섭취 후 간기능과 신기능의 변화도 유의한 차이를 보이지 않았다. 전체 사망률은 두 군 간의 차이는 없었으나 deferoxamine 투여군에서 대조군과 비교시 호흡부전의 빈도가 높았다(4/7 versus 0/9, p=0.019). 결 론: 파라쿼트 중독 시 본 연구에서 적용된 용량과 기간의 deferoxamine (100mg/kg during 24 h)은 치료효과가 없을 것으로 사료된다.

Keywords

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