普瑞巴林中毒：剂量毒性关系的评价

本文由“罂粟花”授权转载

普瑞巴林中毒:剂量毒性关系的评价

贵州医科大学 麻醉与心脏电生理课题组

翻译：刘云琴   编辑：潘志军   审校：曹莹

背景  

普瑞巴林中毒大多是良性的，尽管有时会发生昏迷和惊厥。

目的  

确定普瑞巴林的剂量-毒性关系方法。

方法  

收集分离普瑞巴林中毒的剂量-毒性数据主要源于(1)荷兰毒物信息中心(2014年4月4日至2016年10月4日)进行的一项前瞻性研究，以及(2)文献中报道的个案报告和病例分析。使用中毒严重程度评分（PSS）对中毒进行分级，并评估剂量（mg/kg）与PSS之间的关系。

结果

在我们的研究中（n=21名患者），最常见的症状是嗜睡（62%）、精神错乱（29%）和冷漠（24%）。 PSS评分为0分有3例(14%)，轻度15例（71%），中度3例（14%）。很多病例分析也报道了大多数中毒案例（69-100%）的PSS从零到轻微，对于34名个体患者（21名来自我们的研究，13名来自文献报道）， 根据剂量和临床疗程的详细数据可用于检验剂量-毒性之间的关系。PSS非次要组（“良性”）的中位剂量显著较低（8.6 mg/ kg，四分位间距（IQ25-75）5.0-17.6 mg/kg）与中重度组相比（“显著毒性”）（46.7 mg/kg，（IQ25-75）21.3-64.3 mg/kg）；中位数差异估计值=27.3 mg/kg（95%可信区间：10-48.6）。

结论  

一般来说，普瑞巴林剂量越高，中毒越严重。低于20 mg/kg的大多数患者（83%）只患有轻度中毒。然而，普瑞巴林引起的毒性存在很大的个体差异。因此，院前急救分诊不仅应包括普瑞巴林剂量，还应包括潜在的疾病、共同暴露和报告的症状。

原始文献来源：

Rietjens Saskia J., Sikma Maaike A., Hunault Claudine C., de Lange Dylan W., Hondebrink Laura.(2021). Pregabalin Poisoning: Evaluation of Dose-Toxicity Relationship. Br J Clin Pharmacol, 2021;1–10. doi:10.1111/bcp.15073

英文原文????

Pregabalin Poisoning: Evaluation of Dose-Toxicity Relationship    

CONTEXT

Pregabalin poisoning is mostly benign, although coma and convulsions occasionally occur.

AIM

To determine the dose-toxicity relationship of pregabalin.

Method

Dose-toxicity data of isolated pregabalin poisonings was collected from (1) a prospective study performed by the Dutch Poisons Information Centre (4 April2014 to 4 October 2016) and from (2) case reports and case series reported in literature. Poisonings were graded using the Poisoning Severity Score (PSS) and the relationship between dose (mgkg ) and PSS was evaluated.

Results

In our study (n=21 patients), the most commonly observed symptoms were drowsiness (62%), confusion (29%), and apathy (24%). PSS was none in 3 (14%), minor in 15 (71%), and moderate in 3 patients (14%). Most case series also report a PSS of none to minor in the majority of poisonings (69% to 100%). For 34 individual patients (21 from our study and 13 from literature), detailed data on dose and clinical course were available to examine the dose-toxicity relationship. The median dose was significantly lower in the PSS none-minor group ('benign') (8.6 mg kg-1, IQ25-75: 5.0-17.6 mg kg-1 ) than in the PSS moderate-severe group ('significant toxicity') (46.7 mg kg-1 , IQ25-75: 21.3-64.3 mg kg-1 ); estimate of the median difference = 27.3 mg kg-1 (95% CI [10 ; 48.6]).

Conclusion

In general, higher pregabalin doses result in more severe poisonings. Below 20 mgkg the majority of patients (83%) only suffer from mild poisoning. However, large interindividual differences exist in pregabalin-induced toxicity. Therefore, pre-hospital triage should not only include pregabalin dose, but also underlying illnesses, co-exposures and reported symptoms.

打赏