未经证实:蛇毒毒害会导致严重的肝脏损害,可能是致命的。有几种治疗方法,但其有效性尚未得到系统评估。我们进行了系统评价,以研究最常用的治疗方法的效果:N-乙酰半胱氨酸(NAC),青霉素(PEN),和水飞蓟宾(SIL)对患者预后的影响。此外,确定了影响患者预后的其他因素.
UASSIGNED:我们搜索了MEDLINE和Embase的病例系列和病例报告,这些病例系列和病例报告描述了患者用含天鹅膏的天鹅膏蘑菇中毒后的结果。我们提取了临床特征,治疗细节,和结果。我们使用中毒严重程度评分(PSS)中的肝脏项目对中毒严重程度进行分类。
UNASSIGNED:我们收录了131篇出版物,共描述了877例独特病例。所有患者的总生存率为84%。仅接受支持性护理的患者生存率为59%。使用SIL或PEN与90%(OR6.40[3.14-13.04])和89%(OR5.24[2.87-9.56])的生存率相关,分别。NAC/SIL联合治疗与85%生存率相关(OR3.85[2.04,7.25])。NAC/PEN/SIL医治组的存活率为76%(OR2.11[1.25,3.57])。由于案件数量有限,无法评估单独使用NAC的情况.“已证实病例”的其他分析(检测到amanitin),\“可能的病例\”(由真菌学家鉴定的蘑菇),和“可能的病例”(既没有检测到amanitin也没有发现蘑菇)显示出可比的结果,但结果没有达到统计学意义。无移植幸存者的天冬氨酸转氨酶(AST)峰值明显较低,丙氨酸氨基转移酶(ALT),血清总胆红素(TSB),和国际标准化比率(INR)与肝移植幸存者和具有致命结局的患者相比。较高的PSS峰值与死亡率增加相关。
未经评估:根据现有数据,NAC的影响没有观察到统计学差异,PEN或SIL在含有amanitin的蘑菇中被证实中毒。然而,与单纯支持治疗相比,SIL或PEN单药治疗和NAC/SIL联合治疗的生存率似乎更高.AST,ALT,TSB,和INR值可能是潜在致命结局的预测因子。
Amanita phalloides poisoning causes severe liver damage which may be potentially fatal. Several treatments are available, but their effectiveness has not been systematically evaluated. We performed a systematic
review to investigate the effect of the most commonly used therapies: N-acetylcysteine (NAC), benzylpenicillin (PEN), and silibinin (SIL) on patient outcomes. In addition, other factors contributing to patient outcomes are identified.
We searched MEDLINE and Embase for case series and case reports that described patient outcomes after poisoning with amanitin-containing
Amanita mushrooms. We extracted clinical characteristics, treatment details, and outcomes. We used the liver item from the Poisoning Severity Score (PSS) to categorize intoxication severity.
We included 131 publications describing a total of 877 unique cases. The overall survival rate of all patients was 84%. Patients receiving only supportive care had a survival rate of 59%. The use of SIL or PEN was associated with a 90% (OR 6.40 [3.14-13.04]) and 89% (OR 5.24 [2.87-9.56]) survival rate, respectively. NAC/SIL combination therapy was associated with 85% survival rate (OR 3.85 [2.04, 7.25]). NAC/PEN/SIL treatment group had a survival rate of 76% (OR 2.11 [1.25, 3.57]). Due to the limited number of cases, the use of NAC alone could not be evaluated. Additional analyses in \'proven cases\' (amanitin detected), \'probable cases\' (mushroom identified by mycologist), and \'possible cases\' (neither amanitin detected nor mushroom identified) showed comparable results, but the results did not reach statistical significance. Transplantation-free survivors had significantly lower peak values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total serum bilirubin (TSB), and international normalized ratio (INR) compared to liver transplantation survivors and patients with fatal outcomes. Higher peak PSS was associated with increased mortality.
Based on data available, no statistical differences could be observed for the effects of NAC, PEN or SIL in proven poisonings with amanitin-containing mushrooms. However, monotherapy with SIL or PEN and combination therapy with NAC/SIL appear to be associated with higher survival rates compared to supportive care alone. AST, ALT, TSB, and INR values are possible predictors of potentially fatal outcomes.