| Objectives: 1. We aim to investigate the changes of plasma amino-acid level and neuroelectrophysiological indicators in toxic disease. 2. In the meantime, we evaluate the psychological status of the patients, and further investigate the relationship between plasma amino-acid level and psychological examination. 3. The study explores the use of plasma amino-acid level and neuroelectrophyisological changes for auxiliary diagnosis in the nervous system damage of toxic disease. 4. The findings of the study can provide evidence of early intervention for toxic patient’s treatments. Contents: The clinical data of 34 consecutive poisoning patients who were admitted to the Affiliated Hospital of Academy of Military Medical Sciences between Nov 2012 and Mar 2013 were collected; all patients got psychological tests and analysis, as well as full spectrum measurement of amino-acids; 12 of them underwent video electroencephalogram and event related potential(ERP) P300 examinations. Methods: We consecutively enrolled 34 patients diagnosed with acute chemical poisoning in the Affiliated Hospital of Academy of Military Medical Sciences between Nov 2012 and Mar 2013. We collected clinical data of all patients, and they all received psychological tests, and full spectrum measurement of amino-acids; 12 of them also took the video electroencephalogram and event related potential(ERP) P300 examinations. The psychological tests include five psychological scales(Psychological Health Tests, Hamilton Anxiety Scale, Hamilton Depression Scale, Pittsburgh Sleep Quality index, Perceived Social Support Scale), and the results were analyzed by Shufan Integrated Management Platform for Mental Health. The level of the six amino-acids, including taurine, glycine, glutamate, γ-aminobutyric acid, aspartate and alanine, were determined by LC-MS/MS with isotope dilution internal standard method. We used 32 channels digital electroencephalography(EEG) system to monitor patients’ status and record EEG measurement data. Each patient took 20 to 30 minutes. The parameters of event-related potential(ERP) were amplitude and latency of P300. The results were compared with age- and gender-matched normal control group. The measured values of plasma amino-acids and their reference values were compared by Kruskal-Wallis Test. The comparison of P300 parameters between poising group and control group were made by t-test. Results: 1. The psychological tests showed that among 34 patients of poisoning, the proportions of patients with sub-health status and poor health status were 23% and 13%, respectively. Most of them were suffered from obvious anxiety and relatively heavy sleep disturbance. Patients with possible, definite and definite obvious anxiety were 32%, 21% and 3%, respectively. Over half of the patients have possible or definite anxious symptoms. Mild or moderate depression accounted for 21% of the total, while the proportion of possible severe depression was 3%. Patients with moderate and poor sleep quality accounted for 73% and 18%, respectively, which were far more than good quality sleepers. 2. The measured values of taurine, glycine, glutamate and γ-aminobutyric acid were statistically differentiated compared with their standard values(P<0.05). The level of taurine and glutamate were significantly higher than the standard values, while glycine andγ-aminobutyric acid were significantly lower. The level of aspartate and alanine were not significantly differentiated(P>0.05).3. Among the 12 cases, most of the EEG results showed mild abnormality with low to medium amplitude, 4~7Hz θ rhythms waveform. The waveform, regulation and amplitude modulation were poor. 1 case showed middle abnormality with scattered medium amplitude, 3Hz δ wave in the slow waveform background, which should not appear in normal EEG. 4. The results of P300 in 12 cases showed that the latency prolonged in 2 cases, and amplitude decreased in 3 cases. Compared with normal control, the non-targeted stimuli(FN1, FP2) and targeted stimuli(RN1, RP2, RN2, RP3) in Cz and Pz position have not changed. The AMP was statistically differentiated between two groups. The amplitude was significantly decreased in the poisoning group. Conclusion: 1. Most of the poisoning patients suffered from obvious anxiety and relatively heavy sleep disturbances during their hospitalization. Meanwhile, the level of plasma taurine and glutamate were significantly elevated, while the level of plasma glycine and γ-aminobutyric acid were significantly decreased. These indicate that there is a relationship between mental problems and plasma amino-acid changes. Further study with larger sample size might be able to find specific amino-acid changes which indicate a certain kind of psychological abnormality. These amino acids can be used as objective measurements of psychological health. 2. The abnormal EEG results were found in a proportion of poisoning patients. And the P300 AMP was significantly decreased in poisoning group. These results indicate cognitive impairments. 3. As mentioned above, acute poisoning has potential effects on central nervous system, which is likely to be overlooked in the clinical practice. Therefore, the early intervention of acute poisoning should include protection of central nervous system and psychological intervention. |
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