毒物中心

簡介

有鑑於中毒病人的致病機轉與治療和其他疾病大不相同,為了讓這些病人得到更優質的照護,俠醫林杰樑教授於民國98年成立臨床毒物科,致力於醫療品質提升、醫療人員毒物知識訓練及毒物研究探討。


醫療團隊

長庚毒物科團隊分為臨床醫療團隊和毒物實驗室團隊,可提供完整的醫療服務、實驗室毒物諮詢和檢測。

臨床醫療團隊:顏宗海教授、許景瑋副教授、陳冠興副教授、黃文宏副教授、翁正昊副教授、劉守賢講師

毒物實驗室團隊:譚敦慈護理師、林中英博士、林邑鞙助理

除實驗室應有的基本設備(離心機、細胞培養設備、加熱裝置等),尚有檢驗專用的高效能液相層析儀(high performance liquid chromatography, HPLC)和原子吸收光譜儀(atomic absorption spectroscopy,spectraa 220z)。

毒物實驗室團隊由俠醫林杰樑教授的夫人譚敦慈女士領軍,提供毒物檢驗及諮詢,並積極進行社會服務,教導如何吃得健康,並希望可以延續林教授的遺志,為食品安全的把關盡一份心力。

當有醫院無法測量的罕見毒物需檢測時,將會提供外送服務至國家認證實驗室檢驗。


治療經驗

腎臟系毒物科自成立以來,成功治癒了許多來林口長庚就醫的中毒和腎臟疾病患者。

服務項目

長庚毒物科團隊分為臨床醫療團隊和毒物實驗室團隊,可提供完整的醫療服務、實驗室毒物諮詢和檢測。

臨床醫療團隊:提供各種毒物諮詢及優質醫療服務

毒物實驗室團隊:提供毒物檢驗及諮詢,並積極進行社會服務,教導如何吃得健康,並希望可以延續林教授的遺志,為食品安全的把關盡一份心力。


治療特色

金屬(如鉛)中毒治療:毒物團隊發展出有效的金屬螯合劑療法。當病人的腎功能惡化是因為鉛中毒造成時,適時給予螯合劑治療,可以降低血液中鉛濃度,也能有效減緩腎功能惡化。

農藥(如巴拉刈)中毒治療:毒物團隊採用重覆類固醇及免疫抑制劑脈衝療法,再加上即時的活性碳血液灌流除汙,大幅度降低了巴拉刈中毒病人的死亡率,存活率更高達50~60%。這種方法已為許多國家採用,也被列為巴拉刈中毒的標準治療方法。

中毒類別

毒物細項

職業中毒

金屬、有機溶劑、有毒化合物等

農藥中毒

巴拉刈、有機磷、胺基甲酸、嘉磷賽(年年春)、除蟲菊精等

居家毒物

甲醛、碘酒、漂白水、強酸、強鹼、樟腦丸、老鼠藥等

環境毒物

環境賀爾蒙(多氯聯苯、戴奧辛、塑化劑、雙酚A等),金屬(鉛、鎘、砷、汞、銅、鎳、鉈、硒、銻、鉻、鋅、鉍、碲等)

誤食或被有毒生物叮咬

毒蛇、蜈蚣、虎頭蜂、河豚、蟾蜍、珊瑚礁魚、水母等

黑心食品或藥品

有毒草藥、違法減肥產品、黑心食品等

處方藥中毒

毛地黃、鈣離子阻斷流、抗心律不整藥物、環類抗憂鬱劑,抗精神病藥物、鋰鹽、單胺氧化脢抑制劑、止痛藥、抗生素等

酒精及其他濫用毒品

假酒(甲醇)、乙醇、海洛英、大麻、鴉片類藥物、強力膠、安非他命、搖頭丸、K他命、迷幻藥等

有毒植物

曼陀羅、八角蓮、夾竹桃、姑婆芋、烏頭、毛地黃等

其他

任何懷疑中毒之個案

毒物科團隊目前有兩大研究結果已經成功應用在臨床醫療,並被許多國外權威醫療團隊採用。
 

1. 低劑量鉛暴露引起之慢性腎臟疾病(low dose lead exposure related chronic kidney disease)

當病人的腎功能惡化是鉛污染造成時,適時給予螯合劑治療,可以降低血液中鉛濃度,也能有效減緩腎功能惡化。過去20多年來,團隊在林杰樑教授的帶領下,已陸續發表了一系列關於長期暴露於低劑量鉛對慢性腎病惡化的論文於國際期刊,包括新英格蘭醫學雜誌、內科醫學年鑑、美國腎臟病學會雜誌等等。

圖一、接受螯合劑治療的鉛中毒病人,腎絲球過濾率會較沒有接受螯合劑治療有改善。(N Engl J Med. 2003 Jan 23;348(4):277-86)

團隊發表之相關國際期刊論文

  1. Weng CH, Hsu CW, Hu CC, Yen TH, Chan MJ, Huang WH. Blood lead level is a positive predictor of uremic pruritus in patients undergoing hemodialysis. Ther Clin Risk Manag 2017:13;717-23
  2. Chen CY, Liu MH, Hsu CW, Weng CH, Yen TH, Huang WH. Positive correlation between environmental PM2.5 and blood lead levels in patients undergoing maintenance hemodialysis. Ther Clin Risk Manag 2017;13:555-64
  3. Huang WH, Hsu CW, Weng CH, Lin-Tan DT, Yen TH. Negative Relationship between Erythropoietin Dose and Blood Lead Level in Patients Undergoing Maintenance Hemodialysis. Sci Rep 2016;6:34313
  4. Huang WH, Lin JL, Lin-Tan DT, Hsu CW, Chen KH, Yen TH. Environmental lead exposure accelerates progressive diabetic nephropathy in type II diabetic patients. Biomed Res Int. 2013;2013:742545.
  5. Wu HM, Lin-Tan DT, Wang ML, Huang HY, Lee CL, Wang HS, Soong YK, Lin JL. Lead level in seminal plasma may affect semen quality for men without occupational exposure to lead. Reprod Biol Endocrinol. 2012;10:91.
  6. Chen KH, Lin JL, Lin-Tan DT, Hsu HH, Hsu CW, Hsu KH, Yen TH. Effect of chelation therapy on progressive diabetic nephropathy in patients with type 2 diabetes and high-normal body lead burdens. Am J Kidney Dis. 2012;60:530-8.
  7. Lin JL, Lin-Tan DT, Hsu CW, Yen TH, Chen KH, Hsu HH, Ho TC, Hsu KH. Association of blood lead levels with mortality in patients on maintenance hemodialysis. Am J Med. 2011;124:350-8.
  8. Yen TH, Lin-Tan DT, Lin JL. Chronic renal failure induced by lead. Kidney Int. 2011;79:688.
  9. Yen TH, Lin JL, Weng CH, Tang CC. Colic induced by lead. CMAJ. 2010;182:E381.
  10. Lin JL, Lin-Tan DT, Chen KH, Hsu CW, Yen TH, Huang WH, Huang YL. Blood lead levels association with 18-month all-cause mortality in patients with chronic peritoneal dialysis. Nephrol Dial Transplant. 2010;25:1627-33.
  11. Lee TH, Tseng MC, Chen CJ, Lin JL. Association of high body lead store with severe intracranial carotid atherosclerosis. Neurotoxicology. 2009;30):876-80.
  12. Lin JL, Lin-Tan DT, Yen TH, Hsu CW, Jenq CC, Chen KH, Hsu KH, Huang YL. Blood lead levels, malnutrition, inflammation, and mortality in patients with diabetes treated by long-term hemodialysis. Am J Kidney Dis. 2008;51:107-15.
  13. Lin-Tan DT, Lin JL, Yen TH, Chen KH, Huang YL. Long-term outcome of repeated lead chelation therapy in progressive non-diabetic chronic kidney diseases. Nephrol Dial Transplant. 2007;22:2924-31.
  14. Lin JL, Lin-Tan DT, Li YJ, Chen KH, Huang YL. Low-level environmental exposure to lead and progressive chronic kidney diseases. Am J Med. 2006;119:707.e1-9.
  15. Lin JL, Lin-Tan DT, Yu CC, Li YJ, Huang YY, Li KL. Environmental exposure to lead and progressive diabetic nephropathy in patients with type II diabetes. Kidney Int. 2006;69:2049-56.
  16. Yu CC, Lin JL, Lin-Tan DT. Environmental exposure to lead and progression of chronic renal diseases: a four-year prospective longitudinal study. J Am Soc Nephrol. 2004;15:1016-22.
  17. Lin JL, Lin-Tan DT, Hsu KH, Yu CC. Environmental lead exposure and progression of chronic renal diseases in patients without diabetes. N Engl J Med. 2003;348:277-86.
  18. Lin JL, Tan DT, Ho HH, Yu CC. Environmental lead exposure and urate excretion in the general population. Am J Med. 2002;113:563-8.
  19. Lin JL, Yu CC, Lin-Tan DT, Ho HH. Lead chelation therapy and urate excretion in patients with chronic renal diseases and gout. Kidney Int. 2001;60:266-71.
  20. Lin JL, Tan DT, Hsu KH, Yu CC. Environmental lead exposure and progressive renal insufficiency. Arch Intern Med. 2001;161:264-71.
  21. Lin JL, Ho HH, Yu CC. Chelation therapy for patients with elevated body lead burden and progressive renal insufficiency. A randomized, controlled trial. Ann Intern Med. 1999;130:7-13.
  22. Lin JL, Shih FC. Reversible hypothyroidism with EDTA chelation therapy in a patient with elevated lead burden and chronic renal insufficiency. Nephrol Dial Transplant. 1997;12:364-5.
  23. Lin JL, Lim PS. Does lead play a role in the development of renal insufficiency in some patients with essential hypertension? J Hum Hypertens. 1994;8:495-500.
  24. Lin JL, Huang PT. Body lead stores and urate excretion in men with chronic renal disease. J Rheumatol. 1994;21:705-9.
  25. Lin JL, Yeh KH, Tseng HC, Chen WY, Lai HH, Lin YC. Urinary N-acetyl-glucosaminidase excretion and environmental lead exposure. Green Cross Health Service Association Study Group. Am J Nephrol. 1993;13:442-7.
  26. Lin JL, Lim PS. Elevated lead burden in Chinese patients without occupational lead exposure. Miner Electrolyte Metab. 1992;18:1-5.

2. 巴拉刈中毒(paraquat intoxication)

巴拉刈農藥是劇毒,濃度20%的巴拉刈只要15 mL就足以造成死亡,中毒病人會口腔潰爛、多重器官衰竭、肺部纖維化、並在二至三週時因缺氧而死亡。林杰樑教授率先提出了巴拉刈中毒的有效治療方法,他採用重覆類固醇及免疫抑制劑脈衝療法,再加上即時的活性碳血液灌流除汙,大幅度降低了病人的死亡率,存活率更高達50~60%。這種方法已為許多國家採用,也被列為巴拉刈中毒的標準治療方法,有多家權威實證醫學機構,認為這是目前為止唯一對巴拉刈中毒有效的療法。相關研究除撰寫過教科書外,亦發表了一系列論文於許多國際期刊如美國呼吸及重症照護、重症醫學、胸腔醫學等等。

圖二、接受重覆類固醇及免疫抑制劑脈衝療法的巴拉刈中毒病人,存活率會較沒有接受螯合劑治療的高。(Intensive Care Med. 2011 Jun;37(6):1006-13)


團隊發表之相關國際期刊論文

  1. Weng CH, Chen HH, Hu CC, Huang WH, Hsu CW, Fu JF, Lin WR, Wang IK, Yen TH. Predictors of acute kidney injury after paraquat intoxication. Oncotarget (Epub ahead of print) 
  2. Wu MY, Hsu MY, Chen SJ, Hwang DK, Yen TH, Cheng CM. Point-of-Care Detection Devices for Food Safety Monitoring - Proactive Disease Prevention. Trends Biotechnol. 2017;35:288-300
  3. Kuan CM, Lin ST, Yen TH, Wang YL, and Cheng CM. Paper-based diagnostic devices for clinical paraquat poisoning diagnosis. Biomicrofluidics 2016;10:034118
  4. Lin C, Yen TH, Juang YY, Lin JL, Lee SH. Psychiatric comorbidity and its impact on mortality in patients who attempted suicide by paraquat poisoning during 2000-2010. PLoS One. 2014;9:e112160.
  5. Weng CH, Hu CC, Lin JL, Lin-Tan DT, Hsu CW, Yen TH. Predictors of acute respiratory distress syndrome in patients with paraquat intoxication. PLoS One. 2013;8:e82695.
  6. Chen HH, Lin JL, Huang WH, Weng CH, Lee SY, Hsu CW, Chen KH, Wang IK, Liang CC, Chang CT, Yen TH. Spectrum of corrosive esophageal injury after intentional paraquat or glyphosate-surfactant herbicide ingestion. Int J Gen Med. 2013;6:677-83.
  7. Hsieh YW, Lin JL, Lee SY, Weng CH, Yang HY, Liu SH, Wang IK, Liang CC, Chang CT, Yen TH. Paraquat poisoning in pediatric patients. Pediatr Emerg Care. 2013;29:487-91.
  8. Weng CH, Hu CC, Lin JL, Lin-Tan DT, Huang WH, Hsu CW, Yen TH. Sequential organ failure assessment score can predict mortality in patients with paraquat intoxication. PLoS One. 2012;7:e51743.
  9. Hsu CW, Lin JL, Lin-Tan DT, Chen KH, Yen TH, Wu MS, Lin SC. Early hemoperfusion may improve survival of severely paraquat-poisoned patients. PLoS One. 2012;7:e48397.
  10. Yang CJ, Lin JL, Lin-Tan DT, Weng CH, Hsu CW, Lee SY, Lee SH, Chang CM, Lin WR, Yen TH. Spectrum of toxic hepatitis following intentional paraquat ingestion: analysis of 187 cases. Liver Int. 2012;32:1400-6.
  11. Lin JL, Lin-Tan DT, Chen KH, Huang WH, Hsu CW, Hsu HH, Yen TH. Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids. Intensive Care Med. 2011; 37:1006-13.
  12. Yen TH, Lin JL, Lin-Tan DT, Hsu CW, Weng CH, Chen YH. Spectrum of corrosive esophageal injury after intentional paraquat ingestion. Am J Emerg Med. 2010;28:728-33.
  13. Tsai TY, Weng CH, Lin JL, Yen TH. Suicide victim of paraquat poisoning make suitable corneal donor. Hum Exp Toxicol. 2011;30:71-3.
  14. Lin JL, Lin-Tan DT, Chen KH, Huang WH. Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning. Crit Care Med. 2006;34:368-73.
  15. Jenq CC, Wu CD, Lin JL. Mother and fetus both survive from severe paraquat intoxication. Clin Toxicol (Phila). 2005;43:291-5.
  16. Lin NC, Lin JL, Lin-Tan DT, Yu CC. Combined initial cyclophosphamide with repeated methylprednisolone pulse therapy for severe paraquat poisoning from dermal exposure. J Toxicol Clin Toxicol. 2003;41:877-81.
  17. Hsu HH, Chang CT, Lin JL. Intravenous paraquat poisoning-induced multiple organ failure and fatality--a report of two cases. J Toxicol Clin Toxicol. 2003;41:87-90.
  18. Chen GH, Lin JL, Huang YK. Combined methylprednisolone and dexamethasone therapy for paraquat poisoning. Crit Care Med. 2002;30:2584-7.
  19. Lin JL, Leu ML, Liu YC, Chen GH. A prospective clinical trial of pulse therapy with glucocorticoid and cyclophosphamide in moderate to severe paraquat-poisoned patients. Am J Respir Crit Care Med. 1999;159:357-60.
  20. Lin JL, Wei MC, Liu YC. Pulse therapy with cyclophosphamide and methylprednisolone in patients with moderate to severe paraquat poisoning: a preliminary report. Thorax. 1996;51:661-3.
  21. Lin JL, Liu L, Leu ML. Recovery of respiratory function in survivors with paraquat intoxication. Arch Environ Health. 1995;50:432-9.

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血鎘濃度對於洗腎病人死亡率的影響