Research progress of glucocorticoid therapy for delayed encephalopathy due to acute carbon monoxide poisoning_West China Medical Journal

Authors：

TANG Yu ¹ ,  ZENG Xianrong ^1,2

1. School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610056, P. R. China;
2. Department of Neurology (Hyperbaric Oxygen), Sichuan Academy of Medical Sciences-Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

ZENG Xianrong, Email: 570574804@qq.com

Keywords：

Delayed encephalopathy due to acute carbon monoxide poisoning; glucocorticoid; therapeutic mechanism; risk factor; research progress

DOI：

10.7507/1002-0179.202505046

Video：

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Abstract Full text Figures/Tables Video References Cited by

Delayed encephalopathy due to acute carbon monoxide poisoning (DEACMP) is a serious complication of acute carbon monoxide poisoning. Patients with DEACMP often present with cognitive impairment, abnormal mental behavior, extrapyramidal system symptoms, pyramidal system symptoms, and may also have focal cortical dysfunction, which is closely related to the poor prognosis of the patients. Current research shows that the occurrence of DEACMP is related to multiple factors such as immune disorders, and glucocorticoids can exert certain therapeutic effects by suppressing the immune system. This article reviews the risk factors of DEACMP, the clinical research progress and possible mechanisms of glucocorticoid treatment for DEACMP, providing more references for the clinical treatment of DEACMP.

1.	Ouahmane Y, Hattimy FE, Soulaymani A, et al. Hyperbaric oxygen therapy in carbon monoxide poisoning in Moroccan patients. Acta Neurol Belg, 2023, 123(1): 139-143.
2.	Raub JA, Mathieu-Nolf M, Hampson NB, et al. Carbon monoxide poisoning--a public health perspective. Toxicology, 2000, 145(1): 1-14.
3.	王超成, 段昕昀, 杜宇. 1990—2019 年中国一氧化碳中毒疾病负担趋势分析及预测. 环境与职业医学, 2024, 41(11): 1251-1256.
4.	Hampson NB, Piantadosi CA, Thom SR, et al. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med, 2012, 186(11): 1095-1101.Hampson NB, Piantadosi CA, Thom SR, et al. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med, 2012, 186(11): 1095-1101.
5.	王昆, 李军文, 曾翔, 等. 急性一氧化碳中毒迟发性脑病发生率及其影响因素的 Meta 分析. 实用心脑肺血管病杂志, 2023, 31(11): 73-80.
6.	胡春妍. 急性一氧化碳中毒迟发性脑病危险因素的回顾性分析. 沈阳: 中国医科大学, 2024.
7.	王建. 急性一氧化碳中毒迟发性脑病预后的影响因素探讨. 山西医药杂志, 2020, 49(23): 3284-3286.
8.	Mao Q, Kawaguchi AT, Mizobata S, et al. Sensitive quantification of carbon monoxide in vivo reveals a protective role of circulating hemoglobin in CO intoxication. Commun Biol, 2021, 4(1): 425.
9.	急性一氧化碳中毒诊治专家共识组. 急性一氧化碳中毒诊治专家共识. 中华物理医学与康复杂志, 2022, 44(6): 481-486.
10.	冯顺易, 李勇. 中重度急性一氧化碳中毒迟发性脑病的危险因素分析. 临床急诊杂志, 2021, 22(12): 824-827.
11.	罗华山. 依达拉奉与高压氧联合治疗急诊一氧化碳中毒致迟发性脑病的效果. 吉林医学, 2022, 43(2): 472-475.
12.	Mathieu D, Marroni A, Kot J. Tenth european consensus conference on hyperbaric medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med, 2017, 47(1): 24-32.
13.	张艳杰, 杜敢琴, 郭金朋, 等. 高压氧对一氧化碳中毒迟发脑病干预作用. 中华急诊医学杂志, 2018, 27(7): 794-798.
14.	余小骊, 涂怀军, 何大贵, 等. 地塞米松对一氧化碳中毒后迟发性脑病的预防效果. 中国临床神经科学, 2002(4): 393-394.
15.	王冬香. 地塞米松预防一氧化碳中毒迟发脑病的疗效. 中国药物与临床, 2013, 13(S1): 43-44.
16.	宇仁平, 刘翠艳. 应用地塞米松预防急性 CO 中毒迟发性脑病临床观察. 中国社区医师(综合版), 2007(11): 97-98.
17.	王娜, 许铁, 胡书群, 等. 高压氧联合糖皮质激素治疗急性一氧化碳中毒迟发性脑病的 Meta 分析. 中国急救复苏与灾害医学杂志, 2023, 18(5): 617-624, 673.
18.	宋新华, 陈恺, 李彩虹. 高压氧联合糖皮质激素治疗急性 CO 中毒迟发性脑病的效果观察. 中国实用医刊, 2020, 47(11): 75-78.
19.	潘燕, 张保朝. 鞘内注入激素治疗急性一氧化碳中毒后迟发性脑病 63 例. 中国医学工程, 2010, 18(2): 61, 64.
20.	寇小格, 梁东良, 石金河, 等. 激素和鞘内给药治疗急性一氧化碳中毒迟发性脑病的临床研究. 中国工业医学杂志, 2007(1): 30-31.
21.	高春锦, 葛环, 赵立明, 等. 一氧化碳中毒临床治疗指南(三). 中华航海医学与高气压医学杂志, 2013, 20(1): 72-74.
22.	林哲聪, 黄晓新, 杨丹晓, 等. 激素冲击治疗急性一氧化碳中毒后迟发性脑病的效果. 广东医学, 2015, 36(20): 3218-3219.
23.	张萃萍, 欧阳晓春, 马遥. 不同剂量甲泼尼龙琥珀酸钠联合高压氧治疗急性一氧化碳中毒后迟发性脑病的疗效. 实用临床医学, 2019, 20(6): 10-11, 29.
24.	郝美美, 田甜, 白如玉, 等. 丁苯酞序贯疗法联合高压氧疗及糖皮质激素对急性一氧化碳中毒迟发性脑病的临床疗效研究. 中国药师, 2024, 27(5): 817-825.
25.	程坤, 王玉芬, 陈锋, 等. 糖皮质激素联合高压氧治疗急性一氧化碳中毒迟发性脑病的疗效观察. 中华航海医学与高气压医学杂志, 2019, 26(4): 369-371.
26.	王宪月. 糖皮质激素配合高压氧防治急性一氧化碳中毒迟发性脑病临床研究. 系统医学, 2018, 3(6): 39-40, 44.
27.	张梅杰, 吴跃春, 江敏华, 等. 甲泼尼龙联合冬眠合剂预防急性 CO 中毒迟发性脑病效果观察. 人民军医, 2014, 57(12): 1331-1332.
28.	唐庆, 李颖, 王永义, 等. 糖皮质激素联合高压氧防治急性一氧化碳中毒迟发性脑病疗效与安全性 Meta 分析. 第三军医大学学报, 2016, 38(2): 207-214.
29.	Ashcroft J, Fraser E, Krishnamoorthy S, et al. Carbon monoxide poisoning. BMJ, 2019, 365: l2299.Ashcroft J, Fraser E, Krishnamoorthy S, et al. Carbon monoxide poisoning. BMJ, 2019, 365: l2299.
30.	Du JJ, Liu ZQ, Yan Y, et alThe cannabinoid Win 55,212-2 reduces delayed neurologic sequelae after carbon monoxide poisoning by promoting microglial M2 polarization through ST2 signaling. J Mol Neurosci, 2020, 70(3): 422-432.Du JJ, Liu ZQ, Yan Y, et alThe cannabinoid Win 55,212-2 reduces delayed neurologic sequelae after carbon monoxide poisoning by promoting microglial M2 polarization through ST2 signaling. J Mol Neurosci, 2020, 70(3): 422-432.
31.	Kuriiwa F, Kobayashi M, Mizukami H, et al. Mitochondrial toxins potentiate hydroxyl radical production in rat striatum during carbon monoxide poisoning. J Pharmacol Sci, 2021, 146(1): 29-32.Kuriiwa F, Kobayashi M, Mizukami H, et al. Mitochondrial toxins potentiate hydroxyl radical production in rat striatum during carbon monoxide poisoning. J Pharmacol Sci, 2021, 146(1): 29-32.
32.	AL-Nasser MN, Mellor IR, Carter WG. Is l-glutamate toxic to neurons and thereby contributes to neuronal loss and neurodegeneration? A Systematic Review. Brain Sci, 2022, 12(5): 577.AL-Nasser MN, Mellor IR, Carter WG. Is l-glutamate toxic to neurons and thereby contributes to neuronal loss and neurodegeneration? A Systematic Review. Brain Sci, 2022, 12(5): 577.
33.	Xu H, Meng X, Cui Y, et al. The neuroprotective effect of hyperoxygenate hydrogen-rich saline on CO-induced brain injury in rats. Environ Toxicol Pharmacol, 2019, 67: 117-123.Xu H, Meng X, Cui Y, et al. The neuroprotective effect of hyperoxygenate hydrogen-rich saline on CO-induced brain injury in rats. Environ Toxicol Pharmacol, 2019, 67: 117-123.
34.	Thom SR, Bhopale VM, Han ST, et al. Intravascular neutrophil activation due to carbon monoxide poisoning. Am J Respir Crit Care Med, 2006, 174(11): 1239-1248.
35.	Kuroda H, Fujihara K, Kushimoto S, et al. Novel clinical grading of delayed neurologic sequelae after carbon monoxide poisoning and factors associated with outcome. Neurotoxicology, 2015, 48: 35-43.
36.	Thom SR, Bhopale VM, Fisher D, et al. Delayed neuropathology after carbon monoxide poisoning is immune-mediated. Proc Natl Acad Sci U S A, 2004, 101(37): 13660-13665.
37.	Zhang F, Zeng J, Zhang X, et al. Investigation of the relationship between MBP gene polymorphisms and delayed encephalopathy after acute carbon monoxide poisoning. Neurotoxicology, 2023, 94: 217-222.
38.	Pritzker LB, Joshi S, Harauz G, et al. Deimination of myelin basic protein. 2. Effect of methylation of MBP on its deimination by peptidylarginine deiminase. Biochemistry, 2000, 39(18): 5382-5388.
39.	Cazzato G, Mesiano T, Antonello R, et al. Double-blind, placebo-controlled, randomized, crossover trial of high-dose methylprednisolone in patients with chronic progressive form of multiple sclerosis. Eur Neurol, 1995, 35(4): 193-198.
40.	Wüst S, van den Brandt J, Reichardt HM, et al. Preventive treatment with methylprednisolone paradoxically exacerbates experimental autoimmune encephalomyelitis. Int J Endocrinol, 2012, 2012: 417017.
41.	Lee HM, Reed J, Greeley GH Jr, et al. Impaired mitochondrial respiration and protein nitration in the rat hippocampus after acute inhalation of combustion smoke. Toxicol Appl Pharmacol, 2009, 235(2): 208-215.
42.	宋秀祖, 朱家祥, 刘庆莹, 等. 地塞米松对谷氨酸钠致痫大鼠脑电图及 GABA 免疫反应的影响. 神经解剖学杂志, 2002, 18(3): 251-254, 95.
43.	Yang JT, Lee TH, Lee IN, et al. Dexamethasone inhibits ICAM-1 and MMP-9 expression and reduces brain edema in intracerebral hemorrhagic rats. Acta Neurochir (Wien), 2011, 153(11): 2197-2203.

1. Ouahmane Y, Hattimy FE, Soulaymani A, et al. Hyperbaric oxygen therapy in carbon monoxide poisoning in Moroccan patients. Acta Neurol Belg, 2023, 123(1): 139-143.
2. Raub JA, Mathieu-Nolf M, Hampson NB, et al. Carbon monoxide poisoning--a public health perspective. Toxicology, 2000, 145(1): 1-14.
3. 王超成, 段昕昀, 杜宇. 1990—2019 年中国一氧化碳中毒疾病负担趋势分析及预测. 环境与职业医学, 2024, 41(11): 1251-1256.
4. Hampson NB, Piantadosi CA, Thom SR, et al. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med, 2012, 186(11): 1095-1101.Hampson NB, Piantadosi CA, Thom SR, et al. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med, 2012, 186(11): 1095-1101.
5. 王昆, 李军文, 曾翔, 等. 急性一氧化碳中毒迟发性脑病发生率及其影响因素的 Meta 分析. 实用心脑肺血管病杂志, 2023, 31(11): 73-80.
6. 胡春妍. 急性一氧化碳中毒迟发性脑病危险因素的回顾性分析. 沈阳: 中国医科大学, 2024.
7. 王建. 急性一氧化碳中毒迟发性脑病预后的影响因素探讨. 山西医药杂志, 2020, 49(23): 3284-3286.
8. Mao Q, Kawaguchi AT, Mizobata S, et al. Sensitive quantification of carbon monoxide in vivo reveals a protective role of circulating hemoglobin in CO intoxication. Commun Biol, 2021, 4(1): 425.
9. 急性一氧化碳中毒诊治专家共识组. 急性一氧化碳中毒诊治专家共识. 中华物理医学与康复杂志, 2022, 44(6): 481-486.
10. 冯顺易, 李勇. 中重度急性一氧化碳中毒迟发性脑病的危险因素分析. 临床急诊杂志, 2021, 22(12): 824-827.
11. 罗华山. 依达拉奉与高压氧联合治疗急诊一氧化碳中毒致迟发性脑病的效果. 吉林医学, 2022, 43(2): 472-475.
12. Mathieu D, Marroni A, Kot J. Tenth european consensus conference on hyperbaric medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med, 2017, 47(1): 24-32.
13. 张艳杰, 杜敢琴, 郭金朋, 等. 高压氧对一氧化碳中毒迟发脑病干预作用. 中华急诊医学杂志, 2018, 27(7): 794-798.
14. 余小骊, 涂怀军, 何大贵, 等. 地塞米松对一氧化碳中毒后迟发性脑病的预防效果. 中国临床神经科学, 2002(4): 393-394.
15. 王冬香. 地塞米松预防一氧化碳中毒迟发脑病的疗效. 中国药物与临床, 2013, 13(S1): 43-44.
16. 宇仁平, 刘翠艳. 应用地塞米松预防急性 CO 中毒迟发性脑病临床观察. 中国社区医师(综合版), 2007(11): 97-98.
17. 王娜, 许铁, 胡书群, 等. 高压氧联合糖皮质激素治疗急性一氧化碳中毒迟发性脑病的 Meta 分析. 中国急救复苏与灾害医学杂志, 2023, 18(5): 617-624, 673.
18. 宋新华, 陈恺, 李彩虹. 高压氧联合糖皮质激素治疗急性 CO 中毒迟发性脑病的效果观察. 中国实用医刊, 2020, 47(11): 75-78.
19. 潘燕, 张保朝. 鞘内注入激素治疗急性一氧化碳中毒后迟发性脑病 63 例. 中国医学工程, 2010, 18(2): 61, 64.
20. 寇小格, 梁东良, 石金河, 等. 激素和鞘内给药治疗急性一氧化碳中毒迟发性脑病的临床研究. 中国工业医学杂志, 2007(1): 30-31.
21. 高春锦, 葛环, 赵立明, 等. 一氧化碳中毒临床治疗指南(三). 中华航海医学与高气压医学杂志, 2013, 20(1): 72-74.
22. 林哲聪, 黄晓新, 杨丹晓, 等. 激素冲击治疗急性一氧化碳中毒后迟发性脑病的效果. 广东医学, 2015, 36(20): 3218-3219.
23. 张萃萍, 欧阳晓春, 马遥. 不同剂量甲泼尼龙琥珀酸钠联合高压氧治疗急性一氧化碳中毒后迟发性脑病的疗效. 实用临床医学, 2019, 20(6): 10-11, 29.
24. 郝美美, 田甜, 白如玉, 等. 丁苯酞序贯疗法联合高压氧疗及糖皮质激素对急性一氧化碳中毒迟发性脑病的临床疗效研究. 中国药师, 2024, 27(5): 817-825.
25. 程坤, 王玉芬, 陈锋, 等. 糖皮质激素联合高压氧治疗急性一氧化碳中毒迟发性脑病的疗效观察. 中华航海医学与高气压医学杂志, 2019, 26(4): 369-371.
26. 王宪月. 糖皮质激素配合高压氧防治急性一氧化碳中毒迟发性脑病临床研究. 系统医学, 2018, 3(6): 39-40, 44.
27. 张梅杰, 吴跃春, 江敏华, 等. 甲泼尼龙联合冬眠合剂预防急性 CO 中毒迟发性脑病效果观察. 人民军医, 2014, 57(12): 1331-1332.
28. 唐庆, 李颖, 王永义, 等. 糖皮质激素联合高压氧防治急性一氧化碳中毒迟发性脑病疗效与安全性 Meta 分析. 第三军医大学学报, 2016, 38(2): 207-214.
29. Ashcroft J, Fraser E, Krishnamoorthy S, et al. Carbon monoxide poisoning. BMJ, 2019, 365: l2299.Ashcroft J, Fraser E, Krishnamoorthy S, et al. Carbon monoxide poisoning. BMJ, 2019, 365: l2299.
30. Du JJ, Liu ZQ, Yan Y, et alThe cannabinoid Win 55,212-2 reduces delayed neurologic sequelae after carbon monoxide poisoning by promoting microglial M2 polarization through ST2 signaling. J Mol Neurosci, 2020, 70(3): 422-432.Du JJ, Liu ZQ, Yan Y, et alThe cannabinoid Win 55,212-2 reduces delayed neurologic sequelae after carbon monoxide poisoning by promoting microglial M2 polarization through ST2 signaling. J Mol Neurosci, 2020, 70(3): 422-432.
31. Kuriiwa F, Kobayashi M, Mizukami H, et al. Mitochondrial toxins potentiate hydroxyl radical production in rat striatum during carbon monoxide poisoning. J Pharmacol Sci, 2021, 146(1): 29-32.Kuriiwa F, Kobayashi M, Mizukami H, et al. Mitochondrial toxins potentiate hydroxyl radical production in rat striatum during carbon monoxide poisoning. J Pharmacol Sci, 2021, 146(1): 29-32.
32. AL-Nasser MN, Mellor IR, Carter WG. Is l-glutamate toxic to neurons and thereby contributes to neuronal loss and neurodegeneration? A Systematic Review. Brain Sci, 2022, 12(5): 577.AL-Nasser MN, Mellor IR, Carter WG. Is l-glutamate toxic to neurons and thereby contributes to neuronal loss and neurodegeneration? A Systematic Review. Brain Sci, 2022, 12(5): 577.
33. Xu H, Meng X, Cui Y, et al. The neuroprotective effect of hyperoxygenate hydrogen-rich saline on CO-induced brain injury in rats. Environ Toxicol Pharmacol, 2019, 67: 117-123.Xu H, Meng X, Cui Y, et al. The neuroprotective effect of hyperoxygenate hydrogen-rich saline on CO-induced brain injury in rats. Environ Toxicol Pharmacol, 2019, 67: 117-123.
34. Thom SR, Bhopale VM, Han ST, et al. Intravascular neutrophil activation due to carbon monoxide poisoning. Am J Respir Crit Care Med, 2006, 174(11): 1239-1248.
35. Kuroda H, Fujihara K, Kushimoto S, et al. Novel clinical grading of delayed neurologic sequelae after carbon monoxide poisoning and factors associated with outcome. Neurotoxicology, 2015, 48: 35-43.
36. Thom SR, Bhopale VM, Fisher D, et al. Delayed neuropathology after carbon monoxide poisoning is immune-mediated. Proc Natl Acad Sci U S A, 2004, 101(37): 13660-13665.
37. Zhang F, Zeng J, Zhang X, et al. Investigation of the relationship between MBP gene polymorphisms and delayed encephalopathy after acute carbon monoxide poisoning. Neurotoxicology, 2023, 94: 217-222.
38. Pritzker LB, Joshi S, Harauz G, et al. Deimination of myelin basic protein. 2. Effect of methylation of MBP on its deimination by peptidylarginine deiminase. Biochemistry, 2000, 39(18): 5382-5388.
39. Cazzato G, Mesiano T, Antonello R, et al. Double-blind, placebo-controlled, randomized, crossover trial of high-dose methylprednisolone in patients with chronic progressive form of multiple sclerosis. Eur Neurol, 1995, 35(4): 193-198.
40. Wüst S, van den Brandt J, Reichardt HM, et al. Preventive treatment with methylprednisolone paradoxically exacerbates experimental autoimmune encephalomyelitis. Int J Endocrinol, 2012, 2012: 417017.
41. Lee HM, Reed J, Greeley GH Jr, et al. Impaired mitochondrial respiration and protein nitration in the rat hippocampus after acute inhalation of combustion smoke. Toxicol Appl Pharmacol, 2009, 235(2): 208-215.
42. 宋秀祖, 朱家祥, 刘庆莹, 等. 地塞米松对谷氨酸钠致痫大鼠脑电图及 GABA 免疫反应的影响. 神经解剖学杂志, 2002, 18(3): 251-254, 95.
43. Yang JT, Lee TH, Lee IN, et al. Dexamethasone inhibits ICAM-1 and MMP-9 expression and reduces brain edema in intracerebral hemorrhagic rats. Acta Neurochir (Wien), 2011, 153(11): 2197-2203.

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