Advances in pathogenesis and early prediction of delayed encephalopathy caused by acute carbon monoxide poisoning_West China Medical Journal

Authors：

XIONG Shuyi , ZHONG Ming , HU Qing , HE Man , XIE Mingxin ,  LIU Shiping

Department of Emergency Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

LIU Shiping, Email: liusp456@163.com

Keywords：

Acute carbon monoxide poisoning; Delayed encephalopathy; Pathogenesis; Early prediction

DOI：

10.7507/1002-0179.201904200

Video：

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Acute carbon monoxide poisoning is a common and frequently occurring disease in winter and spring in China, with high disability and mortality. Delayed encephalopathy is a serious sequela after the pseudo-convalescence. Its mechanism is complex, including environmental and genetic factors, hypoxia and energy metabolism disorder, cytotoxicity and oxygen free radical damage, immune disorder and inflammatory activation, neurotransmitter disorder, brain parenchymal changes, vascular and hemorheological abnormalities, calcium overload, and cell apoptosis. At present, methods for predicting delayed encephalopathy in acute carbon monoxide poisoning include detailed inquiry of medical history, laboratory examination of relevant indicators, electrophysiological examination, brain imaging examination, and evaluation scale prediction. This review summarizes the research status of the pathogenesis and early prediction methods of delayed encephalopathy in acute carbon monoxide poisoning, with a view to providing reference for future research directions.

Citation： XIONG Shuyi, ZHONG Ming, HU Qing, HE Man, XIE Mingxin, LIU Shiping. Advances in pathogenesis and early prediction of delayed encephalopathy caused by acute carbon monoxide poisoning. West China Medical Journal, 2019, 34(9): 1075-1080. doi: 10.7507/1002-0179.201904200 Copy

1.	Geraldo AF, Silva C, Neutel D, et al. Delayed leukoencephalopathy after acute carbon monoxide intoxication. J Radiol Case Rep, 2014, 8(5): 1-8.
2.	Chang YC, Lee HY, Huang JL, et al. Risk factors and outcome analysis in children with carbon monoxide poisoning. Pediatr Neonatol, 2017, 58(2): 171-177.
3.	Brugniaux JV, Coombs GB, Barak OF, et al. Highs and lows of hyperoxia: physiological, performance, and clinical aspects. Am J Physiol Regul Integr Comp Physiol, 2018, 315(1): R1-R27.
4.	Xu X, Zhang H, Wang K, et al. Protective effect of edaravone against carbon monoxide induced apoptosis in rat primary cultured astrocytes. Biochem Res Int, 2017, 2017: 5839762.
5.	da Silva IR, Frontera JA. Neurologic complications of acute environmental injuries. Handb Clin Neurol, 2017, 141: 685-704.
6.	顾仁骏, 李文强, 王冀康, 等. 急性一氧化碳中毒后迟发性脑病患者血清和脑脊液中5-羟色胺和多巴胺的水平. 中华劳动卫生职业病杂志, 2011, 29(2): 121-124.
7.	Guan L, Zhang YL, Li ZY, et al. Salvianolic acids attenuate rat hippocampal injury after acute CO poisoning by improving blood flow properties. Biomed Res Int, 2015: 526483.
8.	Huang Y, Ye Z, Ma T, et al. Carbon monoxide (CO) modulates hydrogen peroxide (H₂O₂)-mediated cellular dysfunction by targeting mitochondria in rabbit lens epithelial cells. Exp Eye Res, 2018, 169: 68-78.
9.	Vázquez-Lima MJ1, Álvarez-Rodríguez C, Cruz-Landeira A, et al. Delayed neurological syndrome following carbon monoxide poisoning. Rev Neurol, 2015, 61(4): 153-158.
10.	Le Corfec T, Maurin O, Foucher S, et al. Carbon monoxide poisoning, treatment and orientation. Rev Infirm, 2018, 67(242): 18-20.
11.	Xue L, Wang WL, Li Y, et al. Effects of hyperbaric oxygen on hippocampal neuronal apoptosis in rats with acute carbon monoxide poisoning. Undersea Hyperb Med, 2017, 44(2): 121-131.
12.	Li W, Zhang Y, Gu R, et al. DNA pooling base genome-wide association study identifies variants at NRXN3 associated with delayed encephalopathy after acute carbon monoxide poisoning. PLoS one, 2013, 8(11): e79159.
13.	于建华, 王运良, 潘晓琳. CDH17和LRP1B基因多态性与一氧化碳中毒后迟发性脑病的相关性. 中国实用神经疾病杂志, 2017, 20(12): 18-22.
14.	Li SJ, Zhou DY, Li YF, et al. Mitochondria-targeted near-infrared fluorescent probe for the detection of carbon monoxide in vivo. Talanta, 2018, 188: 691-700.
15.	Bruce EN, Bruce MC. A multicompartment model of carboxyhemoglobin and carboxymyoglobin responses to inhalation of carbon monoxide. J Appl Physiol (1985), 2003, 95(3): 1235-1247.
16.	Jang DH, Khatri UG, Mudan A, et al. Translational application of measuring mitochondrial functions in blood cells obtained from patients with acute poisoning. J Med Toxicol, 2018, 14(2): 144-151.
17.	Brody JS, Coburn RF. Carbon monoxide-induced arterial hypoxemia. Science, 1969, 164(3885): 1297-1298.
18.	陈财良, 田小菲, 田亚汀, 等. B细胞淋巴瘤/白血病-2和腺病毒E1B19000相互作用蛋白3在一氧化碳中毒引起的少突胶质细胞凋亡中的机制. 中华神经科杂志, 2018, 51(2): 127-132.
19.	Bi M, Li Q, Guo D, et al. Sulphoraphane improves neuronal mitochondrial function in brain tissue in acute carbon monoxide poisoning rats. Basic Clin Pharmacol Toxicol, 2017, 120(6): 541-549.
20.	Hara S, Kobayashi M, Kuriiwa F, et al. Hydroxyl radical production via NADPH oxidase in rat striatum due to carbon monoxide poisoning. Toxicology, 2018, 394: 63-71.
21.	Fan DF, Hu HJ, Sun Q, et al. Neuroprotective effects of exogenous methane in a rat model of acute carbon monoxide poisoning. Brain Res, 2016, 1633: 62-72.
22.	Li SG, Li WQ, Wang JK, et al. Association of the genes for tumor necrosis factor-α and myelin basic protein with delayed encephalopathy after acute carbon monoxide poisoning. Genet Mol Res, 2012, 11(4): 4479-4486.
23.	Thom SR, Bhopale VM, Fisher D, et al. Delayed neuropathology after carbon monoxide poisoning is immune-mediated. Proc Natl Acad Sci USA, 2004, 101(37): 13660-13665.
24.	Ide T, Kamijo Y. The early elevation of interleukin 6 concentration in cerebrospinal fluid and delayed encephalopathy of carbon monoxide poisoning. Am J Emerg Med, 2009, 27(8): 992-996.
25.	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.
26.	顾仁骏, 张秀明, 尹景岗. 5-羟色胺、乙酰胆碱和多巴胺测定在急性一氧化碳中毒后迟发性脑病中的意义. 中华神经科杂志, 1999, 32(3): 191.
27.	王维展, 齐洪娜, 肖青勉, 等. 金纳多对一氧化碳中毒迟发性脑病患者一氧化氮及一氧化氮合酶的影响. 中华劳动卫生职业病杂志, 2017, 35(1): 30-33.
28.	Ito A, Jamal M, Ameno K, et al. Perfusion with carbon monoxide does not affect extracellular glutamate in dialysates of the hippocampus of freely moving mice. Drug Chem Toxicol, 2018, 41(2): 245-247.
29.	Watanabe S, Matsuo H, Kobayashi Y, et al. Transient degradation of myelin basic protein in the rat hippocampus following acute carbon monoxide poisoning. Neurosci Res, 2010, 68(3): 232-240.
30.	Ochi S, Abe M, Li C, et al. The nicotinic cholinergic system is affected in rats with delayed carbon monoxide encephalopathy. Neurosci Lett, 2014, 569: 33-37.
31.	Sekiya K, Nishihara T, Abe N, et al. Carbon monoxide poisoning-induced delayed encephalopathy accompanies decreased microglial cell numbers: distinctive pathophysiological features from hypoxemia-induced brain damage. Brain Res, 2019, 1710: 22-32.
32.	Tucker D, Lu Y, Zhang Q. From mitochondrial function to neuroprotection-an emerging role for methylene blue. Mol Neurobiol, 2018, 55(6): 5137-5153.
33.	Reumuth G, Alharbi Z, Houschyar KS, et al. Carbon monoxide intoxication: what we know. Burns, 2019, 45(3): 526-530.
34.	Hampson NB. Myth busting in carbon monoxide poisoning. Am J Emerg Med, 2016, 34(2): 295-297.
35.	Wang R, Chen Z, Wu J, et al. Preconditioning with carbon monoxide inhalation promotes retinal ganglion cell survival against optic nerve crush via inhibition of the apoptotic pathway. Mol Med Rep, 2018, 17(1): 1297-1304.
36.	Ulbrich F, Hagmann C, Buerkle H, et al. The Carbon monoxide releasing molecule ALF-186 mediates anti-inflammatory and neuroprotective effects via the soluble guanylate cyclaseβ1 in rats’ retinal ganglion cells after ischemia and reperfusion injury. J Neuroinflammation, 2017, 14(1): 130.
37.	Choi YK, Kim JH, Lee DK, et al. Carbon monoxide potentiation of l-type Ca²⁺ channel activity increases HIF-1α-independent VEGF expression via an AMPKα/SIRT1-mediated PGC-1α/ERRα axis. Antioxid Redox Signal, 2017, 27(1): 21-36.
38.	刘勇林, 肖卫民, 吴志强, 等. 急性一氧化碳中毒迟发性脑病的危险因素分析. 中国实用神经疾病杂志, 2018, 21(14): 1552-1556.
39.	Lee MS, Marsden CD. Neurological sequelae following carbon monoxide poisoning clinical course and outcome according to the clinical types and brain computed tomography scan findings. Mov Disord, 1994, 9(5): 550-558.
40.	Dubrey SW, Chehab O, Ghonim S. Carbon monoxide poisoning: an ancient and frequent cause of accidental death. Br J Hosp Med (Lond), 2015, 76(3): 159-162.
41.	Harvey WR, Hutton P. Carbon monoxide: chemistry, roIe, toxicity and treatment. Curr Anaesth Crit Care, 1999, 10(3): 158-163.
42.	Ghorbani M, Mohammadpour AH, Abnous K, et al. G-CSF administration attenuates brain injury in rats following carbon monoxide poisoning via different mechanisms. Environ Toxicol, 2017, 32(1): 37-47.
43.	Cha YS, Kim H, Do HH, et al. Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Hum Exp Toxicol, 2018, 37(3): 240-246.
44.	Di C, Zeng Y, Mao J, et al. Dynamic changes and clinical significance of serum S100B protein and glial fibrillary acidic protein in patients with delayed encephalopathy after acute carbon monoxide poisoning. Pak J Med Sci, 2018, 34(4): 945-949.
45.	Kaldirim U, Yolcu U, Arziman I, et al. The relationship between blood lactate, carboxy-hemoglobin and clinical status in CO poisoning. Eur Rev Med Pharmacol Sci, 2014, 18(19): 2777.
46.	Daş M, Çevik Y, Erel Ö, et al. Ischemia-modified albumin levels in the prediction of acute critical neurological findings in carbon monoxide poisoning. Kaohsiung J Med Sci, 2016, 32(4): 201-206.
47.	Moon JM, Chun BJ, Lee SD, et al. Serum neuron-specific enolase levels at presentation and long-term neurological sequelae after acute charcoal burning-induced carbon monoxide poisoning. Clin Toxicol (Phila), 2018, 56(8): 751-758.
48.	Kim H, Choi S, Park E, et al. Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6. Clin Exp Emerg Med, 2018, 5(3): 185-191.
49.	Toman E, Harrisson S, Belli T. Biomarkers in traumatic brain injury: a review. J R Army Med Corps, 2016, 162(2): 103-108.
50.	Moon JM, Chun BJ, Cho YS. The predictive value of scores based on peripheral complete blood cell count for long-term neurological outcome in acute carbon monoxide intoxication. Basic Clin Pharmacol Toxicol, 2019, 124(4): 500-510.
51.	Mouthon-Reignier C, Biberon J, De Toffol B, et al. A delayed neurological syndrome after carbon monoxide intoxication. Rev Neurol (Paris), 2017, 173(4): 237-238.
52.	Liu MS, Ma P. Applied study on ba in carbon monoxide poisoning. 现代电生理学杂志, 2012, 19(2): 91-92.
53.	Du X, Gu H, Hao F, et al. Utility of brain CT for predicting delayed encephalopathy after acute carbon monoxide poisoning. Exp Ther Med, 2019, 17(4): 2682-2688.
54.	郝妮娜, 田超, 廉凯茜, 等. 95例中重度急性一氧化碳中毒影像学诊断. 中华劳动卫生职业病杂志, 2017, 35(6): 463-467.
55.	Kuroda H, Fujihara K, Mugikura S, et al. Altered white matter metabolism in delayed neurologic sequelae after carbon monoxide poisoning: a proton magnetic resonance spectroscopic study. J Neurol Sci, 2016, 360: 161-169.
56.	Arngrim N, Schytz HW, Britze J, et al. Carbon monoxide inhalation induces headache in a human headache model. Cephalalgia, 2018, 38(4): 697-706.
57.	Lim PJ, Shikhare SN, Peh WC. Clinics in diagnostic imaging (154). Carbon monoxide (CO) poisoning. Singapore Med J, 2014, 55(8): 405-409; quiz 410.
58.	Chang CC, Hsu JL, Chang WN, et al. Metabolic covariant network in relation to nigrostriatal degeneration in carbon monoxide intoxication-related parkinsonism. Front Neurosci, 2016, 10: 187.
59.	Messier LD, Myers RA. A neuropsychological screening battery for emergency assessment of carbon-monoxide-poisoned patients. J Clin Psychol, 1991, 47(5): 675-684.
60.	Kudo K, Otsuka K, Yagi J, et al. Predictors for delayed encephalopathy following acute carbon monoxide poisoning. BMC Emerg Med, 2014, 14: 3.
61.	Akcan Yildiz L, Gultekingil A, Kesici S, et al. Predictors of severe clinical course in children with carbon monoxide poisoning. Pediatr Emerg Care, 2018.
62.	Xiang W, Xue H, Wang B, et al. Combined application of dexamethasone and hyperbaric oxygen therapy yields better efficacy for patients with delayed encephalopathy after acute carbon monoxide poisoning. Drug Des Devel Ther, 2017, 11: 513-519.

1. Geraldo AF, Silva C, Neutel D, et al. Delayed leukoencephalopathy after acute carbon monoxide intoxication. J Radiol Case Rep, 2014, 8(5): 1-8.
2. Chang YC, Lee HY, Huang JL, et al. Risk factors and outcome analysis in children with carbon monoxide poisoning. Pediatr Neonatol, 2017, 58(2): 171-177.
3. Brugniaux JV, Coombs GB, Barak OF, et al. Highs and lows of hyperoxia: physiological, performance, and clinical aspects. Am J Physiol Regul Integr Comp Physiol, 2018, 315(1): R1-R27.
4. Xu X, Zhang H, Wang K, et al. Protective effect of edaravone against carbon monoxide induced apoptosis in rat primary cultured astrocytes. Biochem Res Int, 2017, 2017: 5839762.
5. da Silva IR, Frontera JA. Neurologic complications of acute environmental injuries. Handb Clin Neurol, 2017, 141: 685-704.
6. 顾仁骏, 李文强, 王冀康, 等. 急性一氧化碳中毒后迟发性脑病患者血清和脑脊液中5-羟色胺和多巴胺的水平. 中华劳动卫生职业病杂志, 2011, 29(2): 121-124.
7. Guan L, Zhang YL, Li ZY, et al. Salvianolic acids attenuate rat hippocampal injury after acute CO poisoning by improving blood flow properties. Biomed Res Int, 2015: 526483.
8. Huang Y, Ye Z, Ma T, et al. Carbon monoxide (CO) modulates hydrogen peroxide (H₂O₂)-mediated cellular dysfunction by targeting mitochondria in rabbit lens epithelial cells. Exp Eye Res, 2018, 169: 68-78.
9. Vázquez-Lima MJ1, Álvarez-Rodríguez C, Cruz-Landeira A, et al. Delayed neurological syndrome following carbon monoxide poisoning. Rev Neurol, 2015, 61(4): 153-158.
10. Le Corfec T, Maurin O, Foucher S, et al. Carbon monoxide poisoning, treatment and orientation. Rev Infirm, 2018, 67(242): 18-20.
11. Xue L, Wang WL, Li Y, et al. Effects of hyperbaric oxygen on hippocampal neuronal apoptosis in rats with acute carbon monoxide poisoning. Undersea Hyperb Med, 2017, 44(2): 121-131.
12. Li W, Zhang Y, Gu R, et al. DNA pooling base genome-wide association study identifies variants at NRXN3 associated with delayed encephalopathy after acute carbon monoxide poisoning. PLoS one, 2013, 8(11): e79159.
13. 于建华, 王运良, 潘晓琳. CDH17和LRP1B基因多态性与一氧化碳中毒后迟发性脑病的相关性. 中国实用神经疾病杂志, 2017, 20(12): 18-22.
14. Li SJ, Zhou DY, Li YF, et al. Mitochondria-targeted near-infrared fluorescent probe for the detection of carbon monoxide in vivo. Talanta, 2018, 188: 691-700.
15. Bruce EN, Bruce MC. A multicompartment model of carboxyhemoglobin and carboxymyoglobin responses to inhalation of carbon monoxide. J Appl Physiol (1985), 2003, 95(3): 1235-1247.
16. Jang DH, Khatri UG, Mudan A, et al. Translational application of measuring mitochondrial functions in blood cells obtained from patients with acute poisoning. J Med Toxicol, 2018, 14(2): 144-151.
17. Brody JS, Coburn RF. Carbon monoxide-induced arterial hypoxemia. Science, 1969, 164(3885): 1297-1298.
18. 陈财良, 田小菲, 田亚汀, 等. B细胞淋巴瘤/白血病-2和腺病毒E1B19000相互作用蛋白3在一氧化碳中毒引起的少突胶质细胞凋亡中的机制. 中华神经科杂志, 2018, 51(2): 127-132.
19. Bi M, Li Q, Guo D, et al. Sulphoraphane improves neuronal mitochondrial function in brain tissue in acute carbon monoxide poisoning rats. Basic Clin Pharmacol Toxicol, 2017, 120(6): 541-549.
20. Hara S, Kobayashi M, Kuriiwa F, et al. Hydroxyl radical production via NADPH oxidase in rat striatum due to carbon monoxide poisoning. Toxicology, 2018, 394: 63-71.
21. Fan DF, Hu HJ, Sun Q, et al. Neuroprotective effects of exogenous methane in a rat model of acute carbon monoxide poisoning. Brain Res, 2016, 1633: 62-72.
22. Li SG, Li WQ, Wang JK, et al. Association of the genes for tumor necrosis factor-α and myelin basic protein with delayed encephalopathy after acute carbon monoxide poisoning. Genet Mol Res, 2012, 11(4): 4479-4486.
23. Thom SR, Bhopale VM, Fisher D, et al. Delayed neuropathology after carbon monoxide poisoning is immune-mediated. Proc Natl Acad Sci USA, 2004, 101(37): 13660-13665.
24. Ide T, Kamijo Y. The early elevation of interleukin 6 concentration in cerebrospinal fluid and delayed encephalopathy of carbon monoxide poisoning. Am J Emerg Med, 2009, 27(8): 992-996.
25. 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.
26. 顾仁骏, 张秀明, 尹景岗. 5-羟色胺、乙酰胆碱和多巴胺测定在急性一氧化碳中毒后迟发性脑病中的意义. 中华神经科杂志, 1999, 32(3): 191.
27. 王维展, 齐洪娜, 肖青勉, 等. 金纳多对一氧化碳中毒迟发性脑病患者一氧化氮及一氧化氮合酶的影响. 中华劳动卫生职业病杂志, 2017, 35(1): 30-33.
28. Ito A, Jamal M, Ameno K, et al. Perfusion with carbon monoxide does not affect extracellular glutamate in dialysates of the hippocampus of freely moving mice. Drug Chem Toxicol, 2018, 41(2): 245-247.
29. Watanabe S, Matsuo H, Kobayashi Y, et al. Transient degradation of myelin basic protein in the rat hippocampus following acute carbon monoxide poisoning. Neurosci Res, 2010, 68(3): 232-240.
30. Ochi S, Abe M, Li C, et al. The nicotinic cholinergic system is affected in rats with delayed carbon monoxide encephalopathy. Neurosci Lett, 2014, 569: 33-37.
31. Sekiya K, Nishihara T, Abe N, et al. Carbon monoxide poisoning-induced delayed encephalopathy accompanies decreased microglial cell numbers: distinctive pathophysiological features from hypoxemia-induced brain damage. Brain Res, 2019, 1710: 22-32.
32. Tucker D, Lu Y, Zhang Q. From mitochondrial function to neuroprotection-an emerging role for methylene blue. Mol Neurobiol, 2018, 55(6): 5137-5153.
33. Reumuth G, Alharbi Z, Houschyar KS, et al. Carbon monoxide intoxication: what we know. Burns, 2019, 45(3): 526-530.
34. Hampson NB. Myth busting in carbon monoxide poisoning. Am J Emerg Med, 2016, 34(2): 295-297.
35. Wang R, Chen Z, Wu J, et al. Preconditioning with carbon monoxide inhalation promotes retinal ganglion cell survival against optic nerve crush via inhibition of the apoptotic pathway. Mol Med Rep, 2018, 17(1): 1297-1304.
36. Ulbrich F, Hagmann C, Buerkle H, et al. The Carbon monoxide releasing molecule ALF-186 mediates anti-inflammatory and neuroprotective effects via the soluble guanylate cyclaseβ1 in rats’ retinal ganglion cells after ischemia and reperfusion injury. J Neuroinflammation, 2017, 14(1): 130.
37. Choi YK, Kim JH, Lee DK, et al. Carbon monoxide potentiation of l-type Ca²⁺ channel activity increases HIF-1α-independent VEGF expression via an AMPKα/SIRT1-mediated PGC-1α/ERRα axis. Antioxid Redox Signal, 2017, 27(1): 21-36.
38. 刘勇林, 肖卫民, 吴志强, 等. 急性一氧化碳中毒迟发性脑病的危险因素分析. 中国实用神经疾病杂志, 2018, 21(14): 1552-1556.
39. Lee MS, Marsden CD. Neurological sequelae following carbon monoxide poisoning clinical course and outcome according to the clinical types and brain computed tomography scan findings. Mov Disord, 1994, 9(5): 550-558.
40. Dubrey SW, Chehab O, Ghonim S. Carbon monoxide poisoning: an ancient and frequent cause of accidental death. Br J Hosp Med (Lond), 2015, 76(3): 159-162.
41. Harvey WR, Hutton P. Carbon monoxide: chemistry, roIe, toxicity and treatment. Curr Anaesth Crit Care, 1999, 10(3): 158-163.
42. Ghorbani M, Mohammadpour AH, Abnous K, et al. G-CSF administration attenuates brain injury in rats following carbon monoxide poisoning via different mechanisms. Environ Toxicol, 2017, 32(1): 37-47.
43. Cha YS, Kim H, Do HH, et al. Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Hum Exp Toxicol, 2018, 37(3): 240-246.
44. Di C, Zeng Y, Mao J, et al. Dynamic changes and clinical significance of serum S100B protein and glial fibrillary acidic protein in patients with delayed encephalopathy after acute carbon monoxide poisoning. Pak J Med Sci, 2018, 34(4): 945-949.
45. Kaldirim U, Yolcu U, Arziman I, et al. The relationship between blood lactate, carboxy-hemoglobin and clinical status in CO poisoning. Eur Rev Med Pharmacol Sci, 2014, 18(19): 2777.
46. Daş M, Çevik Y, Erel Ö, et al. Ischemia-modified albumin levels in the prediction of acute critical neurological findings in carbon monoxide poisoning. Kaohsiung J Med Sci, 2016, 32(4): 201-206.
47. Moon JM, Chun BJ, Lee SD, et al. Serum neuron-specific enolase levels at presentation and long-term neurological sequelae after acute charcoal burning-induced carbon monoxide poisoning. Clin Toxicol (Phila), 2018, 56(8): 751-758.
48. Kim H, Choi S, Park E, et al. Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6. Clin Exp Emerg Med, 2018, 5(3): 185-191.
49. Toman E, Harrisson S, Belli T. Biomarkers in traumatic brain injury: a review. J R Army Med Corps, 2016, 162(2): 103-108.
50. Moon JM, Chun BJ, Cho YS. The predictive value of scores based on peripheral complete blood cell count for long-term neurological outcome in acute carbon monoxide intoxication. Basic Clin Pharmacol Toxicol, 2019, 124(4): 500-510.
51. Mouthon-Reignier C, Biberon J, De Toffol B, et al. A delayed neurological syndrome after carbon monoxide intoxication. Rev Neurol (Paris), 2017, 173(4): 237-238.
52. Liu MS, Ma P. Applied study on ba in carbon monoxide poisoning. 现代电生理学杂志, 2012, 19(2): 91-92.
53. Du X, Gu H, Hao F, et al. Utility of brain CT for predicting delayed encephalopathy after acute carbon monoxide poisoning. Exp Ther Med, 2019, 17(4): 2682-2688.
54. 郝妮娜, 田超, 廉凯茜, 等. 95例中重度急性一氧化碳中毒影像学诊断. 中华劳动卫生职业病杂志, 2017, 35(6): 463-467.
55. Kuroda H, Fujihara K, Mugikura S, et al. Altered white matter metabolism in delayed neurologic sequelae after carbon monoxide poisoning: a proton magnetic resonance spectroscopic study. J Neurol Sci, 2016, 360: 161-169.
56. Arngrim N, Schytz HW, Britze J, et al. Carbon monoxide inhalation induces headache in a human headache model. Cephalalgia, 2018, 38(4): 697-706.
57. Lim PJ, Shikhare SN, Peh WC. Clinics in diagnostic imaging (154). Carbon monoxide (CO) poisoning. Singapore Med J, 2014, 55(8): 405-409; quiz 410.
58. Chang CC, Hsu JL, Chang WN, et al. Metabolic covariant network in relation to nigrostriatal degeneration in carbon monoxide intoxication-related parkinsonism. Front Neurosci, 2016, 10: 187.
59. Messier LD, Myers RA. A neuropsychological screening battery for emergency assessment of carbon-monoxide-poisoned patients. J Clin Psychol, 1991, 47(5): 675-684.
60. Kudo K, Otsuka K, Yagi J, et al. Predictors for delayed encephalopathy following acute carbon monoxide poisoning. BMC Emerg Med, 2014, 14: 3.
61. Akcan Yildiz L, Gultekingil A, Kesici S, et al. Predictors of severe clinical course in children with carbon monoxide poisoning. Pediatr Emerg Care, 2018.
62. Xiang W, Xue H, Wang B, et al. Combined application of dexamethasone and hyperbaric oxygen therapy yields better efficacy for patients with delayed encephalopathy after acute carbon monoxide poisoning. Drug Des Devel Ther, 2017, 11: 513-519.

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