Basal Level of Cholinesterase in a Population of Residents Over 60 Years Old in Jeju

Park,  Kyung Hye; Kim,  Woo Jeong; Kang,  Young Joon; Park,  Jun Hyuk; Park,  Ju Ok; Kim,  Hyun

J Korean Soc Emerg Med > Volume 23(3); 2012 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2012;23(3): 383-388.

Basal Level of Cholinesterase in a Population of Residents Over 60 Years Old in Jeju

Kyung Hye Park, Woo Jeong Kim, Young Joon Kang, Jun Hyuk Park, Ju Ok Park, Hyun Kim

¹Department of Emergency Medicine, Inje University, Haeundae Paik Hospital, Busan, Korea. erdoc@naver.com
²Department of Emergency Medicine Medical School, Jeju National University, Jeju, Korea.
³Department of Psychiatry Medical School, Jeju National University, Jeju, Korea.
⁴Department of Emergency Medicine, Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea.
⁵Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.

ABSTRACT

PURPOSE:
Measurement of pseudocholinesterase (PChE) is a simple test for evaluation of the severity of intoxication with organophosphate and carbamate insecticides, because they inhibit PChE; however, as demonstrated in several studies, PChE does not reflect severity and mortality. The basal level of PChE in patients who attempt suicide with insecticides could be low, because they are exposed to insecticides for a long period of time, as they are engaged in agriculture. This is part of the reason that PChE level does not reflect severity. No research on the basal level of PChE in the normal population in South Korea has been conducted. The authors of this study investigated the characteristics of residents of Jeju, Korea who have a low level of PChE.
METHODS:
Residents of Jeju over 60 years of age were randomly enrolled. Level of PChE, demographic data, medical history, and occupation were investigated. Groups (higher level vs lower level) were divided on the basis of the median value of PChE. Mann-Whitney test, Pearson chi square, or Fisher's exact test was used for comparison between the two groups. Logistic regression was used for evaluation of factors having an effect on low level of PChE.
RESULTS:
Of a total of 353 residents, 28(7.9%) residents were engaged in agriculture, and had recently used insecticide. Sixteen (4.5%) residents had lower PChE levels out of normal range (5,400~13,200 U/L), and the lower group included 177 residents. Age of residents in the lower group was older, and the level of high-density lipoprotein (HDL) was lower, compared with those of the higher group. Older age and lower HDL levels indicated a risk of lower PChE in univariate logistic regression, however, the only risk factor in multivariate logistic regression was age.
CONCLUSION:
Many potential causes of lower PChE must be considered; genetics, chronic disease, hepatic failure, liver cirrhosis, malnutrition, tumor, infection, and pregnancy. In this study, the only risk factor was age. Future investigation of genetic factors and other risk factors contributing to lower PChE level in residents under 60 years of age will be necessary.

Key words: Pseudochoinesterase, Organophosphates, Carbamates