山黧豆中毒引起的运动神经元损害的临床研究  

Study on motor neuron injury caused by Lanhyrus sativus poisoning

作　　者：郭菊英[1,2] 袁锦楣[1,2] 康德挡 

机构地区：[1]甘肃省人民医院神经内科 [2]北京医科大学第一附属医院神经内科

出　　处：《中华神经科杂志》1997年第4期223-226,共4页Chinese Journal of Neurology

摘　　要：目的探讨山黧豆ＬａｔｈｙｒｕｓＳａｔｉｖｕｓ中毒引起的运动神经元损害，以防止山黧豆对人体健康的损害。方法我们确定了山黧豆中毒的诊断标准：①有吃山黧豆的历史；②有中毒症状；③有锥体束征；④排除神经系统其他疾病。只有前２条标准，不诊断为山黧豆中毒，列为可疑病例。普查了２１２８名农民，并作了神经系统检查，确诊了山黧豆中毒病人，并进行治疗。结果我们所普查的２１２８名农民中发现１１９例中毒病人，占总普查人数的５．６％，其中男性９５例，女性２４例，主要的中毒症状和体征是：双侧下肢痉挛性无力，膝反射、跟踺反射亢进，有持续性或不持续踝阵挛，大多数病人有病理反射，少数病人有小腿肌肉萎缩。结论山黧豆中毒引起的运动神经元损害与过量进食山黧豆有关。山黧豆中含有β－草酰氨基丙氨酸等，结果表明每日食用兴奋性氨基酸，造成了氨基酸的代谢紊乱，这些兴奋性氨基酸引起兴奋性损害，主要为运动神经元变性，对山黧豆中毒的部分病人随访３～２３年无１例完全恢复。Objective The purpose of this report was to increase public awareness about the dangers of Lathyrus sativus consumption, and to describe the motor neuron lesion caused by lathyrus sativus. Method The diagnostic criteria for Lathyrism were as follows: 1) History of Lathyrus sativus consumption; 2) Symptoms of poisoning; 3) Pyramidal signs; 4) Absence of other neurological diseases Patients with only the first 2 criterria should be regarded as suspected cases. 2 128 subjects in the Gangu and Qin'an counties who were suspected of Lathyrus sativus consumption were examined. Results Lathyrism was diagnosed in 119 (5.6%) of the subjects. There were 95 males and 24 females. Their main poisoning symptoms and signs were spastic weakness of both lower extremities (60% of patients), and exaggerated knee and ankle reflexes (100% of patients). Ankle clonus, Babinski's sign and Chaddock'sign were positive in almost all patients. Muscular atrophy was found in a few patients. Conclusion Neurolathyrism is caused by excessive consumption of Lathyrus sativus. Beta N oxally amino alanine (BOAA) and Beta N Methyl Amino Alanine (BMAA) are isolated from the Lathyrus sativus. This suggests that a disturbance of amino acid metabolism may occur following consumption of Lathyrus sativus due to excitotoxic damage caused by BOAA, a dietary excitatory amino acid. The disease was associated with degeneration of motor neurons in all patients. Follow up ranging from 3 to 23 years was conducted for 24 patients, but none of them had fully recovered except some improvement.

关 键 词：山黧豆中毒 食物中毒 运动神经元损害 临床研究 

分 类 号：R595.706[医药卫生—内科学] R744.8[医药卫生—临床医学]