白毒伞中毒与重型肝炎的鉴别  

Clinical differences between amanita verna poisoning and severe hepatitis

作　　者：邢文斌 刘丽娜[2] 吕申[3] 

机构地区：[1]大连市第六人民医院传染科,大连市116024 [2]大连医科大学附属第一医院消化科 [3]大连医科大学附属第二医院分子生物学实验中心

出　　处：《中华实验和临床感染病杂志（电子版）》2012年第2期39-41,共3页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的通过对白毒伞中毒与重型肝炎临床表现及生化指标的对比分析,对二者进行鉴别,以避免临床中的误诊、误治。方法对5例白毒伞中毒患者和7例急性或亚急性重型病毒性肝炎患者的临床表现及生化指标进行对比分析。结果白毒伞中毒与重型肝炎患者均出现恶心、呕吐,皮肤、巩膜黄染等临床症状,同时伴有肝功能改变。多数患者疾病晚期因多脏器功能衰竭而死亡。白毒伞中毒患者早期无发热,伴有严重的腹痛、腹泻,存在假愈期,以多尿和消化道出血多见;重型肝炎患者则多出现发热,无严重的腹痛、腹泻,无假愈期,以少尿多见,且消化道出血少见。白毒伞中毒患者血球蛋白、血小板显著减少,而重型肝炎患者则减少不明显。结论白毒伞中毒和重型肝炎患者的临床症状、体征及生化指标尽管存在许多相似之处,但应仔细鉴别其不同点,避免误诊和误治。Objective To identify the clinical characteristics of amanita verna （AV） poisoning and acute or subacute severe hepatitis and to avoid the misdiagnosis and mistreatment.Methods Clinical manifestations and the values of biochemical tests between 5 cases with AV poisoning and 7 cases with acute or subacute severe hepatitis were analyzed, comparatively. Results The common symptoms in the two groups were nausea, vomiting and signs of skin and sclera jaundice, complicated with liver function change. The majority of patients with advanced diseases died of multiple organ failure. Patients with AV poisoning complicated with severe abdominal pain and diarrhea and followed by polyuria. Gastrointestinal bleeding occurred in the endstage. Patients with severe hepatitis usually sufferred from fever and oliguria, abdominal pain and diarrhea were usually slight. The values of biochemical tests, globulin and platelet counts of poisoning group significantly reduced, which reduced slightly in hepatitis group. Conclusions Amanita poisoning and severe hepatitis patients are with the similiar clinical symptoms, signs and indexes of biochemical tests,the differences of which should be identified carefully in order to avoid the misdiagnosis and mistreatment.

关 键 词：白毒伞 肝炎 重型 临床特征 诊断 鉴别 

分 类 号：R595.4[医药卫生—内科学] R575.1[医药卫生—临床医学]