医源性肉毒素中毒误诊一例并文献复习  

Misdiagnosis of iatrogenic botulinum toxin poisoning:one case report and review of the literature

作　　者：徐霁 王柳清 张守成 王虹[3] 蔡晧东[4] Xu Ji;Wang Liuqing;Zhang Shouchen;Wang Hong;Cai Haodong(Department of Endocrinology,Gaochun People's Hospital of Nanjing,Nanjing,Jiangsu 211300,China;Department of Neurology,Gaochun People's Hospital of Nanjing,Nanjing,Jiangsu 211300,China;Department of Neurology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China;Liver Disease Center of Beijing Ditan Hospital,Beijing 100053,China)

机构地区：[1]南京市高淳人民医院内分泌科,211300 [2]南京市高淳人民医院神经内科,211300 [3]温州医科大学附属第一医院神经内科,325000 [4]北京地坛医院肝病中心,100053

出　　处：《中国基层医药》2020年第4期417-422,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的报道1例误诊为重症肌无力的医源性肉毒素中毒病例,结合文献,分析医源性肉毒素中毒的临床表现、诊疗及预后.方法1例26岁女性患者于2017年6月7日入住南京市高淳人民医院神经内科,患者短时间内2次注射肉毒素共500 U后出现全身乏力、胸闷、眼睑下垂等不适症状.诊疗过程中被误诊为重症肌无力,后经仔细体格检查(下颌肿胀)、多次询问病史等,最终明确为肉毒素中毒诊断.经10余天补液、促代谢等对症处理后,患者不适症状好转.检索PubMed数据库、CNKI和万方医学数据库等,共检索到医源性肉毒素中毒的病例报告文献33篇,其中纳入分析的文献共17篇,包括了30例有效病例.对这30例患者的一般特点、肉毒素注射后中毒发病时间、临床表现、预后等进行统计分析.结果30例患者中女性28例,男性2例,年龄范围3~80岁.除2例不详外,余均为A型肉毒素中毒.发生肉毒素中毒最早为使用肉毒素当天,最晚为注射后3周.病程持续10 d至6个月.经积极治疗后,多数预后尚可.结论临床应高度重视医源性肉毒素相关性不良反应,把控适应证,确保用药安全.Objective To report 1 case of iatrogenic botulinum poisoning misdiagnosed as myasthenia gravis,to discuss the clinical manifestation,distinguishing feature and prognosis of iatrogenic botulinum poisoning combined with literature.Methods We briefly introduced one patient with botulinum toxin poisoning misdiagnosed as myasthenia gravis.A 26-year old female was admitted in June 2017 in Gaochun People's Hospital of Nanjing,who received two injections of botulinum toxin 500 U for a short period of time due to cosmetic needs,then she suffered from fatigue,chest distress,eyelid ptosis and other symptoms.The patient was once misdiagnosed as myasthenia gravis,but the results of neostigmine test and repeated nerve stimulation examination were negative.After careful examination of the body(mandibular swelling)and repeated medical history requiring,the final diagnosis was clarified.After the treatment such as fluid infusion for 10 days,her discomforts were relieved.The literature was retrieved from"US National Library of Medicine National Institutes of Health(Pubmed)","China National Knowledge Infrastructure(CNK1)"and"Wanfang Medicine Data China Information",a total of 17 articles were included in the analysis,including 30 effective cases.We analyzed the general characteristics,clinical manifestations and prognosis of botulinum toxin injection.Results Of the 30 cases,28 cases(96.7%)were female,2 cases(3.0%)were male,aged from 3 to 80 years old.Most of them were botulinum toxin type A,except 2 cases unknown.The clinical onset began from the injection day to 3 weeks after injection.The duration of the disease lasted from 10 days to 6 months.Most of the prognosis was good after treatment.Conclusion Careful attention should be paid to the serious reaction of botulinum toxin to ensure safe medication use.

关 键 词：肉毒毒素类 A型肉毒毒素 医原性疾病 外科 整形 肌无力 肌电描记术 肉毒抗毒素 数据库 文献型 

分 类 号：R74[医药卫生—神经病学与精神病学] R5[医药卫生—临床医学]