HILIC-UPLC-MS/MS在两起河豚中毒事件病因确证和病情预测中的应用研究  

Application of HILIC-UPLC-MS/MS in etiological confirmation and condition predictionin two cases of puffer fish poisoning

作　　者：赵凌国[1] 孙健[1] 刘勇 雷蕾[1] 尹江伟[1] ZHAO Lingguo;SUN Jian;LIU Yong;LEI Lei;YIN Jiangwei(Baoan District Center for Disease Prevention and Control,Shenzhen,Guangdong 518100,China;Shenzhen Hospital of Southern Medical University,Shenzhen,Guangdong 518100,China)

机构地区：[1]广东省深圳市宝安区疾病预防控制中心,广东深圳518100 [2]南方医科大学深圳医院,广东深圳518100

出　　处：《检验医学与临床》2023年第7期880-883,共4页Laboratory Medicine and Clinic

基　　金：广东省医学科学技术研究基金项目(A2021416)。

摘　　要：目的 建立河豚毒素(TTX)亲水液相色谱串联质谱检测方法,查明两起食物中毒事件原因,根据TTX摄入量和体内残留量对患者病情进行预测,并实施抢救,为此类中毒事件处置提供参考。方法 运用亲水液相色谱串联质谱技术对食物和人体样本中的TTX进行检测,评估患者毒素摄入量和体内残留量,预测患者病情和预后情况。结果 方法准确性、重现性和灵敏度良好。TTX在10~200 ng/mL水平,线性相关系数r>0.999。血液中TTX回收率为80%~103%,鱼肉中TTX回收率为75%~87%,相对标准偏差为5.3%~9.2%。血液和鱼肉中TTX检出限分别为0.2 ng/mL和3.7μg/kg。案例1中患者A的TTX摄入量约为0.28 mg,患者B摄入量约为0.04 mg。洗胃后,二者血液中TTX降为摄入量的10%,远远低于致死剂量(0.5 mg),患者预后良好。相反,案例2中,洗胃后患者C血液中TTX残留量为1.9 mg,远远高于致死剂量(0.5 mg),患者死亡。结论 该研究建立的亲水液相色谱串联质谱技术不仅可以为河豚中毒的诊断提供定性确证依据,还可以测定食品及人体中TTX水平,为TTX摄入量、体内残留量判断以及病情和预后评估提供依据。Objective To establish the detection method of HILIC-UPLC-MS/MS for tetrodotoxin(TTX),to find out the cause of two cases of food poisoning incidents,and to predict the patient′s condition and implement the rescue according to TTX intake and in vivo residual quantity so as to provide reference for similar poisoning incidents disposition.Methods The TTX levels in food and human body samples were detected by HILIC-UPLC-MS/MS.TTX intake and residual amount in vivo were evaluated and the patients′condition and prognosis were predicted.Results The method had good accuracy,reproducibility and sensitivity.TTX ranged 10-200 ng/mL,and the linear correlation coefficient r was>0.999.The TTX recovery rate was 80%-103%in the blood and 75%-87%in the fish meat with RSD of 5.3%-9.2%.The detection limit was 0.2 ng/mL and 3.7μg/kg for the blood and fish meat respectively.In case 1,the TTX intake of the patient A was about 0.28 mg,and that of the patient B was about 0.04 mg.After gastric lavage,the TTX level in their blood was decreased to 10%of their intake,which was far lower than the lethal dose of 0.5 mg.The prognosis of the patients was good.In contrast,in case 2,the blood residual amount of TTX in the patient C was 1.9 mg after gastric lavage,which was higher than the lethal dose(0.5 mg),and the patient died.Conclusion HILIC-UPLC-MS/MS established in this study can not only provide qualitative evidence for the diagnosis of puffer fish poisoning,but also measure TTX level in food and human body,and provide the evidence for judging the TTX intake,residual amount in body and assessing the disease condition and prognosis.

关 键 词：河豚 中毒 液相色谱串联质谱 河豚毒素 

分 类 号：R115[医药卫生—公共卫生与预防医学]