中国新疆维吾尔自治区67例肉毒中毒患者临床分析  

Clinical characteristics among 67 cases of botulism in Xinjiang Uygur Autonomous Region,China

作　　者：古丽巴哈热木·亚力洪 马鑫[2] 李方[2] 苏静[2] 孟卫卫[2] 刘萍 马娟 王晓蓓 吴勤奋 Yalkun Gulbahram;Ma Xin;Li Fang;Su Jing;Meng Weiwei;Liu Ping;Ma Juan;Wang Xiaobei;Wu Qinfen(The First Department of Neurology,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830017,China;Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention,Urumqi 830002,China)

机构地区：[1]新疆医科大学第二附属医院神经内一科,乌鲁木齐830017 [2]新疆维吾尔自治区疾病预防控制中心,乌鲁木齐830002

出　　处：《中华神经科杂志》2023年第4期419-426,共8页Chinese Journal of Neurology

基　　金：2021年自治区创新环境建设专项-资源共享平台建设(PT2109)。

摘　　要：目的评估中国新疆维吾尔自治区肉毒中毒患者的流行病学和临床特点、预后和相关因素,以及接受抗毒素治疗后发生不良反应的人群特点。方法回顾性收录自2017年1月至2021年12月于新疆医科大学第二附属医院出院的肉毒中毒患者临床信息。分析肉毒中毒患者流行病学和常见症状/体征;以是否发生院内感染、机械通气为终点分析上述变量的组间差异,进行分组和组间比较;对比抗毒素治疗后发生与未发生不良反应的人群特点,进行分组并对比组间差异。结果共纳入67例肉毒中毒患者,发病时间最常见于1—3月份(32例,47.8%);62例(92.5%)患者为汉族;发病率最高区域为阿克苏地区(15例,22.4%);肉毒中毒患者常见症状/体征包括乏力58例(86.6%),饮水呛咳/吞咽困难48例(71.6%),头晕42例(62.7%),眼睑下垂/睁眼费力42例(62.7%),视物模糊41例(61.2%),肢体无力35例(52.2%)等。共有15例(15/67,22.4%)发生院内感染。与未发生院内感染组(n=52)相比,院内感染组(n=15)严重程度更重(重度比例分别为0/52比5/15,χ^(2)=19.79,P<0.001),复视(16/52,30.8%比11/15,χ^(2)=8.77,P=0.003)、言语含混(17/52,32.7%比11/15,χ^(2)=7.91,P=0.005)、意识障碍(1/52,1.9%比4/15,χ^(2)=10.32,P=0.008)者比例更高。共5例患者有机械通气(5/67,7.5%)。有机械通气组(n=5)和无机械通气组(n=62)比较,前者严重程度更重(重度比例分别为5/5比0,χ^(2)=41.17,P<0.001),有意识障碍者(4/5比1/62,1.6%,χ^(2)=29.58,P<0.001)更多。共19例(28.4%)患者在使用抗毒素后发生不良反应,其中18例(94.7%)表现为皮疹,从开始使用抗毒素到发生不良反应的平均天数为6.5 d;接受抗毒素治疗后发生(n=19)与未发生不良反应组(n=48)之间在年龄、性别、严重程度分布上差异无统计学意义。结论中国新疆维吾尔自治区肉毒中毒患者最常见的临床表现包括乏力、饮水呛咳/吞咽困难、头晕、眼睑下垂/睁眼费力等。感染为肉�Objective To investigate epidemiological and clinical characteristics of botulism,and the adverse events among those received botulinum antitoxin treatment.Methods Patients with discharge diagnosis as botulism in the Second Affiliated Hospital of Xinjiang Medical University were enrolled between 2017 and 2021.The epidemiological and clinical characteristics were evaluated.Infection and mechanical ventilation as in-hospital outcomes according to baseline characteristics were analyzed.Patients with and without the interested outcomes were compared.The adverse outcomes among those received botulinum antitoxin treatment were investigated.Those with and without the adverse outcomes were also compared.Results Sixty-seven cases of botulism were enrolled,and most cases got sick between January and March(32/67,47.8%);among them 62 cases were Han ethnicity(92.5%);prevalence was highest in Aksu region(15/67,22.4%);commonly seen symptoms and signs included fatigue(58/67,86.6%),dysphagia(48/67,71.6%),dizziness(42/67,62.7%),ptosis(42/67,62.7%),blurred vision(41/67,61.2%),and limb weakness(35/67,52.2%).Compared with patients without in-hospital infection(n=52),patients with in-hospital infection(n=15)were more likely to have severe botulism(0/52 vs 5/15,χ^(2)=19.79,P<0.001),diplopia(16/52,30.8%vs 11/15,χ^(2)=8.77,P=0.003),dysarthria(17/52,32.7%vs 11/15,χ^(2)=7.91,P=0.005),consciousness disorder(1/52,1.9%vs 4/15,χ^(2)=10.32,P=0.008).Compared with patients without mechanical ventilation(62/67,92.5%),patients with mechanical ventilation(5/67,7.5%)were more likely to have severe botulism(5/5 vs 0/62,χ^(2)=41.17,P<0.001),and consciousness disorder(4/5 vs 1/62,1.6%,χ^(2)=29.58,P<0.001).Among 67 cases of botulism,19 cases(28.4%)had adverse events after receiving antitoxin treatment,with an average of 6.5 days from the antitoxin treatment beginning to the adverse event onset;among the 19 cases,18 cases(94.7%)had rash.Age,sex,and severity did not differ between the groups with(n=19)and without adverse events(n=48)after receiving a

关 键 词：肉毒中毒 流行病学 感染 肉毒抗毒素 不良反应 

分 类 号：R595[医药卫生—内科学]