2015-2021年北京市两家儿童医院18例婴儿肉毒中毒分析  

Analysis on 18 cases of infant botulism in two children's hospitals in Beijing,2015-2021

作　　者：徐黎霞 王舒萍 王丽娟[3] 李楠[3] 黄英[4] 赵红庆[4] 徐雪芳[4] 卓秀伟[3] 张必科 Xu Lixia;Wang Shuping;Wang Lijuan;Li Nan;Huang Ying;Zhao Hongqing;Xu Xuefang;Zhuo Xiuwei;Zhang Bike(Quzhou Municipal Meternal and Child Health Care Hospital,Quzhou 324000,Zhejiang,China;Xing'an League Agricultural and Animal Husbandry Science Research Institute,Xing'an League 137400,Inner Mongolia,China;National Children's Medical Center,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases,National Institute for Infectious Disease Control and Prevention,Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]衢州市妇幼保健院,浙江衢州324000 [2]兴安盟农牧科学研究所,内蒙古兴安盟137400 [3]国家儿童医学中心,首都医科大学附属北京儿童医院,北京100045 [4]中国疾病预防控制中心传染病预防控制所,传染病溯源预警与智能决策全国重点实验室,北京102206

出　　处：《疾病监测》2024年第6期794-798,共5页Disease Surveillance

基　　金：国家重点研发计划(No.2021YFC2600501)。

摘　　要：目的对2015年5月至2021年4月北京市两家大型儿童医院收治的婴儿肉毒中毒病例进行临床症状和流行病学特征分析,为婴儿肉毒中毒检测、诊断、治疗和预防提供科学的指导。方法收集2015年5月至2021年4月北京市两家儿童医院收治的18例婴儿肉毒中毒病例的年龄、性别、发病时间、地区分布、临床症状和治疗以及实验室毒素检测和分离菌株血清型别等信息进行分析。结果18例病例男女性别比为2.00∶1,最低年龄为3月龄,中位年龄为6月龄,最大发病年龄8月龄。发病地区最多的为河北省和北京市,发病人数有逐年增加的趋势,第一季度发病人数最少,其他季度相差不大。临床症状全身乏力和便秘最为多见。血清型检测结果以B型为主要型别,占94.00%(18例中,B型17例)。检测方法中,实时荧光定量聚合酶链式反应(PCR)法和小鼠实验最灵敏,培养分离法次之。结论检测方法中荧光定量PCR法具有快速简单的优点,可作为日常检测手段。临床诊疗中若有不明原因全身乏力和便秘,应考虑婴儿肉毒中毒并将粪便和血清送相关部门检测。高发地区相关医疗单位应组织培训提高临床医生及相关人员对肉毒中毒的认识,加大对婴儿肉毒中毒的宣传并提高诊治水平;同时需及时储备相应血清型抗毒素,发生肉毒中毒后早期足量使用肉毒抗毒素是救治生命的关键措施,必要时需要呼吸机辅助呼吸。Objective To analyze the clinical symptoms and epidemiological characteristics of infant botulism cases admitted to two large children's hospitals in Beijing from May 2015 to April 2021 and provide evidence for the detection,diagnosis,treatment and prevention of infant botulism.Methods The information of 18 cases of infant botulism admitted to two children's hospitals in Beijing during this period,including age,sex,time of onset,area distribution,clinical symptoms,treatment,laboratory toxin detection and serotype of isolated strains were collected for a descriptive analysis.Results The male to female ratio of the 18 cases was 2.00∶1.The cases were aged 3-8 months,the median age was 6 months.The cases mainly occurred in Hebei and Beijing,and the case count increased year by year.The annual case count was lowest in the first quarter,and it was similar in other quarters.General fatigue and constipation were the most common clinical symptoms.Serotype test results showed that serotype B was predominant,accounting for 94.00%(17 cases).Real-time fluorescence quantitative polymerase chain reaction(PCR)and mouse test were the most sensitive methods,followed by culture and isolation.Conclusion Real time PCR has the advantage of fast and simple,and can be used as a routine detection method.If case has unexplained general fatigue and constipation,infant botulism should be considered in clinical diagnosis and treatment and case's stool and serum samples should be taken for testing.In the area with high incidence of infant botulism,it is necessary to conduct or strengthen professional training in physicians to improve their understanding and diagnosis of infant botulism.Meanwhile,the timely stockpile of serotype specific antitoxin should be made.The early use of adequate botulism antitoxin in treatment is a key measure to save life,and ventilator is needed to assist breathing when necessary.

关 键 词：婴儿肉毒中毒 实验室诊断 实时荧光定量聚合酶链式反应 毒素 

分 类 号：R211[医药卫生—中医学] R725.9