欧氏鹅膏中毒乳酸脱氢酶升高及预后分析

Elevation of lactate dehydrogenase in Amanita oberwinkleran poisoning and prognostic analysis

目的分析欧氏鹅膏毒蕈中毒临床表现、乳酸脱氢酶(LDH)变化及预后,为欧氏鹅膏中毒的诊疗提供依据。方法回顾性分析2019年1月至2022年12月湘雅常德医院12例欧氏鹅膏毒蕈中毒患者临床资料,总结其临床表现、肾功能和LDH变化及预后特点。所有数据使用SPSS 25.0进行统计分析,比较采用成组t检验,相关性分析采用散点图和Pearson相关系数法,以P<0.05为差异有统计学意义。结果12例患者潜伏期6-18h,早期临床表现为恶心、呕吐,3例早期有短暂多尿,都出现急性肾功能衰竭表现和轻度肝功能损害。本组病例LDH明显升高,平均峰值超2000U/L,与同期收治的其他类型毒蕈中毒病例比较,差异有统计学意义(P<0.01),比文献报道的其他病因所致的LDH升高更显著。LDH升高水平跟患者肾功能损害程度无明显相关,但与病程长短呈正相关。12例患者经血液净化等治疗均治愈,预后良好,病程20~60 d,无转为慢性肾衰及死亡病例。结论欧氏鹅膏中毒表现为早期原发性急性肾损伤,LDH显著升高且持续高值可能为其特有表现,LDH升高水平跟患者肾功能损害程度无明显相关,但与病程长短呈正相关,12例患者经过治疗均获得良好预后。

Objective To investigate the clinical characteristics,changes in lactate dehydrogenase(LDH)levels,and prognosis in cases of Amanita oberwinklerana poisoning.Methods A retrospective analysis was conducted on the clinical data of 12 patients who were diagnosed with Amanita oberwinklerana poisoning at Xiangya Changde Hospital between January 2019 and December 2022.The analysis included an assessment of clinical manifestations,renal function changes,LDH levels,and patient prognosis.All statistical analyses were performed using SPSS25.0 Comparisons of ratios between groups were performed using the t test,correlation analyses were performed using scatter diagram and Pearson correlation method,P<0.05 was considered statistically signifi cant.Results The latency period for symptom onset ranged from 6 to 18 hours,with early symptoms primarily consisting of nausea and vomiting.Three patients developed anuria in the early stage.All patients experienced acute kidney injury(AKI)accompanied by mild liver injury.LDH levels were significantly elevated compared to other types of mushroom poisoning cases(P<0.01),with a mean peak value exceeding 2000 U/L.While no correlation was found between LDH levels and kidney injury severity,a positive correlation was observed between LDH levels and length of the course.All 12 patients recovered following dialysis treatment,with recovery periods ranging from 20 to 60 days.No cases of chronic renal failure or mortality were reported.Conclusions Amanita oberwinklerana poisoning primarily causes acute renal injury.A significant elevation in LDH levels may serve as a potential marker for this type of poisoning.LDH levels did not correlate with kidney injury severity,while positively corrected with the length of the course.All patients in this study achieved good prognosis with full renal recovery.