欧式鹅膏毒蕈中毒肝肾损伤的临床病理特点

Clinical pathologic features of liver and kidney injury caused by amanita oberwinklerana poisoning

目的:了解欧式鹅膏毒蕈中毒临床病理特点,为临床医师提供准确的临床病理信息。方法:收集的一家3例毒蕈中毒患者的病例资料、对毒蕈样本进行形态学和分子生物学鉴定,同时结合患者临床、实验室检查以及病理特点进行分析。结果:3例患者均食用自行采摘并烹制的蘑菇,用量不等,潜伏期8~12h,恶心、呕吐胃肠道症状后出现急性肾损伤和轻度肝损伤,经毒蕈形态学和分子生物学鉴定,确定为欧式鹅膏。给予血液净化和激素等对症支持治疗后,肝肾功能逐渐恢复。肾活检病理提示急性肾小管坏死伴急性间质性肾炎。结论:欧式鹅膏毒蕈中毒可引起严重急性肾损伤和轻度肝损伤表现,肾脏病理表现为急性肾小管坏死和急性间质性肾炎,经积极救治临床结局较好。

Objective: To understand clinical and pathological characteristics as well as the clinical prognosis of the Amanita oberwinklerana toxic mushroom poisoning,and to provide accurate information for clinical physicians.Methodology: We found a family of 3 members who eating self picking and cooking mushrooms. Clinical investigation,morphology and molecular biology identification of mushroom samples at the same time,combined with the clinical,laboratory examination and pathological features of the patients were analyzed. Results: The incubation period of 8 to 12 hours,nausea,vomiting,gastrointestinal symptoms secondary oliguria and severe acute renal injury and mild liver damage.According to the morphology and molecular biology identification,the toxic mushroom was identified as Amanita oberwinklerana.Given the continuous blood purification and steroid,liver and kidney function recovered gradually,Renal biopsy pathology showed acute tubular necrosis with acute interstitial nephritis. Conclusion: Amanita oberwinklerana poisoning can cause severe acute kidney injury and mild liver damage,kidney pathology demonstrated acute tubular necrosis and acute interstitial nephritis,the clinical outcome is good after active treatment.