毒蕈中毒3638例临床分型的探讨

A study of the clinical classification of 3638 cases of mushroom poisoning

目的提高对毒蕈中毒的认识和认知,探讨毒蕈中毒的临床分型、特征和预后。方法检索国内1995年1月至2004年12月公开发表的毒蕈中毒191篇文献,共报道了毒蕈中毒3466例,我院1980年1月至2004年12月收治的毒蕈中毒患者172例,共3638例毒蕈中毒患者进行临床分型的探讨。结果胃肠炎型571例,全部治愈;急性肾衰竭型1450例,治愈1414例(97.5%),死亡36例(2.5%);中毒性肝炎型1010例,治愈841例(83.3%),死亡169例(16.7%);神经精神型214例,治愈197例(92.1%),死亡17例(7.9%);溶血型73例,治愈71例(97.3%),死亡2例(2.7%),不同类型毒蕈中毒疗效和预后差异有统计学意义(P<0.001)。分型不详者320例,其中以多器官功能障碍综合征者222例,治愈98例(44.1%),死亡124例(55.9%),无法分型者98例,治愈90例(91.8%),死亡8例(8.2%)。结论毒蕈中毒患者的临床表现和中毒发生机制非常复杂,毒蕈中毒的类型和分型应符合临床报道的病例资料及特征,教科书和专著报道的毒蕈中毒分为4型,这与毒蕈中毒临床实际情况和本研究结果不相符。因此,根据本研究3638例毒蕈中毒资料,临床应分为5种类型:(1)胃肠炎型;(2)急性肾衰竭型;(3)中毒性肝炎型;(4)神经精神型;(5)溶血型。是否存在混合型,有待进一步观察更多的毒蕈中毒临床病例资料。

Objective To study the clinical classification and characteristics as well as prognosis of mushroom poisoning. Methods We retrospectively analyzed 191 papers published domestically for 3466 cases of mushroom poisoning from 1995 to 2004 and studied the Xinqiao Hospital data of 172 cases of mushroom poisoning treated from 1980 through 2004. We made a retrospotive investigation and clinical classification of all the 3638 cases of mushroom poisoning. Results Among the 3638 patients , clinical manifestations as gastroenteritis were found in 571, all of them were cured. The most common symptoms were those of acute renal failure being found in 1450 cases; 1414 were cases （97.5%） and 36 died （2. 5% ）. Symptoms of toxic hepatitis were found in 1010 cases, 841 were cases（83.3% ） and 169 died （ 16. 7% ）. Psychoneurological disorder was manifested in 214 cases; 197 were cases（92. 1% ） and 17 died （7.9%）. Erythrolysis was found in 73 cases; 71 were cases （ 97.3% ） and 2 died （ 2. 7% ）. The therapeutic effect and prognosis of mushroom poisoning with different clinical manifestation varied very significantly （P〈0.001）. Of the 320 cases clinically unclassified , multiple organ dysfunction syndrome was found in 222 cases; 98 were cases（44. 1% ） and 124 died （55.9%）. Definite classification could not be made in 98 cases; 90 were cases （91.8%） and 8 died （8. 2% ）. Conclusions The clinical classification of mushroom poisoning was usually of four types as described in the textbooks or special articles, but it should be of five types according to the analysis of the data of the present study, i. e. gastroenteritis type, acute renal failure type, toxic hepatitis type, psychoneurological disorder type and erythrolysis type. It is not clear whether there is a mixed type or not. Further investigation is needed in this respect.