白毒伞中毒患者肝肾功能损害的超声显像研究——附9例报告

Ultrasound imaging characteristics of liver and kidney in 9 cases of amanita poisoning

目的研究急性白毒伞中毒的肝、肾功能及其二维显像的表现。方法用生化分析仪检测中毒者肝、肾功能变化,用西门子小狮王超声诊断仪观察患者的肝、肾、胆囊壁的影像改变。结果1例患者黄疸指数在治疗前、中、后无明显升高外,余均升高。所有患者肝功能各项指标在治疗期间均明显升高。2例患者治疗后期出现“胆酶分离”现象及肾功能(Cr)升高。所有患者二维超声检查肝脏各径线略增大、光点增粗、肝内胆小管变粗,肾集合系统回声增粗。2例死亡病例后期肝脏缩小,肝周有低回声带,肝内呈弥漫性改变,胆囊壁明显回声增厚,壁三线,肾脏增大,肾周低回声带。结论急性白毒伞中毒的肝、肾功能改变与肝、胆、肾超声显像改变基本一致,Cr升高在重症肝损害中出现,且在肝损害后发生,而肾超声表现为急性肾功能损害的声像早于Cr升高。表明超声影像学对白毒伞中毒不仅有辅助诊断的意义,而且对监护其临床疗效及预后有独特的作用。

Objective To study the ultrasotmd imaging characteristics of liver and kidney damaged by amanita poisoning. Method The hepatic and renal functions of 9 amanita poisoned patients were tested by HITACHI 7060 Automatical Analyzer, at the same time the uhrasotmd imaging changes were also observed using SIEMENS Prima SLC ultrasonic set before, during and after treatment. Result Of the 9 patients, 8 cases showed rising jaundice index. The sertan levels of ALT, AST, γ-GT, TBIL, DBIL and IBIL were all slightly increased during treatment of the 9 patients, in two patients ＂bilirabin-enzyme separation＂ phenomenon appeared, and urinary ereatinine （UCr） increased at the late period of treatment. The ultrasonic examination showed that all the pathway lines of livers were inereseent, the light dots became rough, the biliary ducts were enlarged, and the renal connecting tubules had much rough echo in all these patients. Two dead cases showed dwindled livers, low echo zones around the livers, diffuse changes in livers and obviously thickened gallbladderwalls in all three lines. Their kidneys were also enlarged and low echo zones also found around the kidneys. Conclusion The functional changes of liver and kidney during amanita peisoning were generally consistent with their changes in ultrasound imaging; the renal functional injury only was found in the patients with severe liver damage, and was posterior to the finding of liver damage, however, previous to the increase of urinary Cr, the ultrasound imaging already showed the abnormality of the kidney, that suggests that the nltrasotmd imaging has not only an important assistant value in the diagnosis of amanita peisoning, but also some special effect on clinical monitoring and prognosis of this disease.