聚醚酯类抗生素盐霉素中毒的诊治

Diagnosis and treatment of salinomycin poisoning： analysis of a case of collective food-borne poisoning with 14 patients

目的分析聚醚酯类抗生素盐霉素中毒的临床表现和诊治。方法对2008年2月山东一起群体性食源性盐霉素中毒案例的临床资料进行回顾性分析。结果一户村民举办家宴时误将盐霉素当成淀粉包裹鱼、鸡后油炸食用。19人就餐，14人中毒。食含盐霉素的食物后半小时患者陆续出现乏力、恶心、呕吐、四肢（主要为下肢）麻木、肌肉（主要为腓肠肌）酸痛。四肢肌力呈不同程度的降低，下肢明显，而痛、温、触觉均正常。尿呈酱油色。肌电图检查示神经传导正常。肌肉活检示横纹肌肿胀、纵纹和横纹模糊、伴有收缩带形成，间质水肿。尿蛋白阳性。心电图检查结果为窦性心动过速、QT间期延长。血清肌酸激酶（CK）、天门冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）明显升高。治疗以对症支持、维持水电及酸碱平衡治疗为主。入院首日均给与甲基强的松龙冲击治疗。予碳酸氢钠碱化尿液。重者血浆置换。最后12人痊愈，2人死亡。结论盐霉素中毒的主要病理变化为横纹肌溶解，主要临床表现为肌肉酸痛、肌酶升高。糖皮质激素冲击治疗可缓解病情。持续静滴碳酸氢钠碱化尿液、早期行血浆置换可防止急性肾功能衰竭。

Objective To analyze the clinical manifestations and treatment of poisoning of salinomycin, a polyether antibiotic. Methods The clinical data of a case of collective food-borne salinomycin poisoning involving 14 patients were retrospectively analyzed. Results To hold a family feast, a villager family in Shandong province made deep-fried fish and chicken wrapped with salinomycin taken for starch. Fourteen of the 19 eaters experienced nausea, vomiting, numbness of extremities （especially lower limbs）, aching and soreness of muscles （especially gastrocnemius）. The muscle tone was decreased to different degrees in the extremities （especially in the lower limbs）, and the pain sensation, thermal sensation, and tactile sensation were all normal. The urine appeared soy-sauce-colored. Urine protein was positive. Eleetromyography showed normal nerve conduction. Muscle biopsy showed swelling of striated muscle, blurredness of longitadinal and cross striations, formation of contraction bands , and edema of matrix. Electrocardiography showed sinus tarchycardia and elongation of QT-interval. The serum levels of creatinine kinase, aspartate transaminase, and lactate dehydrogenase were increased remarkably. Symptomatic therapy and maintenance of balance of water and electrolytes were the main therapeutic measurements. In the first day of hospitalization pulse therapy of glucocorticoid was given. Sodium bicarbonate was administered to alkalinize the ui-ine. Plasma exchange was conducted in the severely ill patients. At last 12 patients were cured and 2 died of. Conclusion The main pathological feature of salinomycin poisoning is rhabdomyolysis and the main clinical manifestations include increase of serum mescle enzymes. Pulse therapy of glucocorticoid helps relieve the condition. Alkalinization of the urine by continuous intravenous drip of sodium bicarbonate and early plasma exchange prevent acute renal failure.