美容局部注射A型肉毒毒素后全身无力临床分析(附三例报道)

Clinical characteristics of generalized muscular weakness following cosmetic injections with botulinum A: Report of three cases

目的分析局部注射A型肉毒毒素致全身无力的临床表现及实验室检查特点,并初步探讨其发病机制。方法对作者医院2007—2009年收治的3例因美容局部注射A型肉毒毒素后出现全身无力患者的临床特点和电生理检查资料进行回顾性分析,并行相关文献复习。结果 3例患者于美容局部注射A型肉毒毒素后2～7 d后出现眼外肌麻痹、双侧周围性面瘫、延髓麻痹、四肢无力等全身肌无力症状,电生理检查结果显示除存在神经肌肉接头功能异常外,还出现周围神经源性或肌源性损害的表现。临床症状多在4周左右开始好转,半年左右完全恢复正常。其中1例进行毒素效价检测显示实际效力相当于标示剂量的6倍。结论美容局部注射A型肉毒毒素中毒往往与药品剂量过大有关。提高对其临床表现、电生理特点以及发病机制的认识有利于对其进行诊断和治疗。

Objective To analyze the clinical and laboratory examination characters of the generalized muscular weakness following local injections with botulinum toxin A and to make preliminary discussion on its pathogenesis. Methods Retrospective analysis on the clinical manifestations and electrophysiologic characters of 3 inpatients admitted date from 2007 to 2009, all of them had generalized muscular weakness following cosmetic injections with botulinum toxin A and the related literatures were reviewed. Results Three patients developed generalized muscular weakness in 2 days to 1 week after local injections with botulinum toxin A. They had diplopia, bilaterally facial palsy, dysarthria, dysphagia and limb weakness. Results in electrophysiologic examinations showed the synaptic abnormality, while the phenomena of peripheral neuropathy and myopathy also appeared. The muscle weakness always improved in about 4 weeks, disappeared in half a year. The toxic effect of botulinum toxin A from the blood of one patient was tested, its practical toxicity was 6 times higher than that of standard botulinum toxin A commercially labeled. Conclusions Intoxication following cosmetic injections with botulinum toxin A was often due to the over-dose. Doctors should be familiar with its manifestation, electrophysiologic characters and pathogenesis. Patients could benefit from quick diagnosis and effective therapy.