食物中毒诱发急性肾功能衰竭100例临床分析

An analysis of 100 patients with acute renal failure caused by food poisoning in west China

目的 :探讨食物中毒致急性肾功能衰竭 (ARF)的临床特点。 方法 :对 1 0 0例食物中毒致ARF患者的临床资料进行回顾性比较分析。 结果 :1 0 0例食物中毒致ARF病例中 ,毒蕈中毒 71例、鱼胆中毒 2 9例。其中以农民居多 (64例 )。ARF临床表现为少尿型 97例 ,非少尿型 3例。患者就诊时平均血清尿素氮为 (2 8 9± 1 1 4)mmol/L、平均血清肌酐为 (1 32 8 5± 470 3) μmol/L ,伴肝功能损害 69例 (以鱼胆中毒者发生率最高 )。高钾血症 1 3例、低钾血症 37例 (少尿期 2 6例、多尿期 1 1例 )。痊愈 79例、好转 1 8例 ,未愈 3例 (自动出院 ) ,早期洗胃和及时的透析治疗有助于食物中毒性ARF的恢复。食物中毒患者的治愈率较败血症及感染休克所致的ARF患者明显升高(P <0 0 0 5)。 结论 :引起四川地区食物中毒ARF的主要食物是毒蕈及鱼胆。临床表现为少尿型ARF及肝毒性ARF ,恢复较快 ,预后相对较好。

Objective:To investigate the clinical features of acute renal failure(ARF)caused by food poisoning in west China. Methodology:Clinical data of 100 food poisoning associated ARF patients were studied retrospectively and compared with ARF patients of other causes. Results:Among the 100 patients(45 females and 55 males),71 were associated with mushroom and 29 with fish bile.The mean age was (37 7±14 4) years,with the range between 13 76 years.64 of the 100 patients were peasants.97 patients presented with oliguria and 3 patients without oliguria.The average duration of oliguria was (8 77±2 78) days(ranging from 3 to 17 days).At presentation,the average blood urea nitrogen (BUN)was (28 9±11 4) mmol/L, and serum creatinine(1328 5±470 3) μmol/L.Hyperkalemia is presented in 13 cases,and hypokalemia presented in 26 during oliguric phase and 11 during polyuric phase.Metabolic acidosis appeared in 87 cases.Liver damage presented in 69 cases,with 26/29 in fish bile associated ARF and 43/71 in mushroom associated ARF.Of the 100 patients,79 patients were cured with their serum creatinine level returned to normal range,18 improved before discharge and 3 patients discharged without any funther treatment.As compared to ARF of other causes,food poisoning associated ARF is much better in prognosis. Conclusion:Mushroom and fish bile is the common causes in food poisoning in Sichuan province,China.Clinical features of mushroon and fish bile associated ARF include oliguria,impaired liver function and GI symptoms.Outcome of ARF caused by food poisoning is better than those of other causes.Promotion of public health knowledge in rural areas is in great need to prevent food poisoning and the food poisoning associated ARF.