小龙虾致横纹肌溶解症197例临床分析

Clinical analysis of 197 cases of rhabdomyolysis induced by crayfish

目的总结和探讨2016年7月至8月南京医科大学第一附属医院集中收治的197例因食用“小龙虾”致横纹肌溶解症患者的临床特点及其发病原因。方法回顾性分析197例食用“小龙虾”致横纹肌溶解症患者流行病学特点、临床表现、实验室检查、相关治疗及预后。结果所有患者发病前12h内均有进食“小龙虾”史；均出现不同程度的颈腰背躯干部及四肢肌肉疼痛、乏力、尿色改变；实验室检查提示发病第1天血清肌红蛋白（myoglobin，MB）即达峰值，（2135±1547）μg／L（正常值为0～46μg/L）。血清肌酸激酶（creatine kinase，CK）（4657±2178）U／L（正常值为25～190U／L）、谷草转氨酶（aspartate transaminase，AST）（264±83）U／L（0—45U／L）、乳酸脱氢酶（lactate dehydrogenase，LDH）（1457±673）U／L（正常值为313—618U／L）均在第2天达峰值，其后逐渐下降。所有患者通过休息、补液、碱化尿液及预防并发症等治疗，均痊愈出院。结论2016年7月至8月发生的食用小龙虾导致横纹肌溶解的综合征，及时诊断和正确治疗，预后较好。

Objective To summarize and evaluate the clinical features, therapeutic methods and prognosis of 197 cases with eating crayfish caused rhabdomyolysis in our hospital within July, 2016 to August, 2016. Methods Using retrospective method, 197 rhabdomyolysis cases induced by eating crayfish were admitted into study. Data of epidemiological character, clinical features, therapy protocol and prognosis were collected and analyzed. Results All the patients had the experience of eating crayfish within 12h before the onset. Patients in this cohort had the common symptoms but varying degrees of myalgia, fatigue of the whole body muscles, and urine color change. Laboratory tests revealed： On day 1 of onset, serum myoglobin level had raised up to the peak with average level at （2 135 ± 1 547） μg/L （0-46 μg/L） . Creatine kinase with average level at （4 657 ±2 178） U/L （25-190 U/L）; Aspartate transaminase with average level at 264 ± 83 U/L （ 10-45 U/L） ; Lactate dehydrogenase with average level at （ 1 457 ± 673 ） U/L （313-618 U/L）, all these three markers reached peak on day 2, then gradually declined. All the patients recovered and discharged after relaxation, fluid infusion, alkalization of urine and dealing with the complications. Conclusion Timely diagnosis and treatment of the rhabdomyolysis syndrome induced by eating crayfish could indicate favorable prognosis in these patients from July, 2016 to August, 2016.