注射性肉毒毒素中毒的诊治

Botulism induced by unlicensed injection of botulinum neurotoxins

目的探讨注射性肉毒毒素中毒的临床表现和治疗方法。方法根据临床表现对肉毒毒素中毒的13例患者进行分级并给予相应的治疗，观察病程变化和持续时间。结果13例患者中1例为轻度肉毒毒素中毒，其余12例均为中度中毒。注射性肉毒毒素中毒病程通常分为潜伏期（4．0d）、加重期（9．8d）、高峰期（9．1d）和恢复期（5．2个月）；注射剂量与潜伏期负相关，与加重期正相关。结论肉毒毒素中毒，在注射后2～3周内症状可能加重，必须密切观察；在治疗上需要积极的对症和支持治疗，严格卧床休息有助于症状的缓解。

Objective To illustrate and analyze the clinical feature and treatment of botulism introduced by illegal injection of botulinum neurotoxins （BoNT）, in order to provide some evidence for early diagnosis and treatment strategy. Methods Retrospective analysis of 13 botulism patients was performed in this article. All of the patients were suffered from illegal injection of botulinum neurotox- in products. Support treatments were carried out according to their severe grade, and the courses of disease and the curative effects were observed. Results A new category was first identified as ＂injection induced botulism＂ to describe such a situation of cosmetic injection out of the hospital with neither the prescribed botulinum toxin product nor a doctor. One in 13 patients graded mild botulism, the other 12 patients graded middle level. The processes of the new botulism had 4 stages： preclinical stage （4 days）, progressive stage （9.8 days）, apical stage （9.1 days） and restoration stage （5.2 months）. The relationships of a positive correlation in injection dose and the length of progressive stage were identified, while a negative correlation with the length of preclinical stage was revealed. Conclusions The earlier2-3 weeks after illegal injection are crucial for intense care because of the acceleration in this period. Absolute rest and active treatments as well as antitoxinum are benefit for the recovery of patients.