珠海市四个家庭雪卡毒素食物中毒调查

Investigation on cigartoxin food poisoning of four families in Zhuhai

目的了解雪卡毒素中毒的原因、临床症状及流行病学特征,预防再次发生雪卡毒素中毒。方法通过描述性流行病学方法分析病例的临床资料、流行病学特征及相关危险因素,采用高效液相色谱-串联质谱仪对采集样本进行雪卡毒素定性分析。结果在中毒事件涉及4个家庭中,中毒14人,无死亡病例。发病潜伏期为0.5～5.5 h(中位数3 h)。临床症状主要表现为消化系统症状(腹泻85.7%、呕吐78.6%)、神经系统症状(四肢麻木71.4%、肌肉痛42.9%、口舌麻木42.9%、皮肤瘙痒42.9%、视力模糊35.7%、温度感觉倒错28.6%)、心血管系统症状(心率过缓42.9%、低血压28.6%)等。经流行病学调查发现,四个家庭购买了同一条海鳗的不同部位,所有病例均有进食,病情轻重与进食量呈剂量反应关系。剩余海鳗样品经高效液相色谱-串联质谱仪多反应检测技术分析,提取出1093.5、1075.4、1057.5、1039.5雪卡毒素四个特征子离子。结论本次事件为一起进食海鳗引起的雪卡毒素食物中毒,关键的预防控制措施是加强雪卡毒素食物中毒知识宣传和深海鱼类管理。

Objective To explore the cause of cigartoxin,clinical symptoms and epidemiological characteristics,and prevent the recurrence of cigartoxin food poisoning.Methods Clinical characteristics,epidemiological characteristics and related risk factors were analyzed by descriptive epidemiological methods,and cigartoxin qualitative analysis was performed by high performance liquid chromatography（HPLC）coupled with tandem mass spectrometry（MS/MS）.Results Four families were involved in the incident,14 persons were poisoned,and no deaths.The incubation period was 0.5-5.5 hours（median 3 hours）.Clinical symptoms were mainly digestive system symptoms（diarrhea 85.7%,vomiting 78.6%）,nervous system symptoms（limbs numbness 71.4%,muscle pain 42.9%,tongue numbness 42.9%,skin itching 42.9%,blurred vision 35.7%,temperature perception 28.6%）,cardiovascular system symptoms（heart rate slow 42.9%,hypotension 28.6%）.Four families bought different parts of the same eel,and all cases ate it.The severity of disease was in a dose-response relationship with food intake.The residual eel samples were analyzed by HPLC-MS/MS,and four ciguatoxin characteristic ions such as 1093.5/1075.4/1057.5/1039.5 were extracted.Conclusion The incident is a cigartoxin food poisoning caused by eels.Strengthen publicizing cigartoxin food poisoning and management of deep-sea fish are the key prevention and control measures.