一氧化二氮滥用致神经病变一例并文献复习

Nitrous oxide induced neuropathy: a case report and literature review

目的通过一例一氧化二氮滥用致周围神经和脊髓病变的病例分析,探讨N_2O的毒性作用及其机制。方法报道一例N_2O中毒病例,并结合病例进行文献复习。结果滥用N_2O可引起多系统病变,其中最显著的是周围神经和脊髓亚急性联合变性样改变。可能原因是N_2O将VitB_(12)中钴离子氧化,导致VitB_(12)失活,影响了一系列VitB_(12)作为辅酶参与的生化反应。VitB_(12)不足,影响了神经髓鞘的合成以及DNA的合成,从而造成神经病变和巨幼红细胞性贫血,还可影响细胞因子和生长激素的合成。另外,N_2O还可能影响NMDA受体。结论临床医生在遇到类似青年男女,既往体健,突发肢体麻木无力或精神问题,应考虑到N_2O滥用可能。

Objective To analysis the toxicity of nitrous oxide (N2O) through a patient who abused N2O and with peripheral neuropathy and myelopathy. Methods Report a case who abused N2O and review the literature. Results N2O abuse can cause multisystem lesion, and the most prominent are peripheral neuropathy and subacute combined degeneration of the spinal cord. It is postulated that N2O inactivates VitB12 by oxidizing the cobalt ion. This inactivation has effects on the various biochemical pathways in which vitB12 is a cofactor. Inactivated vitB12 affects the synthesis of myelin and DNA, and then cause neuropathy and megalobastic anemia. VitB12 deficiency may also result in cytokine and growth factor consequences. N2O may be neurotoxic through its to N-methyl-D-aspartate (NMDA) receptors. Conclusions When receiving a young man or woman who is well before, presenting with a short history of numbness and weak of the limbs or psychiatric manifestations, physicians should think of the possible of N2O abuse.