局部注射A型肉毒毒素中毒20例的电生理分析

Botulinum toxin A poisoning by local aesthetic injection:clinical and electrophysiological analyses of 20 cases

目的观察A型肉毒毒素局部美容注射中毒的临床特征和电生理特点,探讨可能的致病机制。方法2016年1月至2018年12月,浙江大学医学院附属邵逸夫医院肌电图室收集20例[女19例,男1例,年龄23~40(28.61±5.97)岁]因A型肉毒毒素局部注射中毒患者资料,并进行电生理检测。结果20例患者临床表现四肢无力15例,20例近端重于远端,上肢重于下肢16例;其次吞咽困难12例、构音障碍5例、颈肌无力5例、眼外肌麻痹4例、咬肌无力3例、呼吸肌无力2例,其中呼吸衰竭1例。神经电生理检查单纤维肌电图异常18例、重复神经电刺激16例、针极肌电图13例、神经传导速度8例。结论局部注射A型肉毒毒素可能导致中毒,中毒症状以四肢无力为主要症状,神经电生理检测可辅助肉毒毒素中毒诊断。

Objective To observe the clinical and electrophysiological characteristics of botulinum toxin A poisoning induced by local cosmetic injection,and to explore the possible pathogenesis.Methods Clinical data of 20 patients with botulinum toxin type A local cosmetic injection poisoning admitted to our hospital from January 2016 to December 2018 were collected and electrophysiological tests were carried out.Results The clinical manifestations of 20 patients were mainly 15/20(75.0%)with limb weakness,and the proximal end was heavier than the distal 20/20(100%),and the upper limb was heavier than the lower limb 26/20(80%),followed by dysphagia 12/20(60%),dysarthria 5/20(25%),cervical muscle weakness 5/20(25%),extraocular muscle paralysis 4/20(20%),masseter muscle weakness 3/20(15%)and respiratory muscle weakness 2/20(5.0%)with respiratory failure 1/20(5.0%).The results of neurophysiological examination showed the highest rate of SFEMG(90.0%),followed by RNS(80.0%),EMG(65.0%)and NCV(40.0%),suggesting that neuromuscular junction dysfunction was the main presentation.Patients who actively gave botulinum antitoxin injection therapy and symptomatic support treatment had good prognosis.Conclusions Local cosmetic injection of botulinum toxin type A may lead to poisoning.The symptoms of poisoning are mainly caused by limb weakness.Neuroelectrophysiological examination can assist in the diagnosis of botulinum toxin poisoning.