食用小龙虾致横纹肌溶解症:附4例分析

Rhabdomyolysis caused by eating crawfish:a report of 4 cases

目的分析食用小龙虾致横纹肌溶解症(RM)的临床特点和治疗方法,观察其临床预后.方法广东省第二人民医院2017年7月至8月收治4例因食用小龙虾致RM患者,分析其流行病学资料、临床症状特点、实验室检查指标变化、治疗方案及转归,分享诊疗经验.结果①流行病学资料:4例患者小龙虾进食量平均(600.0±294.4)g,均有同食者,但同食者均无类似发病情况;②临床表现:颈肩、背部肌肉酸痛、乏力,尿色加深,均无腹部症状;③实验室检查:肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)于进食35~38 h后达到峰值;治疗过程中乳酸脱氢酶(LDH)亦明显升高;3例患者于进食8~14 h后肌红蛋白(Myo)明显高于正常参考值,于进食后35~37 h急剧下降,1例患者于进食后38 h首次检测Myo为326.7μg/L,随后明显降低;4例患者丙氨酸转氨酶(ALT)水平均异常,3例天冬氨酸转氨酶(AST)呈先升高后降低的趋势,1例无明显变化;血、尿常规及肾功能检测均无异常.④治疗及转归:静脉滴注生理盐水2~3 L/d,同时口服大量温开水,维持尿量在100~150 mL/h,必要时给予利尿剂;同时给予保肝护胃、碳酸氢钠(NaHCO_(3))碱化尿液等对症治疗后临床症状均得以缓解,最终4例患者均治愈出院,1个月后随访均无复发及后遗症.结论食用小龙虾所致RM是多种致病因素的结果,其主要表现为颈肩、背部肌肉酸痛、乏力,伴随CK、Myo等指标不同程度升高,经过及时有效治疗,预后良好,极少有严重并发症出现.

Objective To analyze the elinical characteristics,treatment method and prognosis of rhabdomyolysis(RM)caused by eating crayfish.Methods From July to August 2017,4 patients with RM caused by eating crayfish were treated in Guangdong Provincial Second People's Hospital.The epidemiological data,clinical sy mptom characteristics,changes of laboratory examination indexes,treatment plan and outcome were analyzed in order to share the experiences in the diagnosis and treatment of the disease.Results Epidemiological data:the average intake of crayfish in the 4 patients was(600.0±294.4)g.all of them ate with others,but the other eaters had no similar disease.②Clinical manifestations:neck,shoulder and back muscle pain,fatigue,urine color deepening,all without abdominal symptoms.③Laboratory examinations:creatine kinase(CK)and creatine kinase isoenzyme(CK-MB)reached their peaks after 35-38 hours of eating;lactate dehydrogenase(LDH)also inereased significantly during the course of treatment;the myoglobin(Myo)of 3 patients was significantly higher than the normal reference value after 8-14 hours of eating,and dropped sharply during 35-37 hours after eating.The first detection of Myo in I patient at 38 hours after eating was 326.7μg/L,and then decreased significantly.The levels of alanine aminotransferase(ALT)in 4 patients were abnormal,aspartate aminotransferase(AST)in 3 patients increased first and then decreased,and there was no significant change in 1 case.Blood and urine routine tests and renal function test showed no abnormality.④Treatment and outcome:intravenous drip of normal saline 2-3 L/d,while taking a large amount of warm water to maintain urine volume of 100-150 mL/h,diuretics was given if necessary;at the same time,liver and stomach protection,sodium bicarbonate(NaHCO_(3))taken to alkalize urine and other symptomatic treatment were given;the clinical symptoms were all relieved after treatment,finally 4 patients were cured and discharged,and no recurrence and sequelae were found after I month of fllow-up.Conclusions RM caused by eating crayfish is the result of a variety of pathogenic factors,the main manifestations are neck,shoulder and back muscle pain and fatigue,accompanied by different degrees of CK,Myo and other indicators increasing.After timely and efctive treatment,the prognosis is good,and there are very few serious complications.