一起断肠草急性中毒死亡案件的法医毒物学分析及文献总结

Toxicological Analysis and Literature Summary of a Case of Acute Poisoning Death Caused by Heartbreak Grass

本文旨在为断肠草(钩吻)中毒死因判定提供参考数据和病理资料。对一例口服自制中药致钩吻中毒死者进行尸体检验、组织病理检验、毒物检验,采用组织细胞染色和显微镜观察进行病理检验,采用液相色谱–质谱对心血、中药汤进行毒物检验,查阅了钩吻中毒的相关文献,总结钩吻中毒的中毒情况、中毒症状及死后血液或组织中的含量。钩吻中毒死亡案例报道较多,但死后毒物学数据较少,本例死者中毒的毒性成分主要是钩吻素子、钩吻素甲、钩吻素己,血液中浓度分别为77.4、30.3、37.1 ng/mL;脏器组织病理检验发现窦房结动脉狭窄、窦房结区心肌纤维化,钩吻中毒的典型特征。急性钩吻中毒,脏器组织病理检验难以发现典型特征,但中毒死后毒物检验数据的积累可为死因判定提供基础数据,为相关案件的死因鉴定提供参考。

The paper aims to provide the reference and pathological data for the determination of the poisoning caused by heartbreak grass.Post-mortem examination,histopathological examination,and toxicological examination were performed on a deceased case of gelsemium elegans poisoning caused by ingestion of homemade Chinese medicine,and the tissue cells were stained and observed with microscope for pathological examination,while liquid chromatography mass spectrometry(LC-MS)was used for toxicological examination of heart blood and the residue of Chinese medicine.The relevant literature on gelsemium poisoning was reviewed,such as the poisoning symptoms,pathological feature and postmortem content of gelsemium in blood or tissue.Although many poisoning cases were reported,most of them were published by medical and health departments,and post-mortem toxicological data are scarce.This paper reported a dead case which gelsemine,koumine and gelsecine were detected in the heart blood with the concentration of 77.4,30.3 and 37.1 ng/mL respectively,and the pathological examination showed that the SA node artery stenosis and myocardial fi brosis were found,but on typical toxic characteristics in tissues were observed.In this case of acute poisoning of Gelsemium elegans,no typical features were found by autopsy,but the obtained basic data such as toxin concentration in blood contributed to accumulate forensic toxicological data of Gelsemium elegans poisoning,and provided a reference for forensic toxicologists in identifying the cause of death in related cases.