2020年马鞍山市小龙虾相关横纹肌溶解综合征流行病学调查

Epidemiological investigation of crayfish-related rhabdomyolysis in Ma'anshan City in 2020

目的分析马鞍山市2020年小龙虾相关横纹肌溶解综合征病例的流行病学特征,探讨发病的相关因素,为进一步探索致病因子提供思路与方向。方法开展个案调查、病例对照研究及溯源调查,分析病例临床表现和流行病学特征,了解小龙虾的生长与捕捞环境及其分布,寻找可疑致病因子。结果43例横纹肌溶解综合征病例集中分布在7~9月,女性居多,占69.77%;肌肉酸痛为最典型临床症状(97.67%),疾病潜伏期中位数为5h,生化指标肌酸激酶(creatine kinase,CK)、肌红蛋白(myoglobin,Mb)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)明显增高;阳性虾源地理分布与长江及其分支关联的占69.77%;病例对照研究显示,小龙虾食用量和食用虾黄是患病的危险因素。结论马鞍山市小龙虾相关横纹肌溶解综合征小龙虾的溯源指向长江及其分支流域,但具体致病因子需结合后续阳性虾源及生态环境中水草、底泥、水中可疑物质的实验室检测进一步探索研究。

Objective To analyze the epidemiologic features of crayfish-related rhabdomyolysis cases in Ma'anshan City in 2020,explore the related factors of the incidenc of disease,and provide ideas and directions for further exploration of the pathogenic factors.Methods Carry out case study,case-control study and traceability investigation,analyze the clinical manifestations and epidemiologic features of the cases,understand the growth,fishing environment and distribution of crayfish,and search for suspected pathogenic factors.Results The 43 cases of rhabdomyolysis were concentrated distributed from July to September,most of them were women,accounting for 69.77%;muscle soreness was the most typical clinical symptom(97.67%),the median latent period of the disease was 5 hours,and the biochemical indicators creatine kinase(CK),myoglobin(Mb),ALT,and AST were significantly increased;the geographical distribution of positive crayfish sources was associated with the Yangtze river and its branches accounted for 69.77%;case-control studies showed that the amount of crayfish consumed and the consumption of crayfish roe were risk factors for disease.Conclusion Crayfish-related rhabdomyolysis crayfish in Ma'anshan City with the traceability of crayfish pointing to the Yangtze River and its branch basins,but the specific pathogenic factors need to be further explored and research in combination with subsequent positive crayfish sources and laboratory testing of water and grasses,sediments,and water suspicious substances in the ecological environment.