肉毒毒素中毒的诊断和治疗

肉毒毒素中毒的诊断和治疗

靳令经, 潘丽珍, 王琳, 万新华

神经病学与神经康复学杂志 ›› 2016, Vol. 12 ›› Issue (4) : 173-180.

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神经病学与神经康复学杂志 ›› 2016, Vol. 12 ›› Issue (4) : 173-180. DOI: 10.12022/jnnr.2016-0054

肉毒毒素中毒的诊断和治疗

靳令经¹, 潘丽珍¹, 王琳², 万新华²

作者信息 +

Diagnosis and treatment of botulism

JIN Lingjing¹, PAN Lizhen¹, WANG Lin², WAN Xinhua²

Author information +

文章历史 +

摘要

肉毒毒素（botulinum neurotoxin,BoNT）是由肉毒梭状芽胞杆菌产生的神经毒素,通过水解可溶性N-乙基马来酰亚胺-敏感因子附着蛋白受体（soluble N-ethyl-maleimide-sensitive factor attachment protein receptor,SNARE）复合体,阻断神经递质释放,达到化学性去神经支配作用,已在临床诊疗及美容整形等多学科领域得到了广泛的应用。BoNT中毒是由BoNT过量导致的一种神经瘫痪性疾病。医源性BoNT中毒大多与使用非正规渠道来源的BoNT或不规范使用BoNT有关。BoNT中毒的临床症状主要为急性、对称性、下行性迟缓性瘫痪,严重者可致呼吸衰竭而死亡。BoNT中毒最有效的治疗方法是尽早使用BoNT抗毒素,因此早期诊断至关重要。由于病原菌检测或BoNT检测耗时较长,因此临床诊断BoNT中毒主要依靠病史和临床表现,而神经电生理检查则有助于鉴别诊断。本文对BoNT中毒相关文献进行总结和讨论,以期为BoNT中毒的诊断和治疗提供指导。

Abstract

Botulinum neurotoxin (BoNT) produced by Clostridium botulinum selectively cleaves soluble N-ethyl-maleimide-sensitive factor attachment protein receptor (SNARE) complex protein and thus inhibits neurotransmitter release and causes chemodenervation. BoNT has been used in many fields such as clinical diagnosis and treatment and cosmetic surgery. Botulism is a neuroparalytic disease caused by over-dose of BoNT. Iatrogenic botulism is most commonly observed after injection of neurotoxin with poor quality or not following usage rules. The symptoms of botulism commonly present as acute symmetrical descending flaccid paralysis. In some severe cases, respiratory failure may happen, which can even cause death. Once botulism happens, early administration of antitoxin is the most effective therapy, thus early diagnosis is essential. The diagnosis of botulism is mainly based on medical history and physical examination because toxin detection and Clostridium botulinum culture are both time-consuming. Nerve electrophysiological tests may be helpful in differential diagnosis. This paper reviews the researches on botulism, which may provide a basis for the diagnosis and treatment of botulism.

关键词

肉毒毒素类 / 神经毒素类 / 中毒 / 诊断 / 治疗

Key words

Botulinum toxins / Neurotoxins / Poisoning / Diagnosis / Therapy

引用本文

导出引用

靳令经, 潘丽珍, 王琳, 万新华. 肉毒毒素中毒的诊断和治疗[J]. 神经病学与神经康复学杂志. 2016, 12(4): 173-180 https://doi.org/10.12022/jnnr.2016-0054

JIN Lingjing, PAN Lizhen, WANG Lin, WAN Xinhua. Diagnosis and treatment of botulism[J]. Journal of Neurology and Neurorehabilitation. 2016, 12(4): 173-180 https://doi.org/10.12022/jnnr.2016-0054

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基金

国家自然科学基金青年基金项目（编号：81500970）; 上海市卫生和计划生育委员会面上项目（编号：201440535）

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