| 邓跃林,肖桂林,金益强,罗学宏,孟新科,李洁,敖翔,肖奇明.鱼胆中毒致多脏器功能障碍综合征的临床观察[J].中国中西医结合杂志,2001,(8):582-584 |
| 鱼胆中毒致多脏器功能障碍综合征的临床观察 |
| Clinical Observation on Multiple Organ Dysfunction Syndrome due to Fish Gall Bladder Poisoning |
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| DOI： |
| 中文关键词: 鱼胆中毒 多脏器功能障碍综合征 尿N-乙酰-β-D-氨基葡萄糖苷酶 |
| 英文关键词:fish gall bladder poisoning multiple organ dysfunction syndrome urinary N-acetyl-β-D-glucosaminidase |
| 基金项目:湖南省中医药科研基金资助项目 (No .9832 9) |
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| 摘要点击次数: 1441 |
| 全文下载次数: 1931 |
| 中文摘要: |
| 目的 :研究鱼胆中毒后肝、肾、心肌及胃肠道等脏器功能的变化 ,探讨其致急性肾功能衰竭的发病机制。方法 :11例重度鱼胆中毒的患者 ,观察治疗前后肝、肾功能 ,心肌酶学 ,尿N 乙酰 β D 氨基葡萄糖苷酶 (尿N AG酶 )和肾脏B超检查的变化 ,记录 2 4h出入水量 ;1例患者在B超下行肾活检 ,以了解肾脏病理变化。结果 :11例患者全部痊愈出院 ,临床症状消失 ,中毒后多脏器受损程度依次为肾、肝、心肌及胃肠道 ;治疗后血肌酐 (Cr)、尿素氮 (BUN)、尿N AG酶、谷丙转氨酶 (ALT)、总胆红素 (TBIL)明显下降 ;1例肾活检光镜结果提示 :肾小管中毒性损害 (主要为近曲小管 ) ,电镜结果提示 :为肾小管上皮细胞内线粒体空泡样变性 ,上皮细胞肿胀 ,肾小球部分足突融合 ,球囊腔变窄。结论 :鱼胆中毒可引起多脏器功能障碍综合征(MODS) ,按照受损程度依次为肾、肝、心肌及胃肠道 ,鱼胆中毒致急性肾功能衰竭主要损害近曲小管 ;尿N AG酶为肾小管功能损害的诊断和判断预后的敏感指标 |
| 英文摘要: |
| Objective: To study the functional changes of liver, kidney, myocardium and gastro-intestine after fish gall bladder poisoning and the pathogenic mechanism of acute renal failure. Methods: The liver and kidney function, myocardial enzyme, urinary N-acetyl-β-D-glucosaminidase (N-AG), 24 hrs intake and output volume of liquid and kidney B-ultrasonographic examination in 11 patients of severe acute fish gall bladder poisoning were observed. And kidney biopsy was carried out in one patient under B-ultrasonography for understanding the renal pathological changes. Results: All the 11 patients were cured with disappearance of clinical symptoms. After the poisoning the order of the severity of organ damage were kidney, liver, myocardium and gastro-intestine tract. The levels of blood creatinine, blood urea nitrogen, urinary N-AG, glutamic-pyruvic transaminase, total bilirubin were lowered significantly after treatment. Biopsy examination under light microscope showed toxic damage of renal tubules mainly in proximal tubules, and under electron microscope, the pathologic changes were mitochondrial vacuolar degeneration of tubular epithelial cells, swelling of epithelial cells, partial fusion of processes in glomeruli and narrowing of saccular cavity. Conclusion: Fish gall bladder poisoning could cause acute multiple organ dysfunction syndrome (MODS), the affected organs in order of severity of damage were kidney, liver, myocardium and gastro-intestine tract. In kidney the damage was mainly at the proximal tubules. Urinary N-AG is a sensitive criterion for determining the diagnosis and prognosis of renal tubular dysfunction. |
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