Madsen J M
Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, National Capital Consortium Residency in Occupational and Environmental Medicine, Bethesda, Maryland, USA.
Clin Lab Med. 2001 Sep;21(3):593-605.
Toxins are toxic chemical compounds synthesized in nature by living organisms. Classifiable by molecular weight, source, preferred targets in the body, and mechanism of action, they include the most potent poisons on the planet, although considerations of production, weaponization, delivery, environmental stability, and host factors place practical limits on their use as WMD. The two most important toxin threats on the battlefield or in bioterrorism are probably botulinum toxin (a series of seven serotypes, of which botulinum toxin A is the most toxic for humans) and SEB, an incapacitating toxin. Ricin and the trichothecene mycotoxins, including T-2 mycotoxin, are of lesser concern but are still potential threats. Botulinum toxin is a neurotoxin, ricin and trichothecene mycotoxins are membrane-damaging proteins, and SEB is a superantigen capable of massive nonspecific activation of the immune system. The clinical intoxications resulting from exposure to and absorption (usually by inhalation) of these agents reflect their underlying pathophysiology. Because of the hybrid nature of toxins, they have sometimes been considered CW agents and sometimes BW agents. The current trend seems to be to emphasize their similarities to living organisms and their differences from CW agents, but examination of all three groups relative to a number of factors reveals both similarities and differences between toxins and each of the other two categories of non-nuclear unconventional WMD. The perspective that groups toxins with BW agents is logical and very useful for research and development and for administrative and treaty applications, but for medical education and casualty assessment, there are real advantages in clinician use of assessment techniques that emphasize the physicochemical behavior of these nonliving, nonreplicating, intransmissible chemical poisons.
毒素是生物体在自然界中合成的有毒化合物。根据分子量、来源、在体内的主要作用靶点和作用机制进行分类，它们包括地球上毒性最强的毒物，不过，在生产、武器化、投放、环境稳定性和宿主因素等方面的考量对其作为大规模杀伤性武器的使用构成了实际限制。战场上或生物恐怖主义中最重要的两种毒素威胁可能是肉毒杆菌毒素（一系列七种血清型，其中肉毒杆菌毒素A对人类毒性最强）和SEB（一种失能性毒素）。蓖麻毒素和包括T - 2毒素在内的单端孢霉烯族霉菌毒素受关注程度较低，但仍是潜在威胁。肉毒杆菌毒素是一种神经毒素，蓖麻毒素和单端孢霉烯族霉菌毒素是损伤细胞膜的蛋白质，而SEB是一种能够大量非特异性激活免疫系统的超抗原。接触并吸收（通常通过吸入）这些制剂所导致的临床中毒反映了其潜在的病理生理学特征。由于毒素的混合性质，它们有时被视为化学战剂，有时被视为生物战剂。目前的趋势似乎是强调它们与生物体的相似性以及与化学战剂的差异，但相对于多个因素对这三类制剂进行考察后发现，毒素与其他两类非核非常规大规模杀伤性武器之间既有相似之处，也有不同之处。将毒素与生物战剂归为一类的观点在研发、行政和条约应用方面合乎逻辑且非常有用，但对于医学教育和伤亡评估而言，临床医生使用强调这些无生命、不可复制、不可传播的化学毒物物理化学行为的评估技术具有实际优势。
