Santi Luca, Maggioli Caterina, Mastroroberto Marianna, Tufoni Manuel, Napoli Lucia, Caraceni Paolo
U.O. Semeiotica Medica, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
Int J Hepatol. 2012;2012:487480. doi: 10.1155/2012/487480. Epub 2012 Jul 3.
Mushroom poisoning is a relatively rare cause of acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of mushroom poisoning. Liver damage from Amanita phalloides is related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell necrosis. After an asymptomatic lag phase, the clinical picture is characterized by gastrointestinal symptoms, followed by the liver and kidney involvement. Amatoxin poisoning may progress into ALF and eventually death if liver transplantation is not performed. The mortality rate after Amanita phalloides poisoning ranges from 10 to 20%. The management of amatoxin poisoning consists of preliminary medical care, supportive measures, detoxification therapies, and orthotopic liver transplantation. The clinical efficacy of any modality of treatment is difficult to demonstrate since randomized, controlled clinical trials have not been reported. The use of extracorporeal liver assist devices as well as auxiliary liver transplantation may represent additional therapeutic options.
蘑菇中毒是急性肝衰竭（ALF）相对罕见的病因。本文分析了由毒鹅膏菌摄入继发的急性肝衰竭的发病机制、临床特征、预后指标及治疗策略，毒鹅膏菌是蘑菇中毒最常见且致命的病因。毒鹅膏菌造成的肝损伤与鹅膏毒素有关，鹅膏毒素是一种强效毒素，可抑制RNA聚合酶II，导致蛋白质合成不足及细胞坏死。在无症状的潜伏期后，临床表现以胃肠道症状为特征，随后出现肝脏和肾脏受累。如果不进行肝移植，鹅膏毒素中毒可能进展为急性肝衰竭并最终导致死亡。毒鹅膏菌中毒后的死亡率在10%至20%之间。鹅膏毒素中毒的治疗包括初步医疗护理、支持措施、解毒疗法及原位肝移植。由于尚未报道随机对照临床试验，很难证明任何治疗方式的临床疗效。使用体外肝辅助装置以及辅助性肝移植可能是其他治疗选择。
