鹅膏蕈碱所致肝损伤的特点和α-鹅膏蕈碱检测的临床价值。

The characteristics of liver injury induced by Amanita and clinical value of α-amanitin detection.

机构信息

Department of Emergency Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.

Department of Emergency Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; The Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou 310003, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2022 Jun;21(3):257-266. doi: 10.1016/j.hbpd.2022.01.007. Epub 2022 Jan 31.

DOI:10.1016/j.hbpd.2022.01.007

PMID:35168873

Abstract

BACKGROUND

Amanita poisoning as a foodborne disease has raised concerning mortality issues. Reducing the interval between mushroom ingestion and medical intervention could greatly influence the outcomes of Amanita poisoning patients, while treatment is highly dependent on a confirmed diagnosis. To this end, we developed an early detection-guided intervention strategy by optimizing diagnostic process with performing α-amanitin detection, and further explored whether this strategy influenced the progression of Amanita poisoning.

METHODS

This study was a retrospective analysis of 25 Amanita poisoning patients. Thirteen patients in the detection group were diagnosed mainly based on α-amanitin detection, and 12 patients were diagnosed essentially on the basis of mushroom consumption history, typical clinical patterns and mushroom identification (conventional group). Amanita poisoning patients received uniform therapy, in which plasmapheresis was executed once confirming the diagnosis of Amanita poisoning. We compared the demographic baseline, clinical and laboratory data, treatment and outcomes between the two groups, and further explored the predictive value of α-amanitin concentration in serum.

RESULTS

Liver injury induced by Amanita appeared worst at the fourth day and alanine aminotransferase (ALT) rose higher than aspartate aminotransferase (AST). The mortality rate was 7.7% (1/13) in the detection group and 50.0% (6/12) in the conventional group (P = 0.030), since patients in the detection group arrived hospital much earlier and received plasmapheresis at the early stage of disease. The early detection-guided intervention helped alleviate liver impairment caused by Amanita and decreased the peak AST as well as ALT. However, the predictive value of α-amanitin concentration in serum was still considered limited.

CONCLUSIONS

In the management of mushroom poisoning, consideration should be given to the rapid detection of α-amanitin in suspected Amanita poisoning patients and the immediate initiation of medical treatment upon a positive toxin screening result.

摘要

背景

蕈类食物中毒作为一种食源性疾病，已引起人们对死亡率的关注。减少蘑菇摄入与医疗干预之间的时间间隔，可能会极大地影响毒蕈中毒患者的结局，而治疗高度依赖于明确的诊断。为此，我们通过优化诊断流程进行α-鹅膏蕈碱检测，制定了一种早期检测指导干预的策略，并进一步探讨了该策略是否影响毒蕈中毒的进程。

方法

本研究回顾性分析了 25 例毒蕈中毒患者。检测组 13 例患者主要基于α-鹅膏蕈碱检测进行诊断，12 例患者主要基于蘑菇摄入史、典型临床特征和蘑菇鉴定进行诊断（常规组）。所有毒蕈中毒患者均接受了统一的治疗，一旦确诊为毒蕈中毒，即行血浆置换。我们比较了两组患者的人口统计学基线、临床和实验室数据、治疗和结局，并进一步探讨了血清中α-鹅膏蕈碱浓度的预测价值。

结果

毒蕈引起的肝损伤在第 4 天最为严重，丙氨酸氨基转移酶（ALT）升高高于天冬氨酸氨基转移酶（AST）。检测组的死亡率为 7.7%（1/13），常规组为 50.0%（6/12）（P=0.030），因为检测组患者更早到达医院，在疾病早期就接受了血浆置换。早期检测指导干预有助于减轻毒蕈引起的肝损伤，并降低 AST 和 ALT 的峰值。然而，血清中α-鹅膏蕈碱浓度的预测价值仍被认为是有限的。