Jaeger A, Jehl F, Flesch F, Sauder P, Kopferschmitt J
Service de Réanimation Médicale, Hôpitaux Universitaires, Hôpital Civil, Strasbourg, France.
J Toxicol Clin Toxicol. 1993;31(1):63-80. doi: 10.3109/15563659309000374.
The kinetics of alpha and beta amanitin were studied in 45 patients intoxicated with Amanita Phalloides. The amatoxins were analyzed by high performance liquid chromatography in plasma (43 cases), urine (35 cases), gastroduodenal fluid (12 cases), feces (12 cases) and tissues (4 cases). All patients had gastrointestinal symptoms and 43 developed an acute hepatitis. Two patients underwent successful liver transplantation. Eight patients, of whom three were children, died. The detection of amatoxins in the biological fluids was time dependent. The first sample was obtained at an average of 37.9 h post ingestion in the patients with positive results and at 70.6 h in the samples without detectable amatoxins. Plasma amatoxins were detected in 11 cases at 8 to 190 ng/mL for alpha and between 23.5 to 162 ng/mL for beta. In 23 cases amatoxins were detected in urine with a mean excretion per hour of 32.18 micrograms for alpha and 80.15 micrograms for beta. In 10 patients the total amounts eliminated in the feces (time variable) ranged between 8.4 and 152 micrograms for alpha amanitin and between 4.2 and 6270 micrograms for beta amanitin. In three of four cases amatoxins were still present in the liver and the kidney after day 5. Amatoxins were usually detectable in plasma before 36 h but were present in the urine until day 4. The rapid clearance indicates that enhanced elimination of amatoxins requires early treatment. Clearance of circulating amatoxins by day 4 spares the transplanted liver.
对45例毒鹅膏中毒患者的α-鹅膏毒素和β-鹅膏毒素动力学进行了研究。通过高效液相色谱法分析血浆（43例）、尿液（35例）、胃十二指肠液（12例）、粪便（12例）和组织（4例）中的鹅膏毒素。所有患者均有胃肠道症状，43例发展为急性肝炎。2例患者成功接受了肝移植。8例患者死亡，其中3例为儿童。生物体液中鹅膏毒素的检测具有时间依赖性。在检测结果呈阳性的患者中，首次采样的平均时间为摄入后37.9小时，而在未检测到鹅膏毒素的样本中为70.6小时。11例患者血浆中检测到α-鹅膏毒素，浓度为8至190 ng/mL，β-鹅膏毒素浓度为23.5至162 ng/mL。23例患者尿液中检测到鹅膏毒素，α-鹅膏毒素平均每小时排泄量为32.18微克，β-鹅膏毒素为80.15微克。10例患者粪便中（随时间变化）排出的α-鹅膏毒素总量在8.4至152微克之间，β-鹅膏毒素在4.2至6270微克之间。在第5天后，4例中的3例患者肝脏和肾脏中仍存在鹅膏毒素。鹅膏毒素通常在36小时前可在血浆中检测到，但在尿液中可持续到第4天。快速清除表明，早期治疗可增强鹅膏毒素的清除。到第4天循环中的鹅膏毒素清除可使移植肝脏免受损害。
