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目的调查一起生鲜蜂蜜中毒致死事件的具体原因,为预防此类事件的发生提供依据。方法采用回顾性队列研究方法开展流行病学调查,收集临床病例资料和实验室检查结果,分析比较蜂蜜食用人群发病风险与蜂蜜食用史之间的关系,采集病例食用过的蜂蜜样本进行有毒成分检测及急性毒性试验,并对病例涉及蜜蜂养殖点周围3 km范围内的有毒蜜源植物进行实地勘察。结果共发现11例中毒患者,其中死亡4例(病死率为36.36%),重症病例1例,轻症6例。临床表现以呕吐(54.55%)、腹泻(45.45%)、恶心(45.45%)为主,临床实验室检查以血常规异常(早期白细胞降低)及肝、肾功能损害为主。病例食用过的蜂蜜中均检测出了雷公藤甲素(浓度范围0.06~0.67mg/kg),急性动物试验证实小白鼠中毒及死亡情况与蜂蜜中雷公藤甲素浓度呈剂量反应关系。病例涉及蜜蜂养殖点周围3 km范围内发现有大量的雷公藤植物分布。结论本次生鲜蜂蜜中毒致死事件主要由有毒蜜源植物雷公藤引起。
Objective To investigate the specific causes of fatalities caused by poisoning with fresh honey and provide basis for preventing the occurrence of such events. Methods A retrospective cohort study was conducted to carry out epidemiological investigation, clinical case data and laboratory test results were collected. The relationship between the incidence of honey consumption and the consumption history of honey was analyzed. Honey samples collected from the patients were collected for detection of toxic components And acute toxicity test, and conducted field investigation on the poisonous nectary plants in the case involving the bee breeding point within 3 km range. Results A total of 11 cases of poisoning were found, including 4 deaths (case fatality rate 36.36%), 1 severe case and 6 mild cases. The main clinical manifestations were vomiting (54.55%), diarrhea (45.45%) and nausea (45.45%). Clinical laboratory tests mainly included abnormal blood tests (early leukopenia) and liver and renal dysfunction. Triptolide (concentration range 0.06 ~ 0.67mg / kg) was detected in the honey consumed in the cases. Acute animal tests confirmed the dose-response relationship between the poisoning and death of mice and the concentration of triptolide in honey. The cases involved the discovery of a large number of Tripterygium wilfordii distribution within 3 km around the bee breeding site. Conclusion The death of fresh honey poisoning is mainly caused by the poisonous nectar source Tripterygium.