【摘要】 目的用动物试验研究小龙虾相关人群横纹肌溶解综合征的相关危险因素,为确证小龙虾相关横纹肌溶解综合征的致病因子提供动物试验筛查的问题样品。方法基于2016年广东省48例食用小龙虾相关横纹肌溶解综合征病例的流行病学和溯源调查结果,找到可能的问题小龙虾样品,分离虾肝胰腺、虾肉,分别经口灌胃小鼠,在小鼠体内触发小龙虾相关横纹肌溶解综合征,观察血清学和骨骼肌组织病理学等指标的改变。结果 2016年7~9月广东报告的48例食用小龙虾相关横纹肌溶解综合征病例的临床表现主要为肌肉酸痛、乏力、呼吸困难和胸闷等,血液生化检测显示肌酸激酶、肌酸激酶同工酶和肌红蛋白异常的比例超过85%,符合哈夫病的诊断。人群中发生的小龙虾相关横纹肌溶解综合征与小龙虾的批次、个体进食量和个体体质差异均有关。36起事件中涉及同一场所的有A、B两家餐馆,分别报告了2起。30 g/kg BW剂量的A餐馆的雌虾肝胰腺可引起小鼠血清肌酸激酶、肌酸激酶同工酶的升高,高于其他剂量组(10、3.3和1.1 g/kg BW),差异有统计学意义(P<0.05),30 g/kg BW剂量的A餐馆和B餐馆的虾肉可引起小鼠血清肌酸激酶同工酶、肌红蛋白、谷草转氨酶、乳酸脱氢酶、肌酐升高;同一动物横纹肌溶解综合征相关的指标肌酸激酶、肌酸激酶同工酶、肌红蛋白、乳酸脱氢酶、谷丙转氨酶、谷草转氨酶呈现正相关性;横纹肌溶解综合征病理改变主要在血清肌酸激酶和肌酸激酶同工酶异常升高的动物中观察到,主要表现为小鼠股二头肌内炎症细胞浸润,肌纤维嗜伊红染增强,横纹模糊消失。结论小龙虾在部分小鼠体内可触发横纹肌溶解综合征,发病率与小龙虾批次有关,与给样量多少有关。动物试验与人群流行病学的调查结果基本一致。更多还原

【Abstract】 Objective To verify the related risk factors of crayfish-related rhabdomyolysis outbreak using animal experiment,and to provide positive samples by animal experiment screening for the confirmation of the pathogenic factors of crayfish-related rhabdomyolysis. Methods Based on the result of epidemiological investigations and the traceability information of 48 crayfish-related rhabdomyolysis cases in Guangdong Province in 2016,suspected crayfish samples were screened and separated as meat and hepatopancreas,which were given to mice by gavage to trigger crayfish-related rhabdomyolysis through observing the indicators of serology and skeleton histopathology. Results The main clinical symptoms of the cases were muscle soreness,fatigue,dyspnea and chest distress,and the blood biochemistry test showed that the abnormal percentage of creatine kinase( CK),creatine kinase isoenzyme( CKMB) and myoglobin( MB) were above 85%,accordance with the diagnosis of haff disease. The crayfish-related rhabdomyolysis was related with the batchand intake of crayfish,as well as the individual physical difference. In 36 incidents,there were two restaurants( restaurant A and restaurant B) reported 2 incidents respectively,others only reported one. 30 g/kg BW of female hepatopancreas from restaurant A could induce increase of serum CK and CKMB in mice. After giving the highest dose( 30 g/kg BW) of hepatopancreas from restaurant A,serum CK and CKMB were all higher than other dose groups( 10,3. 3,1. 1 g/kg BW).30 g/kg BW crayfish meat from restaurant A and B could both induce increase of serum CKMB, MB, aspartate aminotransferase( AST),lactate dehydrogenase( LDH) and creatinine( CR). The abnormal increase of rhabdomyolysis related indicators CK,CKMB,MB,LDH,glutamic pyruvic transaminase( ALT) and AST were positively correlated in the same animal. The rhabdomyolysis pathological manifestations,such as inflammatory cell infiltration,eosinophilic in bicepsfemoris muscle,and cross striations unclear and disappear were mainly observed in animals with serum CK,CKMB abnormal increase. Conclusion Crayfish-related rhabdomyolysis could be triggered in mice,and was associated with the batch and dose of the crayfish,which was consistent with the result of human epidemiological investigation.更多还原