【摘要】 目的 :为急型克山病患者的暴死病因提供一个科学假设。方法 :将文献中报道急型克山病患者发病过程的主要症状与体征 ,与动物镰刀菌毒素急性中毒实验结果进行比较 ,了解两者的异同点。结果 :动物镰刀菌毒素 (T 2毒素为代表 )急性中毒的主要表现有 :小肠粘膜上皮隐窝细胞分裂相减少或消失 ,小肠粘膜上皮细胞计数下降 ,部分绒毛缺上皮细胞覆盖而裸露 ,小肠内含水量增加 ,血容量减少 ,红细胞压积增加 ,血压下降 ,实验动物当天即可死亡 ,而输液抗休克治疗有效。猴中毒实验中亦可见有明显呕吐、稀便、血压下降、周围血管塌陷等表现。结论 :急型克山病患者与镰刀菌毒素急性中毒者临床表现相似点很多。作者提出一个假设 ,即 :急型克山病患者暴死原因很可能是摄入霉变粮食中污染的镰刀菌毒素 ,导致小肠粘膜表皮损伤 ,从而不断引发了呕吐及大量血浆通过小肠内壁渗漏丢失 ,继发低血容性内休克 ,重症患者可暴死。急型克山病患者暴死的靶器官可能是小肠而不是心脏更多还原

【Abstract】 ObjectiveTo provide a hypothesis about the caus e of sudden deaths in acute_type Keshan disease.MethodsThe chief symptoms and signs of patients with acute_type Keshan disease reported in the l iterature were compared with the results of animal experiments on acute fusario toxicosis(Fusarium mycotoxicosis with T2 toxin as the toxic agent) .The similar and dissimilar points of the two conditions were identified.~{!<~}WTHZ ~{!=~}ResultsIn patients with acute_type Keshan disea se,the chief symptoms are:nausea and vomiting even mixed with bile,chill,ex tremely cool sensation of four extremities,tightness in chest,moans,feeling of terror,difficulty in respiration,shortness of breath,dizziness,polydipsia and as king for drinking,pain in the chest,abdomen region and also at extremities,frigh tened expression.The chief signs are:lowering of blood pressure,feeble and quick pulse,even no pulse,arrhythmia,tachycardia,widening of heart dull region,tachyp nea,cyanosis,venous engorgement,lowering of body temperature,oliguria or anuria. Synchronous sudden death occurres within a relatively short time.The chief resul ts obtained in acute intoxication of T2 toxin(a typical Fusarium m ycotoxin)in experimental animals were:decrease or disappearance of cells in divi sion phase in the crypt of epithelial layer of small intestine and decrease in n umber of ~{*)~}epithelial~{**~} cells,exposure of part of the mucous membrane due to~{*$*$~}loss of epithelial covering,increase in water content of intestine,decreas e blood plasma volume,rise in the hematocrit and lowering of blood press ure.The experimental animal died even on the day of intoxication a nd antishock therapy with f luid transfusion effective.In experimental intoxication of monkeys,s ignificant vomiting,watery diarrhea,lowering of blood pressure,collapse of perip heral vasculature were also seen.Conclusions:The clinical findings of patients with acute_type Keshan disease are quite similar with the results of acute Fusarium mycotoxicosis in experimental animals.The authors pr ovide a hypothesis:the pathogenesis of sudden death of patients suffering from a cute_type Keshan disease might be due to the ingestion of mouldy grain contam inated by fusariomycotoxins,leading to lesions in the epithelium of mucous layer of small intestine,severe vomiting and leakage of large amount of plasma from the intestinal wall,followed b y hypovolemic internal shock and in severe patients,sudden death.The target orga n of death of the acute_type Keshan disease may be the small inte stine rather than the heart.更多还原