摘要
肉毒毒素(botulinum neurotoxin,BoNT)是由肉毒梭状芽胞杆菌产生的神经毒素,通过水解可溶性N-乙基马来酰亚胺-敏感因子附着蛋白受体(soluble N-ethylmaleimide-sensitive factor attachment protein receptor,SNARE)复合体,阻断神经递质释放,达到化学性去神经支配作用,已在临床诊疗及美容整形等多学科领域得到了广泛的应用。BoNT中毒是由BoNT过量导致的一种神经瘫痪性疾病。医源性BoNT中毒大多与使用非正规渠道来源的Bo NT或不规范使用Bo NT有关。BoNT中毒的临床症状主要为急性、对称性、下行性迟缓性瘫痪,严重者可致呼吸衰竭而死亡。BoNT中毒最有效的治疗方法是尽早使用Bo NT抗毒素,因此早期诊断至关重要。由于病原菌检测或BoNT检测耗时较长,因此临床诊断BoNT中毒主要依靠病史和临床表现,而神经电生理检查则有助于鉴别诊断。本文对Bo NT中毒相关文献进行总结和讨论,以期为BoNT中毒的诊断和治疗提供指导。
Botulinum neurotoxin(Bo NT) produced by Clostridium botulinum selectively cleaves soluble N-ethyl-maleimide-sensitive factor attachment protein receptor(SNARE) complex protein and thus inhibits neurotransmitter release and causes chemodenervation. Bo NT has been used in many fields such as clinical diagnosis and treatment and cosmetic surgery. Botulism is a neuroparalytic disease caused by over-dose of Bo NT. Iatrogenic botulism is most commonly observed after injection of neurotoxin with poor quality or not following usage rules. The symptoms of botulism commonly present as acute symmetrical descending flaccid paralysis. In some severe cases, respiratory failure may happen, which can even cause death. Once botulism happens, early administration of antitoxin is the most effective therapy,thus early diagnosis is essential. The diagnosis of botulism is mainly based on medical history and physical examination because toxin detection and Clostridium botulinum culture are both time-consuming. Nerve electrophysiological tests may be helpful in differential diagnosis. This paper reviews the researches on botulism, which may provide a basis for the diagnosis and treatment of botulism.
出处
《神经病学与神经康复学杂志》
2016年第4期173-180,共8页
Journal of Neurology and Neurorehabilitation
基金
国家自然科学基金青年基金项目(编号:81500970)
上海市卫生和计划生育委员会面上项目(编号:201440535)~~
关键词
肉毒毒素类
神经毒素类
中毒
诊断
治疗
Botulinum toxins
Neurotoxins
Poisoning
Diagnosis
Therapy
