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目的验证中毒事件病因判定模型在新疆维吾尔自治区塔城地区发生的一起乌头属植物中毒事件病因判定中的作用。方法中毒事件病因判定模型的要点是根据现场、病例和实验研究结果进行综合判定。接到中毒事件报告后,当地疾病预防控制中心(CDC)专业人员迅速赶往现场开展流行病学调查,了解中毒患者临床情况,采集中毒患者的血液、呕吐物样本及可疑有毒植物新鲜样本,国家CDC组织相关专业机构进行可疑有毒植物的形态学鉴定、DNA分子鉴定和毒素检验,并按照中毒病因判定模型,综合3方面的结果进行病因判定,指导临床诊断和救治。结果 2010年5月30日,新疆塔城地区某县某矿业金属有限公司13名员工食用在附近山上采集的“野芹菜”后15～30 min内陆续出现口唇及四肢麻木、全身乏力、恶心、呕吐等症状,立即被送往当地医院,运送途中死亡4人,9人送到医院进行抢救,其中2人抢救无效均于中毒后4 h左右死亡。可疑有毒植物新鲜样本形态学鉴定确认为毛茛科乌头属植物。1例呕吐物样品和3例血液样品中检测出乌头碱,血液样品中乌头碱含量分别为0.17、0.25和0.48μg/L。DNA分子鉴定结果显示现场采集的可疑有毒植物新鲜叶片与乌头属植物属于同一类。综合上述结果,明确该起事件为误采误食乌头属植物茎叶所致突发中毒事件。结论中毒事件病因判定模型在中毒事件病因判定中可起到重要指导作用。
Objective To verify the role of the model for determining the cause of poisoning in determining the etiology of a poisoning in a genus Aconitum occurring in Tacheng, Xinjiang Uygur Autonomous Region. Methods The main points of the etiological determination model of poisoning incidents are comprehensive judgment according to the field, case and experimental research results. After receiving the report of the poisoning incident, local CDC professionals rushed to the scene to carry out epidemiological investigations, learn about the clinical situation of poisoning patients, collect samples of blood and vomit of poisoning patients and fresh samples of suspected poisonous plants, CDC organizations related professional institutions for morphological identification of suspicious poisonous plants, DNA molecular identification and toxin test, and in accordance with the determination of the cause of poisoning model, the results of three integrated etiology, to guide the clinical diagnosis and treatment. Results On May 30, 2010, 13 employees of a certain Mining Metal Co., Ltd. in a county in Tacheng Prefecture of Xinjiang took oral and numb limbs and numbness within 15 to 30 minutes after consuming “wild celery” collected in nearby mountains. Nausea, vomiting and other symptoms, was immediately sent to the local hospital, delivery of 4 people were killed, 9 were sent to the hospital for treatment, of which 2 were ineffective rescue were poisoned after 4 h died. Morphological identification of fresh samples of suspected poisonous plants was identified as Ranunculaceae aconite. 1 case of vomit samples and 3 cases of blood samples detected aconitine, blood samples of aconitine content were 0.17,0.25 and 0.48μg / L. The results of DNA molecular identification showed that the fresh leaves of the suspected poisonous plants collected on site belong to the same category as the genus Aconitum. Based on the above results, it is clear that the incident was an accidental poisoning accidental poisoning caused by stems and leaves of the genus Aconitum. Conclusion The model of etiological determination of poisoning can play an important guiding role in determining the cause of poisoning.