摘要目的 探讨婴儿肉毒中毒病例的临床特点及诊疗经过.方法 对北京大学第一医院2015年5月收治的3例临床诊断婴儿肉毒中毒患儿的临床资料进行回顾性分析,分别以“infant,botulism”和“婴儿、肉毒中毒”为主题词检索PubMed、万方数据库、中国期刊全文数据库和中国维普数据库,检索时间均从建库起至2015年11月.结果 3例婴儿肉毒中毒患儿4～8月龄,女2例、男1例.均以纳差、精神反应差急性起病,既往智力、运动发育正常,无明确毒物接触史.体格检查均见:肌力、肌张力减低,腱反射正常引出,眼球活动不灵活,瞳孔散大、对光反射减弱或消失,面部表情减少,哭声弱,吞咽困难为主要表现,而意识状态相对较好.通过行粪便细菌分离鉴定及PCR分型鉴定,2例证实为B型肉毒梭菌感染.文献检索共检索到446条外文文献,52条中文文献.全世界报道的婴儿肉毒中毒病例3 000多例.国内多为综述性文章,有较多食源性肉毒中毒病例报告,婴儿肉毒中毒国内仅2000年有1例报道.结论 婴儿肉毒中毒多无明确暴露史,常表现为弛缓性瘫痪、颅神经麻痹,还具有瞳孔散大、对光反射消失等瞳孔括约肌受累的典型表现.粪便肉毒梭菌分离鉴定及肉毒毒素检测可明确诊断.婴儿肉毒中毒在国内少见,可能与国内医务人员对该病的认识及检验水平不足有关,可能存在被低估的情况.

abstractsObjective To analyze the clinical characteristics and diagnosis of three cases with infant botulism.Method Clinical data of three clinically diagnosed cases with infant botulism in May 2015 in Peking University First Hospital were retrospectively analyzed.Literature search at databases of PubMed,Wanfang,China National Knowledge Infrastructure and VIP with the key words" infant AND botulism".The date of literature retrieval was from the database founding to November 2015.The characteristics of infant botulism were summarized through review of literature.Result Three patients were infants of 4-8 months of age,and all had acute onsets of anorexia and poor response.All of them had normal psychomotor development previously,and without clear history of exposure to poisons.The main findings on physical examination were reduced muscle strength and hypotonia,dullness or disappeared pupillary light reflex,reduced facial expression,weak crying and dysphagia.Unexpectedly their states of consciousness were relatively normal.Finally,through identification and PCR genotyping of bacteria in stool,2 cases were confirmed as Clostridium (C.) botulinum type B infection.Totally 446 reports were retrieved from foreign language literature and 52 reports from Chinese literature.More than 3 000 cases of infant botulism cases were reported in the world.Rare cases were reported in China and only 1 case was reported in 2000.Conclusion Most cases of infant botulism had no clear exposure history.The main clinical manifestations are hypotonia,cranial nerve paralysis,flaccid paralysis,but different patients may have different presentations.Detection of C.Botulinum and its toxin in stool can help to confirm the diagnosis.Infant botulism is relatively rare in China,which may be related to the insufficient understanding and inspection level of the disease.It might be underestimated in China.