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雪卡鱼中毒

Author
Erin N Marcus, MD, MPH, FACP
Section Editors
Michele M Burns, MD, MPH
Stephen J Traub, MD
Daniel F Danzl, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
唐文杰, 主任医师，教授

引言

本专题将介绍雪卡鱼中毒的临床表现、诊断和处理。摄入其他海产品引起的中毒会单独详细讨论，如鲭鱼、贝类或河鲀。 (参见“贝类和河鲀中毒的概述”和“鲭鱼(组胺)中毒”)

流行病学

雪卡鱼中毒属于食源性疾病，病因是摄入了被毒素污染的礁石鱼类(如梭鱼、琥珀鱼、海鳗以及某些种类的石斑鱼、鲷鱼或鹦嘴鱼)，毒素来自生长于珊瑚礁上的单细胞生物有毒冈比亚藻(Gambierdiscus toxicus)。雪卡鱼中毒在美国的鱼类相关食源性疾病暴发中约占20%[1]，也是热带沿海地区常见的鱼类食物中毒[2]。全世界每年都有20,000-50,000人发生这种中毒[3]，但该数据可能因漏诊和漏报而偏低[4]。在美国，估计每年会发生16,000例雪卡鱼中毒，导致300例以上的住院，但死亡不足5例[5]。

据估计，雪卡鱼中毒的终身患病率从波多黎各的7%[6]到波利尼西亚群岛的70%[7]不等。病例大多集中于热带和亚热带地区、北纬35度到南纬35度之间。但随着旅游业、鱼类出口和反常鱼类迁徙的不断增加，雪卡鱼中毒病例也可发生在更偏温带的区域。已有多例摄入进口鱼后发生雪卡鱼中毒的报道，如从市场购买进口鱼的纽约市[8]和德国北部[9]患者，和食用瓜德罗普岛进口鱼的巴黎患者[10]。研究者们还报道了2例食用南卡罗莱纳州海岸渔获(梭鱼)导致雪卡鱼中毒的病例，此处远比雪卡鱼中毒多发区偏北[11]。

部分专家推测，气候改变引起的海水温度升高可能会增加雪卡鱼中毒的发生率，因为产毒生物会在更温暖的水中大量繁殖且可能会迁移至非传统生长区域[12]。但2013年的一项分析表明，虽然美国维尔京群岛的海水温度在过去30年中总的来说有所增加，但雪卡鱼中毒发生率并未上升[13]。

现已发现有400多种不同的鱼类与雪卡鱼中毒相关。栖息于礁石的热带鱼是最为常见的致病源，如梭鱼、海鳗、琥珀鱼以及某些种类的石斑鱼、鲭鱼、鹦嘴鱼和红鲷鱼。摄入温带鱼(包括人工养殖的鲑鱼)后发生雪卡鱼中毒的罕见病例也有报道[14]。但总体而言，非热带鱼导致的中毒极为罕见。

             

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-08.
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