Title: Rhabdo Prevalence
题目：横纹肌溶解症的流行病学
Author 作者: Kishan Kapadia
翻译：江利冰 校对：肖锋

Sympathomimetic toxicity is a known toxidrome that is complicated by the development of rhabdomyolysis.  There are multiple stimulant agents that induce sympathomimetic toxicity including, synthetic cathinones, cocaine, amphetamines, and methamphetamines.  
拟交感神经毒性是一种已知的中毒症候群，可以并发横纹肌溶解。有很多兴奋剂可以诱导拟交感神经毒性，包括合成的卡西酮、可卡因、安非他命以及甲基安非他命。

A recent retrospective, single-center, chart review in the age range of 14-65 years sought to determine the prevalence of rhabdomyolysis in patients with sympathomimetic toxicity and compare rates among patients using specific agents.  Rhabdomyolysis and severe rhabdomyolysis were defined as CK>1000 and 10,000 IU/L, respectively.
最近一项回顾性、单中心的病历审查，分析了14-65岁的拟交感神经毒性患者中横纹肌溶解的发生率，并且比较了使用不同的兴奋剂的患者中横纹肌溶解的发生率。横纹肌溶解和严重横纹肌溶解分别定义为CK>1000或>10,000IU/L。

Rhabdomyolysis occurred in 42% of study subjects (43/102)
在研究对象中横纹肌溶解的发生率为42%(43/102)。

Prevalence in 89 subjects due to a single-stimulant exposure:
89例发生在使用单一兴奋剂患者中：

Rhabdomyolysis 横纹肌溶解症
1) Synthetic cathinone (MDPV, alpha-PVP) 63% (12/19)
合成卡西酮（亚甲基二氧吡咯戊酮，alpha-聚乙烯吡咯烷酮）63%(12/19)
2) Methamphetamine 40% (22/55)
甲基安非他命40%(22/55)
3) Cocaine 33% (3/9)
可卡因33%(3/9)
4) Other single agents (methylphenidate, pseudoephedrine, phentermine) 0% (0/6)
其它的单一兴奋剂（哌醋甲酯、假麻黄碱、苯丁胺）0%，(0/6)。

Severe Rhabdomyolysis
严重横纹肌溶解症
1) Synthetic cathinone 26% (5/19)
合成卡西酮26% (5/19)
2) Methamphetamine 3.6% (2/55)
甲基安非他命3.6% (2/55)
3) Cocaine 11% (1/9)
可卡因11% (1/9)
4) Other single agents (methylphenidate, pseudoephedrine, phentermine) 0% (0/6)
其它的单一兴奋剂（哌醋甲酯、假麻黄碱、苯丁胺）0%(0/6)

In this study, patients exposed to synthetic cathinones were more likely to develop rhabdomyolysis and severe rhabdomyolysis compared to the non-cathinone-exposed group.
在这项研究中，服用合成卡西酮的患者要比服用其它兴奋剂，更容易发生横纹肌溶解症和严重横纹肌溶解症。

Bottom Line:
要点：
Be aware of this increased risk from synthetic cathinones along with other stimulants.  Treat aggressively with IV fluids, rapid correction of hyperthermia, benzodiazepines to control manifestations of sympathomimetic toxicity to reduce muscle activity and metabolic demand.
要意识到联合使用合成卡西酮和其它兴奋剂，会增加横纹肌溶解症的发生率。治疗应当积极的静脉补液，快速纠正高热，使用苯二氮卓类药物控制拟交感神经毒性的症状、减少肌肉的活动以及降低代谢的需求。
 
References 参考文献：

O'Connor AD, Padilla-Jones A, Gerkin AD, et al.  Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants. J Med Toxicol 2014; Dec 3; Epub ahead of print.