儿童铅中毒的治疗药物

铅是一种严重危害人类健康的重金属,对血液、神经、肾、肝等均具有毒性,在人体内无任何生理功用,其理想的血浓度为0。儿童由于代谢和发育方面的特点,对铅毒性特别敏感。研究表明,铅中毒正在威胁广大儿童健康,其普遍性和严重性远远超过我们的预料,治疗和预防儿童铅中毒的工作迫在眉睫。本文就治疗儿童铅中毒的常用药物介绍如下。1依地酸二钠钙依地酸二钠钙(CaNa2EDTA)是儿童铅中毒最常用的治疗药物。该药用以治疗铅中毒和其他重金属中毒已有50年的历史。1·1药理学CaNa2EDTA络合铅后从肾脏排除,可使尿铅水平较未用药时上升20~50倍。该药…     

儿童慢性铅中毒患者临床分析

分析我院收治的18例儿童铅中毒患者的临床资料及中毒原因,16例与环境铅污染有关,2例与服含铅药物有关.主要表现为烦躁、多动、注意力不集中,学龄儿童有学习困难,2岁以下幼儿易出现中毒性脑病及生长发育障碍,多伴有食欲差、便秘、腹痛及贫血.驱铅及对症综合治疗有效,个别接铅时间长的婴幼儿遗留智能及体格发育障碍.     

多种营养素联合应用对儿童铅中毒影响

目的 探讨多种营养素联合应用对铅毒性的拮抗作用。方法 采用自身对照及组间对照法,对维生素C、维生素B1及钙、铁、锌、硒6种已知对铅毒性有拮抗作用的营养素进行人体干预研究。结果 试验组血铅平均值由(160.4±29.2)μg/L下降为(125.8±20.1)μg/L;尿铅平均值由(30.4±8.5)μg/L增加为(39.6±11.6)μg/L;与试食前和对照组比较,试食组试食后血铅下降及尿铅排出差异均有统计学意义(P<0.01);试食组相同时间点尿铅排出率高于尿钙、尿锌的排出率(P<0.05),且临床症状有较明显改善(P<0.05)。结论 多种营养素联合应用具有拮抗儿童铅中毒的作用。     

儿童铅中毒饮食高危因素分析

目的掌握武汉市儿童血铅值水平变化趋势及与饮食习惯的关系,制定降低儿童血铅水平的营养干预措施。方法采取分层随机抽取2个城区2条街道所有0~3岁儿童;6所不同等级幼儿园所有3~6岁以上在园儿童作为研究对象。对儿童母亲进行问卷并填写调查表,采集儿童手指血,用钨舟原子吸收光谱仪测定血铅值。结果儿童铅中毒发生率为0.27%。高铅血症率为6.97%,男童发生率明显高于女童(P0.001),不同年龄儿童血铅水平差异有高度统计学意义(P0.001),其中2岁组儿童血铅值最高。偏爱吃爆米花、松花蛋类食品的儿童高铅血症和铅中毒检出率较高;而服用钙、铁、锌制剂的儿童高铅血症和铅中毒检出率较低。爱吃爆米花和松花蛋是儿童高铅血症和铅中毒的危险因素。结论对儿童及家长进行必要的宣教,提倡平衡膳食。而营养综合干预应该是降低儿童血铅水平的首选,同时改进传统的食品加工、储存的工艺。     

A global approach to childhood lead poisoning prevention

Childhood lead poisoning is an important, preventable environmental disease affecting millions of children around the world. The effects of lead are well known and range from delayed and adversely affected neurodevelopment to severe health outcomes including seizures, coma, and death. This article reviews the childhood effects of lead poisoning, the approach being taken to the problem in the United States, and the obstacles faced by developing nations in dealing with lead exposure. The United States has attacked the childhood lead poisoning problem by attempting to eliminate sources of exposure, including gasoline, solder in water pipes and cans, and industrial emissions. These actions have resulted in a dramatic reduction in the number of children with elevated blood lead levels in the United States over the last two decades. However, many developing countries are just beginning to address the problem. Successful efforts will need to incorporate epidemiologic methods, source identification, enforced regulations, and a long-term government commitment to eliminating lead as a threat to the next generation of children.     

儿童铅中毒检测及干预的探讨

目的:探讨锌原卟啉(ZPP)在儿童铅中毒检测中的临床意义及补充锌、钙制剂对儿童铅中毒的治疗效果。方法:对沈阳市市属幼儿园体检中ZPP值高出正常范围的儿童进行血铅浓度检测,对其中血铅水平高出正常范围的儿童进行干预治疗,部分拒绝治疗者作为对照组,在治疗前后分别测定血铅进行对比分析。结果:ZPP值与血铅有相关性,但相关系数较低;男女儿童血铅水平有显著性差异;补充矿物质钙、锌等有助于治疗儿童铅中毒。结论:锌原卟啉测定不太适合作为儿童铅中毒的筛查方法;儿童轻度铅中毒可适当应用钙、锌等矿物质治疗。     

Community-based screening for childhood lead poisoning. Identification of risk factors and susceptible populations in Duluth

The purpose of this matched case-controlled study was to identify local risk factors and susceptible populations for childhood lead poisoning in Duluth, Minnesota. We mailed questionnaires to the parents of 20 children with known elevated capillary lead levels > or = 10 micrograms/dL; 76 age-matched controls had capillary lead levels < 10 micrograms/dL. The study identified these risk factors for elevated capillary lead levels in children: not attending daycare, having nonwhite parents, living in rental property in central Duluth, and moving with family three or more times in the previous five years. We conclude that these risk factors are related to socioeconomics. Minority children and children living in poverty in the Duluth area should be screened for lead poisoning according to the Centers for Disease Control and Prevention screening guidelines for high-risk lead exposure.     

铅对儿童甲状腺功能影响的研究

【目的】本文主要探讨铅中毒对儿童甲状腺功能的影响。【方法】入选对象为0~6岁的儿童,血铅采用钨舟原子吸收光谱法测定,并根据血铅的水平<100μg/L,100~200μg/L,200~499μg/L将儿童分为正常血铅组、轻度铅中毒组和中度铅中毒组。对三组对象均采用化学发光免疫技术,分别测其TT3、TT4、FT3、FT4、TSH共5项甲状腺功能指标,并计算出FT4/TSH的比值,将三组甲状腺功能指标和FT4/TSH的比值进行方差分析。【结果】正常血铅组、轻度铅中毒组和中度铅中毒组TT3、TT4、FT3、FT4值差异均无显著性,而三组的TSH值,FT4/TSH比值存在显著性差异。【结论】虽然未达到甲状腺功能低下的程度,但是轻中度铅中毒对儿童甲状腺功能已存在影响;并且随着血中铅浓度的增高,甲状腺功能损害的程度也会加重。     

Moderate lead poisoning: trends in blood lead levels in unchelated children.

The appropriate clinical management of children who are moderately poisoned with lead (Pb) is under active investigation. To determine the pattern of change in blood Pb (BPb) levels in the absence of chelation therapy, we followed moderately Pb-poisoned children (initial blood Pb levels 1.21-2.66 mumol/l or 25-55 micrograms/dl) for 6 months with repeated BPb level measurements. Chelation therapy was not administered because all the children had negative lead mobilization tests indicating limited response to the chelating agent, calcium disodium edetate (CaNa2EDTA). Eligible children received the following interventions: notification of the health department to remediate lead hazards; reinforced educational efforts about the toxicity sources and treatment of Pb during 10 clinic and 3 home visits; and iron therapy for children with ferritin levels less than 16 micrograms/l. To quantify the lead paint hazards in the home, we combined a visual rating of the surfaces (intact to peeling) with an X-ray fluorescence (XRF) measurement of the lead content of the painted surface. The sum of these assessments is termed the home environmental score (HES). Data were analyzed from 79 children. BPb levels declined by 27%, on average, over 6 months. HES was correlated with BPb at enrollment, but neither the initial nor later HES measurements predicted BPb at other time points. The HES was highest at enrollment and declined by 50% and 75% at the second and third home visits, respectively. However, only a minority of the children (20%) achieved an HES of 0, indicating no lead paint hazards at home. Despite some ongoing Pb exposure, a parallel fall in BPb levels was observed in subgroups of children with either initially low or high HES (above or below the median HES of 37). Iron status did not account for the change in BPb levels. These data provide evidence that our measure, the HES, is quantifiably related to BPb levels in children, that this correlation is significant only prior to intervention; and that BPb levels decline in children who are moderately poisoned with Pb after they are enrolled in a comprehensive intervention program, even in the absence of chelation therapy and in the presence of ongoing lead paint exposure and Fe deficiency.     

Community-based monitoring of diarrhea in urban Brazilian children: incidence and associated pathogens

Community-based monitoring was conducted in order to investigate the occurrence of diarrhea in 'sentinel areas' of Salvador, Brazil, and to establish a preliminary profile of the most common pathogens present in children's diarrhea by screening stool samples. This report describes the results obtained from twice weekly home visits to identify and follow diarrhea episodes and testing of carer-requested stool sample collection over a 6-month period. Participants were selected from a large longitudinal study in 21 areas representing the city's poorer socioeconomic and sanitary conditions. Fecal samples were examined for the presence of pathogenic bacteria, viruses and protozoa. The mean incidence of diarrhea was 4.97 episodes per child-year, and longitudinal prevalence was 13.6 days per child-year (3.7%). Pathogens were found in 44% of the fecal samples examined. Bacteria were the most frequently encountered pathogens (isolated in 22% of samples), followed by protozoa (19.5%) and viruses (16%). Viral and bacterial pathogens were associated with episodes of severe diarrhea, while viral and protozoan pathogens were associated with longer episodes. The study demonstrated the importance of a public health monitoring system based on 'sentinel areas'.     

Clinician follow-up of children screened for lead poisoning.

OBJECTIVES: This study assessed clinicians' compliance with Centers for Disease Control and Prevention recommendations for follow-up of children with blood lead (BPb) levels of 0.48 mumol/L (10 micrograms/dL) or higher. METHODS: Clinicians' success at follow-up was determined for 3 BPb ranges: > or = 0.97 mumol/L, 0.73 through 0.92 mumol/L, and 0.48 through 0.68 mumol/L (> or = 20 micrograms/dL, 15-19 micrograms/dL, and 10-14 micrograms/dL, respectively). RESULTS: A total of 410 children with elevated BPb levels were followed over a 12-month period; within 4 months, 71% of those with initial levels of 0.97 mumol/L or greater were retested and 57% and 34% of children with initial BPb levels of 0.73 through 0.92 mumol/L and 0.48 through 0.68 mumol/L, respectively, were retested. CONCLUSIONS: Follow-up of children with elevated BPb levels is inadequate within an urban ambulatory care network.     

Risk factors for lead poisoning among Cuban refugee children

OBJECTIVES: This study was designed to explore whether parental activities such as repairing cars, welding, and rebuilding car batteries are risk factors for lead poisoning among Cuban refugee children in Miami-Dade County. METHODS: The authors performed a cross-sectional study of 479 children aged 12-83 months who had lived in Cuba during the six months prior to immigrating to the U.S. Lead levels were obtained, and parents provided information on demographics, home/neighborhood environment in Cuba prior to immigration, family/occupational factors prior to immigration, and child behavior factors. RESULTS: Of 479 children, 30 (6.3%) had elevated blood lead levels (EBLLs), defined as > or = 10 microg/dL, based on the Centers for Disease Control and Prevention action level. In multivariate analysis, racial/ethnic identification other than white, living in a home built after 1979, car repair in the home or yard, eating paint chips, and male sex were independently associated with EBLL. CONCLUSIONS: Risk factors for lead poisoning among immigrant children may differ from those among U.S.-born children. Screening of immigrant children who may have been exposed in their country of origin and education of immigrant parents about lead exposure hazards associated with activities such as car repair should be considered in the design of lead poisoning prevention and control programs.     

铅中毒儿童矿物质和微量元素的变化

【目的】　探讨儿童铅中毒对机体矿物质和微量元素的影响。　【方法】　选择来医院就诊的 10 2 0例 0～ 18岁患儿为研究对象。根据铅中毒诊断标准 ,将患儿分为铅中毒组和对照组。患儿血铅、血清钙、铁、铜、锌和镁的测定采用原子吸收方法。　【结果】　铅中毒组血清铜和锌水平 [( 17.17± 3 .61) μmol/L和 ( 14 .3 6± 2 .5 0 ) μmol/L]均显著低于对照组 [( 17.96± 2 .91) μmol/L和 ( 15 .2 7± 2 .3 6) μmol/L] (P <0 .0 0 1) ,并且铅与铜和锌均存在显著负相关关系。对各年龄组 ( <1岁、1～ 5岁、6～ 12岁、13～ 18岁 )的比较发现 ,铅中毒组 6岁以上患儿血清铜、锌水平均低于同年龄对照组 ,2～ 5岁患儿仅血清锌低于对照组 ;<1岁患儿的微量元素在两组之间无差异。　【结论】　铅中毒使儿童机体微量元素铜和锌水平降低 ,这有助于指导儿童铅中毒的防治工作     

2007-2011年中国儿童血铅水平及铅中毒率的分析

摘要:目的　描述2007-2011年我国儿童整体血铅水平、铅中毒率及分布特征。方法　本研究通过计算机检索2007-2012年公开发表的关于儿童血铅水平和（或）铅中毒率研究的论文,依照时间挑选出2007-2011年的文献按年份分类整理。对27省（市）88万多人做了调查研究。结果　2007-2011年我国儿童血铅水平（μg/L）分别是:68.62、59.13、53.36、66.56和46.56,平均血铅水平58.88 μg/L;而相应的儿童铅中毒率（%）分别是:19.56、11.56、12.67、10.41和7.27,平均铅中毒率是12.29%。结果说明,2007-2011年我国0～5岁儿童的血铅水平和铅中毒率随着年龄的增加而升高,尽管6岁组与5岁组相比,血铅水平及铅中毒率有所降低,但仍高于其他年龄组;同样,除2010年的儿童血铅水平比2008和2009年有所增加外,2007-2011年儿童血铅水平和铅中毒率随着年份的增加呈降低趋势。此外,经Meta分析发现,2007-2011年儿童铅中毒率和血铅水平也呈现明显的性别分布特征和地区分布特征。结论　2007-2011年我国儿童血铅水平和铅中毒率仍然较高,预防儿童铅中毒仍然是我国今后应当重视的医学问题和社会问题。     

驱铅治疗前后儿童血微量元素水平的变化

目的 探讨驱铅治疗前后儿童血微量元素水平的变化及临床意义.方法 选择36例诊断为铅中毒的患儿(铅中毒组)与同期36例健康儿童(对照组)作为研究对象,对于铅中毒组进行依地酸二钠钙(CaNa2EDTA)驱铅治疗,并于驱铅前后检测铁、锌、钙、铜4种元素,与对照组进行比较.结果 驱铅治疗前铅中毒组血中铁、锌、钙、铜水平较对照组低,两组比较差异有统计学意义(t分别为9.8355、7.1538、4.8717、6.2559,均P<0.05),而驱铅治疗后铅中毒组血中铁、锌、钙、铜水平与对照组比较,差异无统计学意义(t分别为1.2134、1.4408、0.3440、0.9864,均P>0.05).结论 铅中毒影响小儿血铁、锌、钙、铜水平,应重视铅中毒的防治.     

韶关市2～6岁1 139名儿童血铅水平及影响因素的分析

【目的】了解韶关市2～6岁儿童血铅水平分布特点及影响因素，以期为做好儿童保健工作提供依据。【方法】根据韶关市布局特点，随机抽取居民、近郊、交通繁忙及厂矿区8个幼儿园1139名2～6岁儿童为调查对象,采指端末梢血20μl，用钨舟原子吸收光谱法．测定血铅水平，并进行问卷调查。【结果】2～6岁1130名儿童血铅水平均值为0．47μmol／L，铅中毒率30．955％，以轻度铅中毒者居多（38.02％）；男、女童血铅水平及铅中毒率差异无显著性;随年龄的增加．铅中毒率逐渐增高。5岁组血铅水平、铅中毒率最高;近郊及厂矿区血铅水平,铅中毒率较高;不良卫生习惯、铅作业家庭成员、被动吸烟是影响血铅的高危因素，常用乳类食品则是保护因素。【结论】韶关市近郊及厂矿区儿童是高危人群15岁左右可能是铅暴露的关键时期;不良卫生习惯和环境因素增加铅吸收风险。     

利用二水平Logistic模型探讨儿童铅中毒的影响因素

目的 探讨0～6岁儿童铅中毒的影响因素.方法 采用分层整群抽样方法 ,于2008年2～5月在全国12个省会城市中抽取0～6岁学龄前儿童12 714名进行问卷调查及血铅测定,采用二水平Logistic回归模型探讨儿童铅中毒的影响因素.结果 儿童铅中毒的总体患病率为4.8%,男童(5.2%)与女童(4.3%)比较差异有统计学意义(χ2=4.823,P=0.028<0.05).影响儿童铅中毒的主要因素为:性别、距交通干道距离、燃料类型、住房装修、常啃手指甲、服用奶类和食松花蛋.结论 儿童铅中毒与环境铅污染及儿童行为习惯密切相关,改善居住环境及加强健康教育是防治儿童铅中毒的关键.     

儿童铅中毒对红细胞CD35影响的研究

目的　了解铅中毒时儿童红细胞CD35的变化。方法　选择湖州市某乡接受婴幼儿系统管理儿童 86名进行全面健康检查 ,并测定血铅 ,血铅 >0 483 μmol/L (10 μg/dl)者为铅中毒组 ,血铅 <10 μg/dl为自然对照组。两组同时采用美国B D公司生产的流式细胞仪测定红细胞CD35阳性率和平均荧光强度。结果　铅中毒儿童红细胞CD35阳性率下降 ,但与对照组比较差异无显著意义 ;红细胞CD35的平均荧光强度明显下降 ,与对照组比较差异有显著意义。结论　铅中毒时儿童红细胞CD35的变化 ,首先改变的是红细胞CD35的平均荧光强度 ,提示轻度铅中毒时红细胞免疫功能已受到影响。