职业性慢性重度铅中毒合并中毒性脑病3例报告

目的 报告3例由于生产过程中吸收大量铅烟及铅尘而发生慢性重度铅中毒合并中毒性脑病的发病情况、临床表现及治疗转归.方法 选择我院近年来收治的3例重度铅中毒的病人临床资料进行总结分析.结果 3例患者接触大量铅烟铅尘1.O～1.5年发病,分别由慢性中度铅中毒发展为慢性重度铅中毒合并中毒性脑病.结论 职业性慢性铅中毒性脑病是中枢神经系统严重器质性病变,其病程长、病情重、疗效欠满意、预后较差.临床上应引起高度重视.在碰到类似情况时应尽快明确诊断,及时治疗,确保患者能全面康复.     

38例慢性铅中毒临床分析

职业性慢性铅中毒是生产过程中长期接触铅烟或铅尘所致的全身性疾症。早期表现为卟啉代谢障碍、神经衰弱综合征和消化系统症状 ,中毒较重时出现贫血、腹绞痛 ,严重时出现铅麻痹或中毒性脑病[1] 。现将我所收治的 38例慢性铅中毒病人临床资料分析如下。1　对象方法1 1　一般情况　 38例慢性铅中毒患者为我省铅锌矿厂、蓄电池厂、矿灯厂、印刷厂的工人 ,长期接触铅烟或铅尘 ,具有铅中毒症状和体征 ,尿铅或血铅超过正常值 ,按照国家职业性慢性铅中毒诊断标准均已诊断为慢性铅中毒 ;其中男性 31例 ,占 81 6 % ,女性 7例 ,占18 4 % ;平均年龄 4 1…     

两种不同方法治疗40例慢性铅中毒腹绞痛疗效比较

慢性铅中毒是由于在生活中或职业性接触铅烟或铅尘所致的以神经、消化、造血等系统障碍为主的全身性疾病。慢性中、重度铅中毒患者腹绞痛的发生率颇高[1]。病人发病时疼痛难忍、面色苍白,严重时甚至发生休克。为了对慢性铅中毒腹绞痛的治疗提供参考依据,现对河南省职业病防治研究院2009~2011年收治的40例慢性铅中毒腹绞痛患者的治疗情况总结如下。     

慢性重度铅中毒并中毒性脑病1例报告

报道１名接触二盐基亚磷酸铅、三盐基硫酸铅男工,由患铅吸收到慢性重度铅中毒,慢性重度铅中毒并中毒性脑病的发病,治疗过程。     

88例职业性慢性铅中毒的临床分析

目的分析88例职业性慢性铅中毒病例,探讨铅中毒的临床表现和驱铅治疗效果。方法分析88例职业性慢性铅中毒患者的临床特点,并给予驱铅治疗,检查尿铅变化等。结果其中84例为轻度铅中毒,3例为中度铅中毒,1例重度铅中毒。经2～8个疗程驱铅治疗后以上病例的相关临床表现均明显好转。结论职业性铅中毒的症状是多方面的,驱铅治疗效果好,一般预后良好。     

儿童重度铅中毒的临床诊治疗效分析

目的探讨儿童重度铅中毒的临床特点和治疗疗效。方法回顾分析本院收治9例铅中毒患儿的临床资料,按照《儿童高铅血症和铅中毒预防指南》和《儿童高铅血症和铅中毒分级和处理原则（试行）》进行诊治,对各项结果进行综合分析。结果重度铅中毒的患儿贫血7例（77.8%）、纳差5例（55.6%）、多动4例（44.4%）、爱哭闹4例（44.4%）、脾气暴躁3例（33.3%）、有攻击性行为2例（22.2%）、经常便秘2例（22.2%）、腹痛1例（11.1%）、明显发育落后1例（11.1%）。经过3次驱铅治疗后,血铅下降明显（0.01〉P〈0.05）。结论环境污染、生活接触是儿童铅中毒的主要原因,重度铅中毒需要多个疗程的驱铅治疗,血铅水平才能稳定降至250 mg/L以下。     

神经生长因子治疗5例金属类化学物所致周围神经病疗效观察

在驱排金属类化学物及营养神经的基础上加用神经生长因子(NGF)治疗金属类化学物所致周围神经病,2例慢性重度铅中毒(垂腕)患者经长期用药,获得治愈;铅、汞、砷所致轻度周围神经病患者经短期用药观察到疗效。提示NGF治疗慢性重度铅中毒是有效、安全的,治疗金属类化学物所致轻度周围神经病可能有效。     

慢性铅中毒患者血铅消除的动力学

作者对65例慢性铅中毒患者,在其脱离铅接触及静脉给予EDTA后随访2419天以上,并用一级动力学一室模型进行描述,以得出血铅消除动力学及确定可能影响血铅半排期的因素。 在65例慢性铅中毒病例中,41例为蓄电池厂工人,6例为熔铅工,5例为铸造厂工人,13例为其它铅接触者。这些病例均符合铅接触史6月以上;有慢性铅中毒症状;血铅大于60μg/dl;全血锌卟啉大于     

龙岩市14年铅中毒发病情况分析

目的探讨福建省龙岩市慢性铅中毒的患病特点及分布规律，为今后控制铅中毒发生提供依据。方法对龙岩市职业病防治院1990—2003年毒检室体检资料和门诊记录、病历档案等资料进行回顾性调查。结果共对1605人次进行尿铅检查，铅异常278例（慢性轻度铅中毒146例，慢性中度铅中毒58例，慢性重度铅中毒1例，观察病例73例），其中男性铅异常268例，异常率为18．75％；女性铅异常10例，异常率为5．68％，男性明显多于女性。冶炼行业明显高于生活性接触、蓄电池业和印刷业。蓄电池行业明显高于印刷业。冶炼作业工人铅异常中31—35岁组明显高于26—30岁组，36—40岁组明显高于41-45岁组，男性多于女性。石油行业工人尿铅未检出。结论饮用含铅的酒是生活性铅异常的主要原因，冶炼、蓄电池行业是今后铅中毒防治的重点。     

职业性慢性铅中毒的护理体会

铅中毒是常见的职业病之一。主要是由于铅作业工人在工业生产中直接长期接触铅尘,铅烟,引起慢性铅中毒或铅吸收。现将我院收治65例慢性铅中毒或铅吸收患者的护理体会报告如下: 1 临床资料 1.1 一般资料,65例患者均是直接从事铅作业,长期接触铅尘,铅烟,经市职业病中毒诊断小组集体诊断,而收入院。其中铅中毒30例,铅吸收35例。男50     

Chelated lead and bone lead.

In this study a close correlation [correlation coefficient (r) = 0.86, P less than 0.001] was found between the blood lead level of 20 lead workers and their urinary excretion of lead for 24 h after intravenous infusion with 1 g of the chelating agent calcium disodium edetate. In addition, there were significant associations between lead levels in different bones (tibia/calcaneus: r = 0.93, P less than 0.001; tibia/phalanx: r = 0.67, P less than 0.002; calcaneus/phalanx: r = 0.80, P less than 0.001), as measured by in vivo X-ray fluorescence. Chelation produced no significant change in the lead level in either tibia or calcaneus. There was a significant correlation between chelated lead and bone lead (eg, for calcaneus, r = 0.62) in currently exposed workers. However, there was no significant relationship when a retired worker and an inactive worker were included (r = 0.14). It was concluded that chelatable lead mainly reflects the blood and soft-tissue lead pool, which is only partly dependent upon the skeletal lead content that comprises the biggest share of the total body burden.     

Predictors of DMSA chelatable lead, tibial lead, and blood lead in 802 Korean lead workers

OBJECTIVES—To examine the interrelations among chelatable lead (by dimercaptosuccinic acid, DMSA), tibial lead, and blood lead concentrations in 802 Korean workers with occupational exposure to lead and 135 employed controls with only environmental exposure to lead.
METHODS—This was a cross sectional study wherein tibial lead, DMSA chelatable lead, and blood lead were measured. Linear regression was used to identify predictors of the three lead biomarkers, evaluating the influence of age, job duration, sex, education level, alcohol and tobacco use, creatinine clearance rate, and body mass index.
RESULTS—DMSA chelatable lead concentrations ranged from 4.8 to 2102.9 µg and were positively associated with age, current smoking, and creatinine clearance rate. On average, women had 64 µg less DMSA chelatable lead than men. When blood lead and its square were added to a model with age, sex, current smoking, body mass index, and creatinine clearance rate, blood lead accounted for the largest proportion of the variance and sex became of borderline significance. Tibial lead concentrations ranged from −7 to 338 µg/g bone mineral and were positively associated with age, job duration, and body mass index. Women had, on average, 9.7 µg/g less tibial lead than men. Blood lead concentrations ranged from 4.3 to 85.7 µg/dl and were positively associated with age and tibial lead, whereas current smokers had higher blood lead concentrations and women had lower blood lead concentrations.
CONCLUSIONS—The data suggest that age and sex are both predictors of DMSA chelatable lead, blood lead, and tibial lead concentrations and that tibial lead stores in older subjects are less bioavailable and may contribute less to blood lead concentrations than tibial lead stores in younger subjects. Although blood lead concentrations accounted for a large proportion of the variance in DMSA chelatable lead concentrations, suggesting that measurement of both in epidemiological studies may not be necessary, the efficacy of each measure in predicting health outcomes in epidemiological studies awaits further investigation.


Keywords: dimercaptosuccinic acid; bone lead; x ray fluorescence     

Urinary non-precipitable lead in lead workers.

Sixty-six workers engaged in lead-glazing pottery with a presumed moderate exposure to lead were studied. The group comprised 20 men with long-term exposure to lead and positive laboratory signs of increased lead absorption (Group A); 22 with long-term exposure and negative laboratory signs (Group B); 11 with short-term exposure and positive laboratory signs (Group C); and 13 with short-term exposure and negative laboratory signs (Group D). In addition, 14 workers employed in casting the kelmet alloys with presumed heavy exposure to lead (Group E) and seven healthy individuals (Group F) were included. Urine samples from all the subjects were analysed to determine, first, the total lead using the ashing technique, and then the precipitable lead using the coprecipitation technique of Cholak, Hubbard, and Burkey (1948), but modified slightly by us. Thus, the non-precipitable lead fraction in urine was the difference between the two measurements and this was also expressed as a percentage of the total lead. The mean total lead and the mean proportion of non-precipitable lead were 0.62 mumol/l and 48.7%, 0.35 mumol/l and 44.9%, 0.40 mumol/l and 48.9%, 0.17 mumol/l and 24.6%, 1.43 mumol/l and 44.3%, 0.14 mumol/l and 18.8% for Groups A, B, C, D, E, and F respectively, showing that a large part of urinary lead was eliminated as precipitable lead in Groups D and F who had normal lead excretion, while about half was eliminated as non-precipitable lead in the other four groups who had excessive lead excretion. No essential difference in the proportion of non-precipitable lead among Groups A, B and C excluded the possibility that the proportion might be directly related to the period of exposure to lead and to the laboratory findings of excessive lead absorption. The mean proportion of non-precipitable lead for the physiological (up to 0.240 mumol/l), intermediate (0.241 to 0.721 mumol/l), and excessive (above 0.722 mumol/l) total lead levels was 26.7, 41.3, and 52.3% respectively, in the lead workers comprising Groups A, B, C, and E each showing increased lead excretion when grouped together. these data suggested that, when urinary lead is within the normal range, it is excreted largely as precipitable lead even in individuals exposed to lead, and that the principal conditions determining the excretion of non-precipitable lead would be the current or recent degree of lead absorption. The excretory mechanisms and the biological significance of the non-precipitable lead are also discussed.     

职业铅接触者血铅、发铅、尿铅相关性的研究

本文通过对32名铅蓄电池制造工和36名排字工的血铅、发铅、尿铅的相关性研究,发现血铅/发铅(r=0.604),血铅/尿铅(r=0.548)均呈高度显著性相关(P<0.0005),故认为血铅是铅接触工人较好的健康监护指标。文章还进一步探讨了发铅作为铅接触者活体生物检测材料的应用前景。     

Associations of patella lead and other lead biomarkers with renal function in lead workers

OBJECTIVE: We sought to compare associations of patella lead, which may represent a unique cumulative and bioavailable lead pool, with other lead measures in models of renal function. METHODS: Renal function measures included blood urea nitrogen, serum creatinine, measured and calculated creatinine clearances, and urinary N-acetyl-beta-D-glucosaminidase (NAG) and retinol-binding protein. RESULTS: In 652 lead workers, mean (SD) blood, patella, and tibia lead were 30.9 (16.7) microg/dL, 75.1 (101.1) and 33.6 (43.4) microg Pb/g bone mineral, respectively, and were correlated (Spearman's r = 0.51-0.74). Patella lead was associated (P < 0.05) with NAG in all lead workers. In models of effect modification by age, higher patella lead also was associated with higher serum creatinine in older participants. Similar associations were observed for blood and tibia lead. CONCLUSIONS: Associations between patella lead and adverse renal outcomes were not unique; this may be due, in part, to high correlations among the lead biomarkers in this study.     

Past occupational exposure to lead: association between current blood lead and bone lead

Mobilization of lead from bone is known to increase with age. The authors performed the current study to determine whether there was an association between current blood lead and bone lead in workers with no current exposure but with significant past workplace exposure. The authors assessed 58 men, aged 40 to 76 years, who had earlier exposure to lead and determined both current blood lead levels and bone lead levels. At the time of the current assessment, the average blood lead level was 10.9 microg/dL and tibia bone lead concentrations ranged from -12.5 to 223.3. The authors divided workers into 3 groups by age (40-49, 50-59, and 60-76). Correlations between blood lead and bone lead were highest in the 2 oldest age groups (.49 and .75, respectively). Hierarchical regression analysis was significant for an interaction between bone lead and age in predicting blood lead (the combination of age and bone lead significantly predicted an increase in current blood lead levels). The results support the hypothesis that lead stored in bone is a significant source of blood lead later in life. Older workers with past occupational exposure may face a particular risk for recirculation of lead in blood with advancing age.     

Blood lead and the symptoms of lead absorption

ABSTRACT Eighty-one percent of all hourly paid men who had been employed for more than six months in a factory making lead acid batteries and plastics completed a modified Cornell medical index health questionnaire. Blood lead and erythrocyte protoporphyrin (EPP) were also measured. The questions were grouped into symptom categories as follows: all physical, all psychological, “potentially lead induced,” pulmonary, cardiovascular, gastrointestinal, skin, nervous system, genitourinary, and fatigue. For each symptom category the pooled percentages of men whose symptom scores were above the common median of the three blood lead groups 10-, 40-, and 60 and over μg/100 ml (0·48-, 1·93-, and 2·90 and over μmol/l) within age/smoking subgroups were calculated. In every symptom category the percentages in the two lower blood lead groups differed little, but the percentages were consistently higher in men with blood concentration of 60 μg/100 ml (2·90 μmol/l) and over. Differences between a combined 10-59 μg/100 ml (0·48-2·85 μmol/l) blood lead group and the 60 and over μg/100 ml (≥2·90 μmol/l) group were statistically significant at the 0·01 level for “potentially lead induced” symptoms and at the 0·05 level for skin and psychological symptoms. Broadly similar results were obtained with four log₁₀ EPP groups 0·6-, 1·5-, 1·7-, and ≥2·0, but differences did not reach statistical significance. There was no obvious explanation as to why symptoms that are not found in classic lead poisoning should be increased almost as much as those that are. It was thought that these results could be biased due to the men's knowledge of the symptoms associated with lead exposure, but the possibility that they may be partly due to lead absorption cannot be excluded.