六种金属中毒解毒药治疗肝豆状核变性的临床研究

目的　探讨金属中毒解毒药治疗肝豆状核变性 (HLD)的临床应用价值。方法　将 85 2例HLD随机分为还原型谷胱甘肽组 (GSH组 )、二巯基丁二钠组 (DMS组 )、依地酸钙钠组 (EDTA组 )、二巯基丙磺酸钠组 (DMPS组 )、青霉胺组 (PCA组 )及二巯基丁二酸组 (DMSA组 )等六个治疗组 ,对各组治疗前后的尿铜等元素、疗效及不良反应进行对比。结果　治疗前后尿排铜量对比GSH组无显著变化 ,其他各组由高到低依次为DMPS组 ( 4 8.68± 2 0 .67) μmol·2 4h-1、PCA组 ( 3 0 .0 4± 10 .5 1) μmol·2 4h-1、DMS组 ( 2 4.3 0± 8.60 ) μmol·2 4h-1、DMSA组 ( 18.2 5± 7.73 ) μmol·2 4h-1、EDTA组 ( 10 .5 8± 4.67) μmol·2 4h-1,均较疗前有显著增高 (P <0 .0 1)。上述解毒药对HLD的锌、铁、钙元素代谢亦有一定影响。治疗后各组的有效率依次为DMPS组 ( 78.9% ) >DMS组 ( 74.5 % ) >PCA组 ( 71.3 % ) >DMSA组 ( 69.1% )>EDTA组 ( 5 3 .7% ) >GSH组 ( 2 8.8% ) ,组间对比差异有非常显著性 ( χ2 =73 .5 ,P <0 .0 1)。各治疗组不良反应发生率依次为 :PCA组 ( 4 4.5 % ) >DMPS组 ( 4 3 .8% ) >DMS组 ( 4 2 .2 % ) >DMSA组 ( 4 1.2 % ) >EDTA组 ( 3 9.8% ) ,与GSH组对比差异有非常显著性 ( χ2 =3 3 .6,P <0 .0 1)。常见的

The clinical study of six antidotes against heavy metal poisoning in Wilson's disease

Objective To study the clinical effect of six antidotes against heavy metal poisoning in Wilson's disease(WD).Methods 852 cases of WD patients were divided into six groups(GSH group,DMS group,CaNa 2EDTA group,DMPS group,PCA group and DMSA group)randomly.The urinary copper,clinical effects and side effect of each group were observed,and these results were compared between pre-treatment and post-treatment in each group.Results Except for GSH group(P>0.05),the average urinary copper levels of other groups increased.The urinary copper levels from high to low were as follows:DMPS group(48.68±20.67)μ mol·24h -1 ,PCA group(30.04±10.51)μ mol·24h -1 ,DMS group(24.30±8.60)μ mol·24h -1 ,DMSA group(18.25±7.73)μ mol·24h -1 and CaNa 2EDTA group(10.58±4.67)μ mol·24h -1 .There were significant differences between the pre-treatment and post-treatment groups(P<0.01).These antidotes also had some influences on metabolism of zinc,ferrum and calcium.The clinical effective rate of each group which had significant difference(χ 2=73.5,P<0.01)from high to low were as follows:DMPS group(78.9%),DMS group(74.5%),PCA group(71.3%),DMSA group(69.1%),CaNa 2EDTA group(53.7%),and GSH group(28.8%).The rates of side effect of each group from high to low were as follows:PCA group(44.5%),DMPS group(43.8%),DMS group(42.2%),DMSA group(41.2%),and CaNa 2EDTA group(39.8%),and they were significant differences compared with GSH group(χ 2=33.6,P<0.01).The common side effects include digestive dysfunction,allergic reaction,hemorrhagic tendency,cytopenia,liver dysfunction,renal dysfunction,and so on.Conclusion The urinary copper level and clinical effect of these antidotes suggest that PCA is the best among oral drugs,DMSA takes the second place, DMPS is the best among injection drugs,DMS takes second place,CaNa 2EDTA is mild,GSH is effectless.