尿汞增高患者二巯基丙磺酸钠驱汞治疗特点分析
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摘要
目的探讨二巯基丙磺酸钠(DMPS)对尿汞增高患者驱汞治疗的疗效和安全性。方法采用随机抽样的方法,以68例尿汞增高患者为研究对象,其中汞作业观察对象61例,职业性慢性轻度汞中毒7例。采用肌内注射DMPS进行驱汞治疗,观察治疗前后患者尿汞水平变化情况,分析疗效。结果 68例患者自然排尿汞中位数和第25、75百分位数[M(P_(25),P_(75))]为36.6(28.4,55.6)μmol/mol肌酐,第1疗程驱汞治疗后24 h尿汞总量M(P_(25),P_(75))为1 074.7(608.0,1 646.3)μg/d。经1~8个疗程驱汞治疗后,68例患者的24 h尿汞总量均低于驱汞治疗正常参考值(45.0μg/d);出院前一次性晨尿尿汞水平M(P_(25),P_(75))为2.7(1.8,4.0)μmol/mol肌酐,低于驱汞治疗前的自然排尿汞水平(P<0.05)。第1和2疗程驱汞治疗之间尿汞水平下降最快,其后疗程的尿汞水平下降趋于平缓。汞作业观察对象驱汞治疗疗程数少于慢性轻度汞中毒患者[(4.0±1.3)vs(5.6±1.1)个,P<0.05)。驱汞治疗疗程数与自然排尿汞水平及第1疗程24 h尿汞总量均呈正相关(P<0.01),与性别、工龄及年龄均不相关(P>0.05)。1例患者肌注DMPS后有头晕伴面色苍白,对症治疗后症状消失;68例患者用药后均无其他不良反应。结论 DMPS驱汞治疗的疗效肯定,且较为安全;DMPS驱汞后尿汞变化情况可为制定慢性汞中毒患者临床路径标准提供基础。
Objective To evaluate the efficacy and safety of sodium dimercaptopropane sulfonate( DMPS) in the treatment of patients with increased urinary mercury. Methods By random sampling method,68 patients with elevated urinary mercury were chosen as study subjects. Among them,61 cases were observation subjects working with mercury and 7 cases were chronic occupational mild mercury poisoning. DMPS was used to eliminate mercury by intramuscular injection. The changes of urinary mercury level were observed before and after treatment,and the curative effect was analyzed. Results The median( the 25 th and 75 th percentiles) of natural voiding urinary mercury was 36. 6( 28. 4,55. 6) μmol / mol creatinine and 24 hours total urine mercury amount was 1 074. 7( 608. 0,1 646. 3) μg / d in the first course of treatment.After 1 to 8 courses of mercury expulsion,the 24 hours total urine mercury amount in 68 patients were lower than the normal reference level( 45. 0 μg / d). The median( the 25 th and 75 th percentiles) of one-time morning urinary mercury level before hospital discharge was 2. 7( 1. 8,4. 0) μmol / mol creatinin,which was lower than the level of natural voiding urinary mercury( P < 0. 05). The first and second course of treatment resulted in the highest decline in urinary mercury,followed by a gradually decreased in urinary mercury in later courses. The number of treatment courses in observation subjects working with mercury was less than that in patients with chronic mild mercury poisoning [( 4. 0 ± 1. 3) vs( 5. 6 ±1. 1) times,P < 0. 05]. There was a positive correlation between the number of treatment courses and the level of natural voiding urinary mercury or 24 hours total urine mercury amount in the first course of treatment( P < 0. 01). The number of courses of mercury expulsion was not related to gender,length of service and age( P > 0. 05). One patient had dizziness and pale after intramuscular injection of DMPS,the symptom was disappeared with symptomatic treatment; 68 patients after treatment have no other adverse reactions. Conclusion Using DMPS as mercury displacement treatment was effective and relatively safe. The change of urinary mercury after DMPS treatment can be used as a basis for establishing clinical standard for patients with increased urinary mercury.
Objective To evaluate the efficacy and safety of sodium dimercaptopropane sulfonate( DMPS) in the treatment of patients with increased urinary mercury. Methods By random sampling method,68 patients with elevated urinary mercury were chosen as study subjects. Among them,61 cases were observation subjects working with mercury and 7 cases were chronic occupational mild mercury poisoning. DMPS was used to eliminate mercury by intramuscular injection. The changes of urinary mercury level were observed before and after treatment,and the curative effect was analyzed. Results The median( the 25 th and 75 th percentiles) of natural voiding urinary mercury was 36. 6( 28. 4,55. 6) μmol / mol creatinine and 24 hours total urine mercury amount was 1 074. 7( 608. 0,1 646. 3) μg / d in the first course of treatment.After 1 to 8 courses of mercury expulsion,the 24 hours total urine mercury amount in 68 patients were lower than the normal reference level( 45. 0 μg / d). The median( the 25 th and 75 th percentiles) of one-time morning urinary mercury level before hospital discharge was 2. 7( 1. 8,4. 0) μmol / mol creatinin,which was lower than the level of natural voiding urinary mercury( P < 0. 05). The first and second course of treatment resulted in the highest decline in urinary mercury,followed by a gradually decreased in urinary mercury in later courses. The number of treatment courses in observation subjects working with mercury was less than that in patients with chronic mild mercury poisoning [( 4. 0 ± 1. 3) vs( 5. 6 ±1. 1) times,P < 0. 05]. There was a positive correlation between the number of treatment courses and the level of natural voiding urinary mercury or 24 hours total urine mercury amount in the first course of treatment( P < 0. 01). The number of courses of mercury expulsion was not related to gender,length of service and age( P > 0. 05). One patient had dizziness and pale after intramuscular injection of DMPS,the symptom was disappeared with symptomatic treatment; 68 patients after treatment have no other adverse reactions. Conclusion Using DMPS as mercury displacement treatment was effective and relatively safe. The change of urinary mercury after DMPS treatment can be used as a basis for establishing clinical standard for patients with increased urinary mercury.
引文
[1]孙贵范.职业卫生与职业医学[M].7版.北京:人民卫生出版社,2012:77-79.
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[5]KOSNETT M J.The role of chelation in the treatment of arsenic and mercurypoiso-ning[J].J Med Toxicol,2013,9(4):347-354.
[6]MCKAY C A Jr.Public health department response to mercury poisoning:the importance of biomarkers and risks and benefits analysis for chelation therapy[J].J Med Toxicol,2013,9(4):308-312.
[7]YE B J,KIM B J,JEON M J,et al.Evaluation of mercury exposure level,clinical diagnosis and treatment for mercury intoxication[J].Ann Occup Environ Med,2016,28:5.
[8]杨红专.28例尿汞增高病例临床分析[J].职业卫生与应急救援,2005,23(1):17.
[9]陈杏,韩博,王汉斌.汞中毒的合理治疗[J].中国医刊,2012,47(2):27-29.
[10]储蕙.二巯基丙磺酸钠驱汞治疗引起药疹反应199例分析[J].环境与职业医学,2010,27(3):158-159.
[11]金鑫.口服和肌肉注射二巯基丙磺酸钠驱汞效果的观察[J].职业卫生与应急救援,2000,18(1):15-16.
[12]董博芳,吴命君,刘宏鹏.尿液的采集时间对尿汞测定结果的影响[J].职业与健康,2012,28(11)1342-1343,1346.
[13]郝凤桐,牛颖梅.48例化妆品汞中毒临床分析[J].中国工业医学杂志,2008,21(6):368-369.
[14]赵凤玲,陈新,郭伟,等.汞中毒性肾病综合征临床病理分析[J].中国职业医学,2016,43(3):281-284.
[15]杜旭芹,王涤新,宋玉果,等.汞中毒性肾病6例临床分析[J].中国工业医学杂志,2010,23(1):25-27.
[2]中华人民共和国卫生部.职业性汞中毒诊断标准:GBZ 89—2007[S].北京:人民卫生出版社,2008.
[3]李洁雅,苏冬梅.药源性汞中毒29例临床分析[J].职业与健康,2006,22(6):415-416.
[4]张伊莉,刘薇薇,刘移民.不同途径汞中毒对机体影响的分析研究[J].职业卫生与应急救援,2015,33(4):234-237.
[5]KOSNETT M J.The role of chelation in the treatment of arsenic and mercurypoiso-ning[J].J Med Toxicol,2013,9(4):347-354.
[6]MCKAY C A Jr.Public health department response to mercury poisoning:the importance of biomarkers and risks and benefits analysis for chelation therapy[J].J Med Toxicol,2013,9(4):308-312.
[7]YE B J,KIM B J,JEON M J,et al.Evaluation of mercury exposure level,clinical diagnosis and treatment for mercury intoxication[J].Ann Occup Environ Med,2016,28:5.
[8]杨红专.28例尿汞增高病例临床分析[J].职业卫生与应急救援,2005,23(1):17.
[9]陈杏,韩博,王汉斌.汞中毒的合理治疗[J].中国医刊,2012,47(2):27-29.
[10]储蕙.二巯基丙磺酸钠驱汞治疗引起药疹反应199例分析[J].环境与职业医学,2010,27(3):158-159.
[11]金鑫.口服和肌肉注射二巯基丙磺酸钠驱汞效果的观察[J].职业卫生与应急救援,2000,18(1):15-16.
[12]董博芳,吴命君,刘宏鹏.尿液的采集时间对尿汞测定结果的影响[J].职业与健康,2012,28(11)1342-1343,1346.
[13]郝凤桐,牛颖梅.48例化妆品汞中毒临床分析[J].中国工业医学杂志,2008,21(6):368-369.
[14]赵凤玲,陈新,郭伟,等.汞中毒性肾病综合征临床病理分析[J].中国职业医学,2016,43(3):281-284.
[15]杜旭芹,王涤新,宋玉果,等.汞中毒性肾病6例临床分析[J].中国工业医学杂志,2010,23(1):25-27.