职业中毒性神经系统疾病的机理及诊断研究

Studies on the Mechanism and Diagnosis of Occupational Neurotoxic Diseases

国家科委“七五”重点医药科技攻关课题——职业病防治的研究(75-62-03)各分题均按时完成任务,取得重大成果,于1990年11月通过国家验收。本刊受中华劳动卫生职业病学会职业病学组的委托,组织职业病各有关专题(主要是职业病临床,也吸收部分其它有关专题)的综合报告稿件作学术交流。限于篇幅,只能简略刊登研究工作内容。署名也从简,按送交的综合报告简署刊登,不代表该项研究的上报排名及顺序。参加研究工作的单位名单从略。

The clinical manifestations of acute carbonmonoxide poisoning, chronic carbon disulphidepoisoning and acrylamide poisoning representthe three main syndromes of occupationalneurotoxic diseases, i. e. toxic encephalopa-thy,toxic neurotic syndrome and toxic poly-neuropathy. In order to investigate the mechanism anddiagnosis of these neurotoxic illnesses, thefollowing studies were carriedout.I. Acute carbon monoxide (CO), poisoningand delayed encephalopathy The somatosensory (SEP), visual (VEP)and brain stem auditory (BAEP) evokedpotentials were conducted in 109 healthy adultsand the normal limits of the three modalitiesof evoked potential were obtained by a regre-ssion equation with 2.5 times standard devia-tion of the residual deviation. The results ofmultimodality of evoked potentials in 180patients compared with the normal valuesshowed that the changes of long latency com-ponents of SEP(N32,N60), the Ⅲ-Ⅴ interpe-ak latency of BAEP and the P_(100) latency ofVEP were significantly sensitive parametersin evaluating brain dysfunction and predictionof prognosis. The CT scanning in 100 patientsconfirmed the selective lesions in bilateral su-bcortical white matter and globus palliduswhich led to brain atrophy at later stage. The results of an epidemiological study on223 in patients and analysed by Logistic regr-ession revealed that the risk factors for thedevelopment of delayed encephalopathy inclu-ding elderliness, mental work, previouslywith hypertension, coma lasting for 2-3 days,long standing dizziness and fatigue afterregaining conciousness and mental stimulationduring recovery. The determination of myelin basic proteinand IgG in cerebral spinal fluid indicates thepossible immunological mechanism of occurre-nce of delayed encephalopathy. 2. Chronic carbon disulphide poisoning To detect the neurobehavioral effects ofcarbon disulphide and other solvents, the WHOneurobehavioral core test batteries (WHO/NCTB)were adapted into Chinese version sho-wing comparable validity and higher applica-bility. The reaction time equipment has beenreproduced in China following the WHO designand supplied to the users in China with muchcheaper cost. A computerized neurobehavioralevaluation system in Chinese version (NES-C)has also been developed which is as efficientand applicable as those applied in the Englishspeaking countries. Evidences obtained by electromyographicstudies, ophthalmological examinations anadetection of urinary TTCA point out the nec-essity of revision of the current diagnositiccriteria for chronic carbon disulphide poiso-ning. In addition depletion of prostaglandin F_2in brain was found in the animal studies. 3. Acrylamide poisoning The significance of electroneuromyographyin early detection of toxic neuropathy inaddition to the occupational history and clini-cal manifestations has led to the establishmentof diagnostic criteria for occupational acrylam-ide poisoning. Disturbances of calcium hemostasis wereexplored in the investigation of mechanism of crylamide neurotoxicity.