铊中毒与急救的研究进展

Thallium poisoning and emergency care:research advances

稀有元素铊对人体的毒性因一系列中毒事件的出现而广受重视。近10年来,铊中毒的作用机制和救治措施成为研究热点。初步研究表明,铊经胃肠道、呼吸道和皮肤吸收后,在体内广泛分布,浓度最高的是肾脏,其次为唾液腺。以离子状态存在的铊可以取代体内的钾离子,影响钾离子参与的生理功能及神经信号传导,并影响一系列酶的活性,使之失去正常功能。此外,铊还能拮抗钙离子,从而影响心脏功能、与核黄素结合干扰生物氧化等途径。在临床上,铊中毒可见周围神经中毒症状、胃肠道症状、黏膜炎症、毛发脱落和视力受损等。24h尿液中铊浓度检测为评价铊中毒的最佳方法,尿铊>5μg/L具有诊断意义。当前临床治疗措施主要是减少吸收、加速清除和对症治疗。最新研究表明,血液灌流能有效清除已吸收的铊。

As a result of a series of thallium poisoning events,the rare element thallium has attracted wide attention.For near-ly a decade,the mechanisms of thallium poisoning and treatment measures have become hot research topics.Preliminary results showed that thallium was absorbed by gastrointestinal tract,respiratory tract and skin,then distributed in the body widely.The thallium con-centration in kidneys was the highest,followed by salivary glands.Thallium ions can replace potassium ion in body and influence the activity of several enzymes.Moreover,thallium can antagonize calcium ions and affect heart function.Clinically,thallium induces pe-ripheral nerve poisoning,gastrointestinal symptoms,mucosal inflammation,hair loss and visual damage.Examination of 24-hour urine thallium concentration is the most accurate way to assess thallium poisoning.If urine thallium concentration is higher than 5 μg/L,it is of diagnostic significance.The clinical treatment measures include reducing the absorption,accelerating elimination and practicing symptomatic treatment.Hemoperfusion has been reported to be effective in eliminating absorbed thallium.