不同原因所致非职业性汞中毒的临床特点分析

Analysis of Clinical Characteristics on Non-occupational Mercury Poisoning Caused by Different Reasons

[目的]分析比较不同原因导致的非职业性汞中毒的临床特点。[方法]将北京朝阳医院2005-2009年收治的171例非职业性汞中毒住院患者按中毒原因分为环境污染组、使用化妆品组和使用偏方组,分别对各组患者进行临床症状和体征、实验室检查指标以及治疗效果的分析。[结果]在171例患者中,环境污染组34例,使用化妆品组90例,使用偏方组47例。各组患者主要出现神经衰弱症候群、消化道症状、周围神经损害和肾脏损害。与环境污染组相比,使用偏方组烦燥、恶心及水肿表现明显;与使用化妆品组相比,使用偏方组烦燥、口腔异味、食欲下降、恶心、腹痛、牙龈肿胀和水肿等症状体征明显,蛋白尿和尿β2微球蛋白升高的发生率明显增加,差异有统计学意义(P<0.05)。使用偏方组患者驱汞治疗前空白尿汞值较其他两组高(P<0.05),以二巯基丙磺酸钠驱汞治疗疗程长于其他两组。[结论]不同原因所致非职业性汞中毒的临床特点不同;使用偏方中毒患者临床表现较重,尿汞含量高,所需驱汞疗程较长。

[ Objective ] To analyze and compare the clinical characteristics on non-occupational mercury poisoning caused by different reasons. [ Methods ] Total of 171 hospitalized patients of non-occupational mercury poisoning in Beijing Chaoyang hospital from 2005 to 2009 were divided into three groups according to their exposure reasons, namely environmental pollution group, cosmetic group and folk remedies group. Their clinical symptoms and signs, laboratory indices and therapeutic effects were analyzed. [ Results ] Among 171 patients, 34 cases were in environmental pollution group, 90 cases in cosmetic group and 47 cases in folk remedies group. Neurasthenia syndrome, gastrointestinal symptoms, peripheral nerve damage and kidney damage were main manifestations in all patients. Compared with environmental pollution group, the patients in folk remedies group showed more serious symptoms such as irritable, nausea and edema. Compared with application of cosmetics group, it showed more serious symptoms such as irritable, mouth ador, loss of appetite, nausea, abdominal pain, swollen gums and edema, and had more serious proteinuria and significantly increased β2-microglobulin （ P 〈 0.05 ）. Urinary mercury level was higher in folk remedies group than the other two groups before treatment by sodium dimercaptosulphonate, and the course of treatment was significantly longer （ P 〈 0.05 ）. [ Conclusion ] The clinical characteristics of non-occupational mercury poisoning caused by various reasons were different. The severer clinical symptoms, the higher levels of urinary mercury, and the longer course of treatment were in patients caused by folk remedies.