七例化妆品汞中毒相关肾小球微小病变病报告

Minimal change disease caused by mercury-containing cosmetics： 7 cases report

目的探讨化妆品汞中毒相关微小病变病（MCD）的临床病理表现及治疗方法。方法回顾性分析首都医科大学附属北京安贞医院肾内科确诊的7例化妆品汞中毒相关MCD患者的临床及病理资料。结果7例患者均为女性，平均年龄37．2岁，均曾间断使用美白祛斑化妆品。7例患者尿汞均明显升高，为正常值的2．2～59．1倍。其中2例患者化妆品的汞检测，汞浓度为国家规定化妆品汞限量的1000多倍。7例患者均表现为肾病综合征，肾组织病理检查符合MCD诊断。经停用含汞化妆品，并予糖皮质激素及驱汞治疗，7例患者肾病综合征均在应用激素后1～2个月完全缓解。结论对非少年儿童及老年的MCD女性患者，要注意询问美白祛斑化妆品的应用史，检测尿和血汞浓度，以早期发现化妆品汞中毒相关MCD．

Objective To enhance the understanding of mercury poisoning related minimal change disease （MP-MCD）. Methods A retrospective analysis about the clinical, laboratory and pathological manifestations, diagnosis, treatment and outcome of 7 patients with MP-MCD caused by skin-lightening cosmetics were conducted. Results All of the 7 patients were female with mean age 37.2 years. One patient had intermittently used skin-lightening cosmetics for 15 years and the other 6 patients continuously used the cosmetics for 2 ~ 6 months. Urine mercury levels of the 7 patients were significantly increased, reaching to 2.2 ~ 59.1 times of the normal value. The mercury content of 2 cosmetics used by patients was 1200 to 1560 times the mercury limit in cosmetics set by the government in 1987. Seven patients all presented as nephrotic syndrome, and all had MCD on renal biopsy. After the diagnosis of MP-MCD was confirmed, all the patients stopped using the mercury- contain cosmetics and accepted corticosteroid and chelation therapy. The nephrotic syndrome underwent complete remission after 1 ~ 2 months of therapy. Urine mercury levels in the 5 patients who repeated test returned to normal levels after 1 - 3 courses of chelation therapy. Conclusion MP- MCD caused by skin-lightening cosmetics should be considered as one of the differential diagnosis in the patients, especially in adult females who present with nephrotic syndrome in China.