儿童铅中毒129例门诊病例分析

Clinical analysis of 129 children with lead poisoning

目的了解铅中毒门诊患儿的血铅水平分布规律，探讨铅中毒患儿的铅污染源及临床表现的特征，为儿童铅中毒的临床诊疗提供指导建议。方法收集2012年9月至2013年8月在上海交通大学医学院附属新华医院儿童铅中毒门诊就诊的129例患儿的资料，患儿均需填写“重金属门诊问卷”（患儿人口学资料、生长发育评估、手一口动作频率、进食前洗手、饮食结构、铅污染源接触情况、家庭环境等）、病史询问、体格检查及相应的辅助检查，采集静脉血，用石墨炉原子吸收光谱法测定血铅，进行体格检查（身高、体质量、生长发育情况）。结果（1）129例患儿来自全国14个省（市、自治区），其中浙江64例（49．6％），上海30例（23．0％），江苏13例（10．1％），江西6例（4．7％），河北5例（3．9％），安徽和广东各2例（各1．6％），福建、河南、湖南、吉林、内蒙古、黑龙江、山东各1例（各0．8％）。（2）就诊患儿血铅水平17．0～892．0μg／L[（251．5±155．8）μg／L]，中位数235．0μg／L。（3）就诊患儿年龄4个月～15岁，平均4．3岁。其中≤1岁组15例，血铅水平（367．8±137．7）μg/L；〉1～3岁组患儿37例，血铅水平（250．5±116．3）μg/L；〉3—6岁组患儿50例，血铅水平（237．7±179．7）μg/L；〉6～15岁组患儿27例，血铅水平（213．9±141．8）μg／L。（4）111例儿童有明确的铅污染来源，主要为工业污染46例（35．7％）和生活污染65例（50．4％），还有18例血铅水平测定低于100μg／L，也未找到明确铅污染源。（5）铅中毒儿童突出的临床表现为多动、注意力不集中、脾气暴躁、攻击性行为、便秘及腹痛等。（6）对血铅水平≥235．0μg／L进行Logistic回归分析，儿童血铅污染源和年龄是主要的影响因素。结论本次收集的铅中毒门诊儿童以0～6岁为主，年龄越小，患儿血铅水平越高；铅暴露源中工业污染约占1／3，红丹粉、黄丹粉及锡壶等生活性污染所致的儿童铅中毒的初始血铅水平更高，应引起重视。

Objective To assess the distribution of blood lead levels and the sources of lead exposure in chil- dren with lead poisoning, and thus to offer recommendations for clinical diagnosis and treatment of childhood lead poi- soning. Methods The clinical data of 129 patients with lead poisoning was collected and analyzed at the Out-patient Department of Lead Poisoning Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine during Sep. 2012 and Aug. 2013 were collected and analyzed. All children were required to fill out the ＂ outpatient question- naire on heavy metal＂ （including children＇s demographic data, growth assessment, frequency of hand-mouth behavior, and the behavior of washing hands before eating, dietary, sources of lead exposure, and the family environment, etc. ）. Other data of medical history, physical examinations （height, weight, growth and development） were also collected. Blood samples were collected to measure blood lead level by graphite furnace atomic absorption spectrometry. Results （ 1 ） The above 129 patients were from 14 provinces （municipalities and autonomous regions） , including 64 cases in Zhe- jiang （49.6%） ,30 cases in Shanghai （23.0%） ,13 cases in Jiangsu （10.1%） ,6 cases in Jiangxi （4.7%） ,5 cases in Hebei （3.9%） ,2 cases in Anhui and Guangdong （ 1.6% ） ; and 1 case in Fujian, Henan, HuMan, Jilin, Inner Mon- golia, Heilongjiang and Shandong （0.8 % ）, respectively. （2） In the patients, the blood lead level was 17.0 - 892.0 μg/L[ （ 251.5 ＋ 155.8 ） μg/L] and the median was 235.0μg/L. （ 3 ） The mean age of the children was 4.3 years. Fifteen eases were less than 1 year old,and the mean blood lead level was （367.8 ＋ 137.7） μg/L. Thirty-seven eases were 1 - 3 years old children, and the mean blood lead level was （ 250.5 _＋ 116.3 ） μg/L. Fifty cases were 3 - 6 years old children, and the mean blood lead level was （237.7 ＋ 179.7） μg,/L. Twenty-seven eases were over 6 years old, and the mean blood lead level was （213.9 ＋ 141.8 ） μg/L. （4）One hundred and eleven eases of the children could find the definite sources of lead exposure, mainly from industrial pollution （35.7%） and domestic pollution （64.3 % ）. The blood lead levels in 18 eases were less than 100 μg/L, and their definite lead pollution source was not found. （5） Most of the children had the symptoms of inattention, hyperactivity, aggressive behavior, constipation and abdominal pain, and so on. （6）Logistic regression analysis of children with blood lead levels 1〉 235. 0 μg/L showed that lead pollutants and age were the main risk factors for lead poisoning. Conclusions Industrial pollution are associated with higher blood lead levels among children aged 0 - 6 years old （ occupying one-third of the pollutants ）. The younger children tend to have higher blood lead levels, and the data also suggest that greater attention should be paid to children who used red powder.