以疼痛为主要表现的化妆品引起汞中毒15例分析

Analysis of main manifestation as pain in 15 patients with mercury poisoning caused by cosmetics

目的报道以疼痛为主要表现的化妆品应用所致汞中毒病例。分析使用美白、祛斑化妆品引起疼痛的汞中毒的特点。方法选取自2009年1月至2013年12月郑州大学第一附属医院神经内科收治的汞中毒患者15例为研究对象，分析其发病过程、临床表现特点、辅助检查结果。结果15例患者半年内均有美白、祛斑化妆品应用史，化妆品引起的汞中毒有接触时间长、起病慢、症状类似神经症、易误诊等特点。所有患者均以疼痛为主要临床表现，按WHO主诉疼痛分级法（VRS）分级大多为中度至重度疼痛。驱汞治疗3～5疗程后，患者尿汞含量逐渐降低，全身疼痛逐渐减轻至消失。结论汞中毒可导致神经损害出现疼痛，疼痛患者如病因不明时可询问有元应用美白、祛斑化妆品史．可查尿汞明确有无汞中毒。

Objective To report 15 patients whose main manifestation was pain after mercury poisoning caused by smearing cosmetics, and analyze the characteristics of mercury poisoning caused by smearing whitening or freckle cosmetics. Methods These 15 patients with pain as their main manifestation after mercury poisoning caused by smearing cosmetics, admitted to our hospital from January 2009 to December 2013, were used in our study; the pathogenesis, clinical features and laboratory examinations of these patients were analyzed. Results All of the 15 patients had smeared the whitening or freckle cosmetics within six months. The mercury poisoning caused by cosmetics had these characteristics： the exposure time was long; onset slowly appeared; the symptoms was similar to neurosis, which was often misdiagnosed. All patients appeared pain, according to WHO chief complaint ranking （VRS）, most patients suffered severe pain; after treatment of expelling mercury for 2 to 5 cycles, the urinary mercury decreased, and the pain reduceded, and disappear gradually. Conclusion Mercury poisoning can lead to nerve damage and appeared pain, and if the reason of pain is unknown, doctors should ask whether the patients have history of smearing whitening or freckle cosmetics, and check the urine mercury to define whether it is the mercury poisoning.