12例铊中毒患者临床和电生理特征与治疗

Clinical features, electrophysiological characteristics and treatment of thallium poisoning in twelve patients

目的探讨铊中毒患者的临床、电生理特征及治疗方法。方法回顾性选取2012年6月至2017年10月就诊于解放军307医院的铊中毒患者12例,选取12例性别、年龄相匹配的健康受试者为对照组。收集两组受试者相关资料并进行比较分析。结果铊中毒患者临床表现以神经系统症状、胃肠道症状、毛发脱落为主。运动神经检测结果显示,与正常组相比,中毒组尺神经、腓总神经潜伏期延长,腓总神经、胫神经波幅降低且传导速度减慢(P<0.05);感觉神经检测结果显示,与正常组相比,中毒组正中神经、尺神经、腓肠神经潜伏期延长且波幅降低;正中神经、尺神经、桡神经及腓肠神经传导速度减慢(P<0.05或P<0.01)。7例患者行脑电图检查,其中轻度异常脑电图6例,中度异常脑电图1例。给予患者补钾、利尿、口服普鲁士蓝、肌注二巯基丙磺酸钠等治疗措施,严重者行血液灌流或血浆置换,疗效较好。结论铊中毒临床比较罕见,典型的临床特征及神经电生理检查有助于疾病的鉴别与诊断;及时采取驱铊及对症支持治疗,能有效改善患者的预后。

Objective To investigate the clinical and electrophysiological features and treatments for thallium poisoning.Methods Twelve cases of thallium poisoning patients were from hospital 307 of PLA between June 2012 and October 2017 and their data were retrospectively analyzed.Twelve sex-and age-matched healthy subjects were selected as control group.Result The clinical manifestations of thallium poisoning were mainly symptoms of nervous and gastrointestinal systems as well as hair loss.Thallium poisoning compromised function of motor nerves including the prolonged distal latency of ulnar and common peroneal nerve,the decreased amplitude and slowed nerve conduction velocity of common peroneal nerve and tibial nerve,which were statistically different from control group(P<0.05).Thallium poisoning also impaired function of sensory nerve including the prolonged distal latency and decreased amplitude of median,ulnar and sural nerve,the slowed nerve conduction velocity of median,ulnar,radial and sural nerve which were statistically different from control group(P<0.05 or P<0.01).Electroencephalogram(EEG)of 7 cases revealed mild abnormality EEG in 6 cases and moderate abnormality EEG in one case.Patients received potassium supplementation,diuresis,oral Prussian blue,intramuscular injection of sodium dimercaptopropanesulfonate and other treatment.Severe cases had good outcome after hemoperfusion and plasma exchange.Conclusions Thallium poisoning is rare in clinic and typical clinical features and electrophysiological examination are helpful to the diagnosis and differential diagnosis of diseases.Timely increasing thallium excretion and symptomatic support treatment can effectively improve the prognosis of the patients.