职业性慢性轻度二硫化碳中毒临床分析

Clinical analysis of chronic mild occupational carbon disulfide poisoning

目的分析职业性慢性轻度二硫化碳中毒病例的临床特点和神经-肌电图(ENMG)检查结果。方法采用回顾性调查方法,以2006—2019年依据GBZ 4—2002《职业性慢性二硫化碳中毒诊断标准》诊断为职业性慢性轻度二硫化碳中毒的344例患者为研究对象,收集其临床资料进行分析。结果研究对象主要症状为头晕、头痛、失眠多梦、记忆力减退、四肢远端感觉麻木和乏力,阳性体征主要有四肢远端对称性手套、袜套样浅感觉障碍,跟腱反射、膝反射减弱或消失;上述症状和体征检出率多数呈随着工龄的增加而增加趋势(P值均<0.01)。研究对象眼底动、静脉改变检出率为41.3%,呈随着工龄增加而增加趋势(P<0.01)。研究对象ENMG检查均不同程度地出现四肢末端运动神经和(或)感觉神经异常,运动神经异常检出率高于感觉神经(21.1%vs 3.7%,P<0.01),且右侧运动神经异常检出率高于左侧(23.7%vs 18.5%,P<0.01);运动神经异常检出率由高到低依次为正中神经、腓总神经、尺神经和胫后神经(34.9%vs 27.9%vs 16.6%vs5.1%,P<0.01),感觉神经异常检出率由高到低依次为正中神经、尺神经和腓肠神经(5.2%vs 5.1%vs 0.7%,P<0.01)。男性患者上肢运动神经左尺神经、右尺神经和右正中神经检出阳性率均高于女性(15.2%vs 5.3%,24.0%vs 11.7%,44.8%vs28.7%,P值均<0.05),而下肢运动神经左、右腓总神经检出阳性率均低于女性(18.4%vs 52.1%,21.2%vs 46.8%,P值均<0.01)。结论职业性慢性轻度二硫化碳中毒主要表现为多发性周围神经损伤;ENMG检查以远端运动神经传导异常较感觉神经传导异常明显,上肢受累程度高于下肢,右侧神经受累多于左侧。

Objective To analyze clinical features and electroneuromyography(ENMG) results of chronic mild occupational carbon disulfide poisoning cases.Methods A total of 344 patients diagnosed with chronic mild occupational carbon disulfide poisoning based on GBZ 4-2002 Diagnostic Criteria of Occupational Chronic Carbon Disulfide Poisoning were selected as study subjects from 2006 to 2019 using the retrospective study method.Their clinical data was collected and analyzed.Results The main symptoms of the study subjects were dizziness,headache,insomnia,dreaming,memory impairment,numbness and weakness in the distal extremities.Positive signs mainly included symmetrical glove and stocking distribution like sensory disorders in the distal extremities,and the weakening or absent Achilles tendon reflex and knee reflex.The incidence of symptoms and signs increased with the length of service(all P<0.01).The incidence of fundus and venous changes in patients was 41.3%,which increased with the length of service(P<0.01).ENMG examination showed varying degrees of abnormalities in the peripheral motor and/or sensory nerves in all patients,with a higher incidence of motor nerve abnormalities than sensory nerve abnormalities(21.1% vs 3.7%,P<0.01).The incidence of motor nerve abnormality was higher on the right side than the left side(23.7% vs 18.5%,P<0.01).The incidences of motor nerve abnormalities from high to low in the order were median nerve,common peroneal nerve,ulnar nerve and posterior tibial nerve(34.9% vs 27.9% vs 16.6% vs 5.1%,P<0.01).The incidences of sensory nerve abnormalities from high to low in the order were median nerve,ulnar nerve and sural nerve(5.2% vs 5.1% vs 0.7%,P<0.01).The incidences of left ulnar nerve,right ulnar nerve and right median nerve were higher in male patients than in female patients(15.2% vs 5.3%,24.0% vs 11.7%,44.8% vs 28.7%,all P<0.05),while the incidences of the left and right common peroneal nerve in lower extremity motor nerve were lower in male patients than in female patients(18.4%vs 52.1%,21.2% vs 46.8%,all P<0.01).Conclusion Chronic mild occupational carbon disulfide poisoning was mainly manifested as multiple peripheral nerve injury.ENMG results showed that the distal motor nerve conduction abnormalities were more sensitive than the sensory nerve conduction abnormalities,with a higher degree of impairment in the upper limb than the lower limb,and more impairment in the right side than the left side.