中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
11期
831-834
,共4页
郜振彦%徐健%古桂雄%颜崇淮
郜振彥%徐健%古桂雄%顏崇淮
고진언%서건%고계웅%안숭회
铅中毒%高危因素%铅暴露%儿童
鉛中毒%高危因素%鉛暴露%兒童
연중독%고위인소%연폭로%인동
Lead poisoning%High-risk factors%Lead exposure%Child
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-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～ 892.0 μg/L[(251.5±155.8) μg/L],中位数235.0 μg/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100 μg/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≥235.0 μg/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.
目的 瞭解鉛中毒門診患兒的血鉛水平分佈規律,探討鉛中毒患兒的鉛汙染源及臨床錶現的特徵,為兒童鉛中毒的臨床診療提供指導建議.方法 收集2012年9月至2013年8月在上海交通大學醫學院附屬新華醫院兒童鉛中毒門診就診的129例患兒的資料,患兒均需填寫“重金屬門診問捲”(患兒人口學資料、生長髮育評估、手-口動作頻率、進食前洗手、飲食結構、鉛汙染源接觸情況、傢庭環境等)、病史詢問、體格檢查及相應的輔助檢查,採集靜脈血,用石墨爐原子吸收光譜法測定血鉛,進行體格檢查(身高、體質量、生長髮育情況).結果 (1)129例患兒來自全國14箇省(市、自治區),其中浙江64例(49.6％),上海30例(23.0％),江囌13例(10.1％),江西6例(4.7％),河北5例(3.9％),安徽和廣東各2例(各1.6％),福建、河南、湖南、吉林、內矇古、黑龍江、山東各1例(各0.8％).(2)就診患兒血鉛水平17.0～ 892.0 μg/L[(251.5±155.8) μg/L],中位數235.0 μg/L.(3)就診患兒年齡4箇月～15歲,平均4.3歲.其中≤1歲組15例,血鉛水平(367.8±137.7) μg/L;＞1～3歲組患兒37例,血鉛水平(250.5 ±116.3) μg/L; ＞3 ～6歲組患兒50例,血鉛水平(237.7±179.7) μg/L;＞6 ～ 15歲組患兒27例,血鉛水平(213.9±141.8) μg/L.(4)111例兒童有明確的鉛汙染來源,主要為工業汙染46例(35.7％)和生活汙染65例(50.4％),還有18例血鉛水平測定低于100 μg/L,也未找到明確鉛汙染源.(5)鉛中毒兒童突齣的臨床錶現為多動、註意力不集中、脾氣暴躁、攻擊性行為、便祕及腹痛等.(6)對血鉛水平≥235.0 μg/L進行Logistic迴歸分析,兒童血鉛汙染源和年齡是主要的影響因素.結論 本次收集的鉛中毒門診兒童以0～6歲為主,年齡越小,患兒血鉛水平越高;鉛暴露源中工業汙染約佔1/3,紅丹粉、黃丹粉及錫壺等生活性汙染所緻的兒童鉛中毒的初始血鉛水平更高,應引起重視.
목적 료해연중독문진환인적혈연수평분포규률,탐토연중독환인적연오염원급림상표현적특정,위인동연중독적림상진료제공지도건의.방법 수집2012년9월지2013년8월재상해교통대학의학원부속신화의원인동연중독문진취진적129례환인적자료,환인균수전사“중금속문진문권”(환인인구학자료、생장발육평고、수-구동작빈솔、진식전세수、음식결구、연오염원접촉정황、가정배경등)、병사순문、체격검사급상응적보조검사,채집정맥혈,용석묵로원자흡수광보법측정혈연,진행체격검사(신고、체질량、생장발육정황).결과 (1)129례환인래자전국14개성(시、자치구),기중절강64례(49.6％),상해30례(23.0％),강소13례(10.1％),강서6례(4.7％),하북5례(3.9％),안휘화엄동각2례(각1.6％),복건、하남、호남、길림、내몽고、흑룡강、산동각1례(각0.8％).(2)취진환인혈연수평17.0～ 892.0 μg/L[(251.5±155.8) μg/L],중위수235.0 μg/L.(3)취진환인년령4개월～15세,평균4.3세.기중≤1세조15례,혈연수평(367.8±137.7) μg/L;＞1～3세조환인37례,혈연수평(250.5 ±116.3) μg/L; ＞3 ～6세조환인50례,혈연수평(237.7±179.7) μg/L;＞6 ～ 15세조환인27례,혈연수평(213.9±141.8) μg/L.(4)111례인동유명학적연오염래원,주요위공업오염46례(35.7％)화생활오염65례(50.4％),환유18례혈연수평측정저우100 μg/L,야미조도명학연오염원.(5)연중독인동돌출적림상표현위다동、주의력불집중、비기폭조、공격성행위、편비급복통등.(6)대혈연수평≥235.0 μg/L진행Logistic회귀분석,인동혈연오염원화년령시주요적영향인소.결론 본차수집적연중독문진인동이0～6세위주,년령월소,환인혈연수평월고;연폭로원중공업오염약점1/3,홍단분、황단분급석호등생활성오염소치적인동연중독적초시혈연수평경고,응인기중시.
Objective To assess the distribution of blood lead levels and the sources of lead exposure in children with lead poisoning,and thus to offer recommendations for clinical diagnosis and treatment of childhood lead poisoning.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 questionnaire 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 Zhejiang (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,Hunan,Jilin,Inner Mongolia,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 235.0 μg/L.(3)The mean age of the children was 4.3 years.Fifteen cases were less than 1 year old,and the mean blood lead level was (367.8 ± 137.7) μg/L.Thirty-seven cases 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 cases were over 6 years old,and the mean blood lead level was (213.9 ± 141.8) μg/L.(4) One hundred and eleven cases 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 cases 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 ≥ 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.
