铅中毒患者驱铅治疗效果的影响因素  

Factors on the effect of lead-elimination treatment in lead-poisoned patients

作　　者：刘志东[1] 刘念 农骐郢 李裕 刘晓蕾 赵娜[3] 王婷[1] 黄永顺[3] 何滨 胡立刚[2,4] LIU Zhidong;LIU Nian;NONG Qiying;LI Yu;LIU Xiaolei;ZHAO Na;WANG Ting;HUANG Yongshun;HE Bin;HU Ligang(Huizhou City Occupational Disease Prevention and Control Hospital,Huizhou,516008,China;School of Environment,Hangzhou Institute for Advanced Study,University of Chinese Academy of Sciences,Hangzhou,310024,China;Guangdong Province Hospital for Occupational Disease Prevention and Treatment,Guangzhou,510300,China;State Key Laboratory of Environmental Chemistry and Ecotoxicology,Research Center for Eco-Environmental Sciences,Chinese Academy of Sciences,Beijing,100085,China)

机构地区：[1]惠州市职业病防治院,惠州516008 [2]国科大杭州高等研究院,杭州310024 [3]广东省职业病防治院,广州510300 [4]中国科学院生态环境研究中心,环境化学与生态毒理学国家重点实验室,北京100085

出　　处：《环境化学》2023年第10期3310-3316,共7页Environmental Chemistry

基　　金：国家自然科学基金(22193052,22106022)资助.

摘　　要：铅是有毒的环境污染物,铅中毒严重危害人体健康.静脉注射依地酸二钠钙(CaNa_(2)EDTA)是目前临床上最常使用的驱铅治疗方法,但其治疗效果不令人满意,治疗效果的影响因素有待进一步探究.本文以铅中毒患者作为研究对象,使用CaNa_(2)EDTA进行驱铅治疗,分别在用药前、用药后24 h以及用药后72 h测定全血、血浆和尿液中的铅含量以及尿液的酸碱度(pH值),分析了铅中毒患者在驱铅治疗过程中,血铅、血浆铅和尿铅的变化趋势和铅脱除率,并进一步探究了影响铅脱除率的因素.实验结果显示,随着用药治疗,血铅和血浆铅逐渐降低,同时尿铅升高;血浆铅的脱除率显著高于血铅,说明血浆铅与EDTA的络合效率高于血细胞中铅;尿铅与血浆铅呈正相关关系,而与血铅的相关性较弱,说明血浆铅是影响驱铅治疗效果的重要因素;用药后24 h,尿液pH值与血铅脱除率呈显著正相关关系,说明尿液酸碱度可能是影响驱铅治疗效果的重要参数.本研究为提高铅中毒患者驱铅治疗效果提供了重要依据.Lead(Pb)is a toxic environmental pollutant,and Pb poisoning seriously threatens human health.The most commonly used Pb-eliminating treatment in clinical practice is intravenous injection of calcium disodium edetate(CaNa_(2)EDTA).However,the therapeutic effect is unsatisfactory,and the factors that influence it need to be investigated further.Pb-poisoned patients were used as research subjects in this paper and CaNa_(2)EDTA was used in the Pb-eliminating treatment.The Pb concentration in whole blood,plasma,urine,and urine pH were all measured before medication,as well as 24 and 72 hours later.The changing trend of blood Pb,plasma Pb,urine Pb,and their Pb elimination rate during Pb-eliminating treatment and the factors influencing Pb elimination rate were investigated.The results showed that the elimination rate of plasma Pb was significantly higher than that of blood Pb,indicating that the complexation efficiency of plasma Pb and EDTA was higher than that of Pb in blood cells.Urine Pb was found to be positively related to plasma Pb,whereas the correlation between urine Pb and blood Pb was weak,indicating that plasma Pb is an important factor influencing the treatment effect of Pb elimination.The urine pH was found to be positively correlated with the blood Pb elimination rate 24 hours after medication,indicating that urine pH could be an important factor influencing the therapeutic effect of Pb elimination.This study provides an important basis for improving the therapeutic effect of Pb poisoning.

关 键 词：铅中毒 治疗效果 影响因素 血浆铅 血铅 尿铅 pH值 

分 类 号：X503.1[环境科学与工程—环境工程] R595.2[医药卫生—内科学]