慢性汞中毒患者周围神经病变危险因素研究  

Risk factors of peripheral neuropathy in patients with chronic mercury poisoning

作　　者：张晶 王丹蕾 王曼 陈新 ZHANG Jing;WANG Danei;WANG Man;CHEN Xin(The Third People's Hospital of Henan Province,Zhengzhou,Henan 450052,China)

机构地区：[1]河南省第三人民医院,河南郑州450052

出　　处：《现代疾病预防控制》2024年第7期494-497,503,共5页MODERN DISEASE CONTROL AND PREVENTION

基　　金：河南省医学科技攻关计划项目(LHGJ20220255)。

摘　　要：目的分析慢性汞中毒患者周围神经病变的相关危险因素,以便早期发现,降低并发症和致残的风险。方法回顾性收集2010—2022年河南省第三人民医院接受治疗的102例慢性汞中毒患者资料。根据神经肌电图结果将患者分为损伤组(66例)和未损伤组(36例)。比较两组患者性别、年龄、周围神经症状、接汞时间、吸烟状况、高血压及神经传导速度的差异。采用多因素logistic回归筛选慢性汞中毒患者发生周围神经病变的危险因素并构建列线图,采用受试者工作特征曲线(ROC)和校准曲线进行评价。结果损伤组平均年龄[(45.24±13.96)岁]高于未损伤组[(35.33±8.59)岁](t=3.873,P<0.05),损伤组接汞时间[(14.64±5.86)月]长于未损伤组[(8.50±2.90)月](t=5.896,P<0.05)。损伤组肢体颤动、乏力、麻木、疼痛、运动传导速度下降和感觉传导速度下降的比例均高于未损伤组(分别为42.4%比11.1%、57.6%比27.7%、66.7%比22.2%、72.7%比9.0%、54.5%比22.2%、51.5%比11.1%,P均<0.05)。多因素logistic回归分析结果显示,性别(OR=1.740,95%CI:1.107~2.737)、年龄(OR=1.970,95%CI:1.344~2.887)、接汞时间(OR=4.836,95%CI:2.416~9.678)、吸烟(OR=3.504,95%CI:1.535~7.998)、高血压(OR=3.463,95%CI:1.730~6.930)为汞中毒患者发生周围神经病变的影响因素。根据上述影响因素构建的列线图具有较好的校准度(χ^(2)_(H-L)=5.378,P>0.05)和区分度(曲线下面积(AUC)为0.909,95%CI:0.795~0.971)。结论性别、年龄、接汞时间、吸烟、高血压是慢性汞中毒患者周围神经病变的影响因素,根据上述指标构建的列线图模型可用于早期发现周围神经病变,减少并发症及致残风险。Objective To analyze the risk factors associated with peripheral neuropathy in patients with chronic mercury poisoning and to facilitate early detection to reduce the risk of complications and disability.Methods The data retrospectively collected for 102 patients treated for chronic mercury poisoning at The Third People's Hospital of Henan Province from 2010 to2022.Patients were categorized into an injured group(66 cases)and an uninjured group(36 cases)based on neuromyography results.Gender,age,peripheral nerve symptoms,mercury exposure duration,smoking status,hypertension,and nerve conduction velocity were compared between groups.Multivariate logistic regression was used to identify risk factors and construct a predictive nomogram,which was evaluated using a ROC curve and calibration curve.Results The mean age of the injured group(45.24±13.96)years was significantly higher than the uninjured group(35.33±8.59)years(t=3.873,P<0.05).The mercury exposure duration was longer in the injured group(14.64±5.86)months compared to the uninjured group(8.50±2.90)months(t=5.896,P<0.05).The injured group showed a higher prevalence of numbness,fatigue,pain,limb fibrillation,and decreased motor and sensory conduction velocities(2.4%vs 11.1%,57.6%vs 27.7%,66.7%vs 22.2%,72.7%vs 9.0%,65.5%vs 22.2%,51.5%vs 11.1%,all P<0.05).Multivariate logistic regression identified gender(OR=1.740,95%CI:1.107-2.737),age(OR=1.970,95%CI:1.344-2.887),mercury exposure time(OR=4.836,95%CI:2.416-9.678),smoking(OR=3.504,95%CI:1.535-7.998),and hypertension(OR=3.463,95%CI:1.730-6.930)as risk factors.The nomogram demonstrated good calibration(χ^(2)_(H-L)=5.378,P>0.05)and discrimination(AUC=0.909,95%CI:0.795-0.971).Conclusions Gender,age,mercury exposure duration,smoking,and hypertension are significant risk factors for peripheral neuropathy in patients with chronic mercury poisoning.The nomogram model can be utilized for the early detection of peripheral neuropathy and to mitigate the risk of complications and disability.

关 键 词：汞中毒 周围神经病变 危险因素 列线图 

分 类 号：R563.1[医药卫生—呼吸系统]