CLINICAL AND EPIDEMIOLOGICAL ASPECTS OF METHYLMERCURY POISONING
CLINICAL AND EPIDEMIOLOGICAL ASPECTS OF METHYLMERCURY POISONING
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DOI：
10.1136/pgmj.56.651.1
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发表时间：
1980-01-01
影响因子：
5.1
通讯作者：
SHIHRISTANI, H
中科院分区：
文献类型：
--
作者：
BAKIR, F;TIKRITI, S;SHIHRISTANI, H
1971-1972 年伊拉克大规模爆发甲基汞中毒，为研究甲基汞中毒对人类的影响提供了机会。在成年人中，中毒是由于摄入了用甲基汞处理的籽粒制成的自制面包引起的，并且摄入的面包量与血液汞水平之间存在高度显着的相关性。婴儿中毒要么是由于之前在子宫内接触过，要么是因为哺乳，或者两者兼而有之。婴儿和儿童的血汞水平高于成人。先天性缺陷的发生率没有增加。中毒症状和体征及组织病理学变化主要局限于中枢神经系统。症状平均出现 1-2 个月。接触后。儿童出现智力低下，言语开始延迟，运动、感觉和自主功能受损。受影响严重的儿童失明和失聪。在成人中，临床表现可分为 1 级，轻度（主要是感觉症状）；2 级，中度（感觉症状伴有小脑体征）；3 级，重度（严重共济失调，伴有明显的视力和听力丧失，在某些情况下，进展为运动不能性沉默症，随后昏迷）。 1 级和 2 级的预后优于 3 级。在研究的患者中，14% 发现肌神经连接处的传播受到干扰。没有证据表明周围神经本身受累，感觉症状可能源于中枢。伊拉克和日本疫情之间的临床差异可能部分是由于后者疫情中发生的严重、长期和持续的暴露所致。在轻度组和中度组中观察到改善。螯合剂、硫醇树脂、血液透析和换血治疗降低了血汞浓度，但没有产生令人信服的临床益处。为了有效，可能需要在接触后立即开始治疗。
An opportunity to study the effects of methylmercury poisoning in humans was provided by the large outbreak in Iraq in 1971-1972. In adults, poisoning resulted from the ingestion of homemade bread prepared from methylmercury-treated seed grain, and there was a highly significant correlation between the amount of bread ingested and blood Hg levels. Poisoning in infants resulted either from prior exposure in utero or from suckling or both. Blood Hg levels were higher in infants and children than in adults. There was no increased incidence of congenital defects. Symptoms and signs of poisoning and histopathological changes were mainly confined to the CNS. Symptoms developed, on average, 1-2 mo. after exposure. In children there was mental retardation with delayed onset of speech and impaired motor, sensory and autonomic function. Severely affected children were blind and deaf. In adults, the clinical picture could be classified as 1, mild (mainly of sensory symptoms) 2, moderate (sensory symptoms accompanied by cerebellar signs) and 3, severe (gross ataxia with marked visual and hearing loss which, in some cases, progressed to akinetic mutism followed by coma). Grades 1 and 2 carried a better prognosis than grade 3. Interference with transmission at the myoneural junction was found in 14% of patients studied. There was no evidence of peripheral nerve involvement per se and sensory symptoms may be of central origin. The clinical differences between the Iraqi and Japanese outbreaks may partly be a result of the severe, prolonged and continuous exposure which occurred in the latter outbreak. Improvement was observed among the mild and moderate group. Treatment with chelating agents, thiol resin, hemodialysis and exchange transfusion lowered blood Hg concentrations but produced no convincing clinical benefit. To be effective, treatment may need to be instituted soon after exposure.