切换至 "中华医学电子期刊资源库"

中华卫生应急电子杂志 ›› 2024, Vol. 10 ›› Issue (05) : 290 -297. doi: 10.3877/cma.j.issn.2095-9133.2024.05.007

综述

儿童铅中毒研究进展
赵慧1, 张晶1, 朱元州2,()   
  1. 1.430070 湖北武汉,湖北省妇幼保健院急诊科
    2.430077 湖北武汉,华中科技大学同济医学院附属梨园医院
  • 收稿日期:2024-04-29 出版日期:2024-10-18
  • 通信作者: 朱元州

Research progress in lead poisoning in children

Hui Zhao, Jing Zhang, Yuanzhou Zhu()   

  • Received:2024-04-29 Published:2024-10-18
  • Corresponding author: Yuanzhou Zhu
引用本文:

赵慧, 张晶, 朱元州. 儿童铅中毒研究进展[J/OL]. 中华卫生应急电子杂志, 2024, 10(05): 290-297.

Hui Zhao, Jing Zhang, Yuanzhou Zhu. Research progress in lead poisoning in children[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2024, 10(05): 290-297.

表1 儿童螯合疗法
状况 药物及剂量 用法
铅中毒脑病 BAL 450 mg/m2体表面积/d和 75 mg/m2体表面积,1次/4 h,持续5 d肌注
EDTA 1 500 mg/m2体表面积/d 连续输注或分2~4次静脉注射,持续5 d(BAL 4 h后,注射第二剂BAL后开始)
实验室:基线腹部放射学检查、CT扫描、外周血细胞形态学检查及计数、Ca2+、Na+、血铅浓度、BUN、Cr、肝功能、尿液分析;每天重复外周血细胞形态学检查及计数、Ca2+、Na+、BUN、Cr、肝功能、尿液分析;第3天和第5天检测血铅浓度
无症状(无铅中毒脑病)或>0.69 mg/L BAL 300~450 mg/m2体表面积/d和 50~75 mg/m2体表面积,1次/4 h,持续3~5 d肌注(剂量、持续时间取决于血铅浓度、症状严重程度)
EDTA 1 000~1 500 mg/m2体表面积/d 连续输注或分2~4次静脉注射,持续5 d(BAL 4 h后,注射第二剂BAL后开始)
实验室:基线腹部放射学检查、外周血细胞形态学检查及计数、Ca2+、血铅浓度、BUN、Cr、肝功能、尿液分析;第3天和第5天复查外周血细胞形态学检查及计数、Ca2+、BUN、Cr、肝功能、U/A,第5天复查血铅浓度
无症状:0.45~0.69 mg/L DMSA 700~1 050 mg/m2体表面积/d或 350 mg/m2体表面积,3 次/d,口服5 d,然后2次/d,持续14 d
实验室:基线腹部放射学检查、外周血细胞形态学检查及计数、血铅浓度、肝功能;第7天和第21天复查外周血细胞形态学检查及计数、肝功能、血铅浓度
EDTA 1 000 mg/m2体表面积/d 连续输注或分2~4次静脉注射,持续5 d
实验室:基线腹部放射学检查、外周血细胞形态学检查及计数、Ca2+、血铅浓度、BUN、Cr、肝功能、尿液分析;第3天和第5天复查 Ca2+、BUN、Cr、肝功能、尿液分析,第5天复查血铅浓度
0.2~0.4 mg/L 不适用常规螯合疗法 如果使用DMSA,疗程与上组相同
<0.2 mg/L 不适用螯合疗法
表2 世界卫生组织儿童和青少年铅中毒螯合疗法
≤10岁 血铅浓度≥0.45 mg/L的儿童,建议采用口服或肠道外螯合疗法 强烈推荐,极低确定性证据
血铅浓度为0.40~0.44 mg/L的儿童,如果对测量结果的准确性有怀疑,尽管采取了阻止接触铅的措施,但血铅浓度仍持续升高或有明显的铅中毒临床特征,则应考虑口服螯合疗法 条件推荐,极低确定性证据
血铅浓度≥0.70 mg/L的儿童,在螯合疗法期间和之后,如果血铅浓度仍然很高,则应密切监测临床恶化的迹象,包括定期进行神经系统评估 良好实践声明
铅中毒脑病患儿,建议紧急入院并进行肠外螯合治疗 强烈推荐,极低确定性证据
非怀孕青少年(11~18)岁 血铅含量为0.45~0.70 mg/L女性,无铅中毒临床特征的,应考虑采用口服螯合疗法 条件推荐,极低确定性证据
血铅浓度为0.45~0.70 mg/L男性,无铅中毒的临床特征,则不需要进行螯合治疗。不过,患者应在2~4 周后接受重新评估,以确保血铅浓度正在下降,并且患者的身体状况依然良好 条件推荐,极低确定性证据
血铅含量为0.45~0.70 mg/L的青少年,如果有轻度-中度铅中毒临床特征(如腹痛、便秘、关节痛、头痛、嗜睡),建议采用螯合疗法 条件推荐,极低确定性证据
血铅浓度>0.70~1 mg/L的青少年,无论是否进行螯合治疗,都应密切监测其临床恶化的迹象 良好实践声明
血铅浓度>0.70~1 mg/L的青少年,如果无明显的神经系统毒性特征,建议采用螯合疗法 条件推荐,极低确定性证据
血铅浓度>0.70~1 mg/L,且有明显铅中毒神经特征(如烦躁、嗜睡、共济失调、抽搐、昏迷)或铅中毒脑病的青少年,建议进行紧急肠外螯合治疗 强烈推荐,极低确定性证据
怀孕青少年 患有铅中毒脑病的孕妇,无论其处于哪个孕期,都建议进行紧急螯合治疗,首选的螯合剂取决于妊娠阶段和有关妊娠期使用安全性的现有数据 强烈推荐,极低确定性证据
血铅浓度≥0.45 mg/L,有或没有铅中毒临床特征,但没有铅脑病的孕妇:妊娠前三个月由于风险和益处之间的平衡存在不确定性,指南制定小组无法提出建议 强烈推荐,极低确定性证据
血铅浓度≥0.45 mg/L,有或没有铅中毒临床特征,但没有铅脑病的孕妇:妊娠中期或晚期建议采用螯合疗法 强烈推荐,极低确定性证据
表3 世界卫生组织四种螯合剂
BAL(肌肉注射)
成人剂量 典型的治疗方案是肌肉注射2.5~3 mg/kg/4 h,连续2 d;3 mg/kg/次,肌肉注射,第3天2~4次,然后3 mg/kg,肌肉注射,1~2次/d,持续10 d或直到康复
不良反应 这些症状包括:血压升高、心动过速、恶心和呕吐(随剂量增加而加重)、头痛、嘴唇、口腔和咽喉烧灼感、咽喉和胸部紧缩感、结膜炎、流泪、眼睑痉挛、出汗、流涎、鼻出血、手刺痛、腹痛、肌肉疼痛和痉挛、注射部位疼痛以及偶尔出现疼痛的无菌脓肿。儿童在第2次或第3次注射后可能会发烧,并持续到治疗停止。许多不良反应 与剂量有关。剂量较大时可能会出现短暂的肝酶升高。葡萄糖-6-磷酸脱氢酶缺乏症患者可能发生溶血。有报告称铅毒性会加剧
孕期安全性 C类:动物实验数据表明对胎儿有风险
青霉胺(口服)
成人剂量 典型的治疗方案是1~2 g/d,分次口服,饭前服用
不良反应 关于不良事件的大部分信息是针对肝豆状核变性(威尔逊病)、胱氨酸尿症或类风湿性关节炎长期治疗的患者。铅中毒的疗程较短,这些不良反应的发生率可能较低。最常见的不良反应是皮疹、厌食、恶心、呕吐和味觉障碍。少见的不良反应包括发热、过敏、瘙痒、荨麻疹、蛋白尿和口腔溃疡。罕见病症包括血尿、血小板减少症、白细胞减少症、粒细胞减少症、再生障碍性贫血、溶血性贫血、肾病综合征、红斑狼疮、Goodpasture 综合征、肝功能障碍、丘疹性荨麻疹、皮肌炎、重症肌无力、多发性肌炎和史蒂文斯-约翰逊综合征。对青霉素过敏的人可能会有交叉过敏的风险,但这种情况似乎很少见。在治疗铅中毒时,曾报告过以下不良反应:白细胞减少症、皮疹、血小板减少症、嗜酸性粒细胞增多症、蛋白尿和血管性水肿。这些影响在终止治疗后消失。青霉胺剂量越大,不良反应发生的可能性越大
孕期安全性 D类:已知胎儿风险
EDTA(静脉注射或肌肉注射)
成人剂量 典型的治疗方案为40 mg/kg,2次/d,静脉或肌肉注射,疗程5 d。如有必要,可在间隔48 h后重复使用
不良反应 常见的不良反应包括打喷嚏、鼻塞、麻木、刺痛、恶心、腹泻、腹部绞痛、发热、乏力、头痛、肌痛、口渴和发冷。少见的不良反应包括肾小管坏死、注射部位疼痛、血栓性静脉炎、流泪和一过性低血压。罕见病症包括粘膜病变。肾毒性似乎与剂量有关。长期使用高剂量的EDTA可能会产生一过性骨髓抑制以及皮肤和粘膜病变(包括口角炎),但这些病变通常会在停药后消失。这种药物还可能导致锌和铜等微量元素的排泄增加
孕期安全性 B类:实验动物未显示出对胎儿风险,没有对孕妇进行充分研究
二巯丁二酸(口服)
成人剂量 典型的治疗方案是口服10 mg/kg或350 mg/m2,1次/8 h,持续5 d,然后1次/12 h,持续14 d。必要时可重复疗程,通常间隔不少于2周,除非血铅浓度显示需要更激进的治疗。其他方案,例如将整个疗程延长至21 d或 28 d
不良反应 最常见的不良反应是胃肠道功能紊乱(恶心、呕吐、腹泻、大便稀溏)、血清转氨酶活性短暂升高、锌或铜排泄增加以及皮肤糜烂(可能影响粘膜)。在一个大型病例系列中,有不到2.5%的儿童出现丙氨酸氨基转移酶活性升高。报告的其他影响包括:流感样症状、头痛、嗜睡、头晕和轻中度中性粒细胞减少症。极少有报道出现荨麻疹和血管性水肿等过敏反应。据报道,一名患有葡萄糖-6-磷酸脱氢酶缺乏症的患者出现了溶血性贫血,但二巯丁二酸也曾用于其他患有这种病症的患者,未发生任何意外。大多数不良反应为轻度至中度,并 终止治疗后即可缓解
孕期安全性 C类:动物实验数据表明对胎儿有风险
[1]
朱元州, 赵慧, 甘泉, 等. 成人铅中毒[J]. 巴楚医学, 2023, 6(4):14-28.
[2]
Needleman HL. The persistent threat of lead:medical and sociological issues[J]. Curr Probl Pediatr, 1988, 18(12):697-744.
[3]
Cissé N. Saving tens of millions of children a year from the effects of lead poisoning is a surprisingly solvable problem[J]. Nature,2023, 619(7971):674.
[4]
Yıldız S, Gözü Pirinççioğlu A,Arıca E. Evaluation of heavy metal(lead, mercury, cadmium, and manganese) levels in blood,plasma, and urine of adolescents with aggressive behavior[J].Cureus, 2023, 15(1):e33902.
[5]
Coulton C, Richter FG, Cho Y, et al. Making the case for lead safe housing:downstream effects of lead exposure on outcomes for children and youth[J]. Health Place, 2023(84):103118.
[6]
Council on Environmental Health. Prevention of childhood lead toxicity[J]. Pediatrics, 2016, 138(1):e20161493.
[7]
Whitehead LS, Buchanan SD. Childhood lead poisoning:a perpetual environmental justice issue?[J]. J Public Health Manag Pract, 2019 (25 Suppl 1):S115-S120.
[8]
Shakya S, Stedman-Smith M, White PC, et al. Knowledge,attitudes, practices, and prevention barriers related to childhood lead poisoning among nepali-speaking bhutanese parents in northeast ohio, united states[J]. J Immigr Minor Health, 2024, 26(2):351-360.
[9]
Chen S, Guo Q, Zhou T, et al. Levels and health risk assessment of inorganic arsenic, methylmercury, and heavy metals in edible mushrooms collected from online supermarket in China[J]. Biol Trace Elem Res, 2024, 202(4):1802-1815.
[10]
WHO. Guideline for clinical management of exposure to lead[EB/OL]. (2021-10-27)[2024-04-29]. https://www.who.int/zh/publications/i/item/9789240037045.
[11]
Markowitz M. Lead poisoning[J]. Pediatr Rev, 2000, 21(10):327-335.
[12]
José S. Casas, José Sordo. Lead-Chemistry, Analytical Aspects,Environmental Impact and Health Effects[M].Amsterdam:Elsevier Science, 2011:158-228.
[13]
Raymond J, Brown MJ. Childhood blood lead levels in children aged <5 years - united states, 2009-2014[J]. MMWR Surveill Summ, 2017, 66(3):1-10.
[14]
Sambanis A, Osiecki K, Cailas M, et al. Using artificial intelligence to identify sources and pathways of lead exposure in children[J]. J Public Health Manag Pract, 2023, 29(5):E208-E213.
[15]
Dong J, Li X. Lead pollution-related health of children in China:disparity, challenge, and policy[J]. Sci Total Environ, 2023(882):163383.
[16]
Harshitha P, Bose K, Dsouza HS. Influence of lead-induced toxicity on the inflammatory cytokines[J]. Toxicology, 2024(503):153771.
[17]
Wessel L, Anderko L. Assessment and prevention of lead poisoning in refugee populations[J]. J Health Care Poor Underserved,2023, 34(1):447-465.
[18]
Lidsky TI, Schneider JS. Lead neurotoxicity in children:basic mechanisms and clinical correlates[J]. Brain, 2003, 126(Pt 1):5-19.
[19]
Patrick L. Lead toxicity, a review of the literature. Part 1:exposure, evaluation, and treatment[J]. Altern Med Rev, 2006, 11(1):2-22.
[20]
Papanikolaou NC, Hatzidaki EG, Belivanis S, et al. Lead toxicity update. a brief review[J]. Med Sci Monit, 2005, 11(10):RA329-RA336.
[21]
Schneider JS. Neurotoxicity and outcomes from developmental lead exposure:persistent or permanent?[J]. Environ Health Perspect,2023, 131(8):85002.
[22]
Mitra P, Sharma S, Purohit P, et al. Clinical and molecular aspects of lead toxicity:an update[J]. Crit Rev Clin Lab Sci, 2017,54(7-8):506-528.
[23]
Disalvo L, Varea A, Matamoros N, et al. Blood lead levels and their association with iron deficiency and anemia in children[EB/OL]. (2024-04-03) [2024-04-29]. https://link.springer.com/article/10.1007/s12011-024-04163-y#citeas.
[24]
Valentine WN, Paglia DE, Fink K, et al. Lead poisoning:association with hemolytic anemia, basophilic stippling, erythrocyte pyrimidine 5'-nucleotidase deficiency, and intraerythrocytic accumulation of pyrimidines[J]. J Clin Invest, 1976, 58(4):926-932.
[25]
Pal M, Sachdeva M, Gupta N, et al. Lead exposure in different organs of mammals and prevention by curcumin-nanocurcumin:a review[J]. Biol Trace Elem Res, 2015, 168(2):380-391.
[26]
Singh N, Kumar A, Gupta V K, et al. Biochemical and molecular bases of lead-induced toxicity in mammalian systems and possible mitigations[J]. Chem Res Toxicol, 2018, 31(10):1009-1021.
[27]
Farzan SF, Howe CG, Chen Y, et al. Prenatal lead exposure and elevated blood pressure in children[J]. Environ Int, 2018, 121(Pt 2):1289-1296.
[28]
Lin JL, Lin-Tan DT, Hsu KH, et al. Environmental lead exposure and progression of chronic renal diseases in patients without diabetes[J]. N Engl J Med, 2003, 348(4):277-286.
[29]
Zachariah JP, Wang Y, Penny DJ, et al. Relation between lead exposure and trends in blood pressure in children[J]. Am J Cardiol, 2018, 122(11):1890-1895.
[30]
Al-Kharraz K, Tabbah MJ, LaChance J, et al. The effect of the flint water crisis secondary to increased lead levels in drinking water on constipation in children in the city of flint, michigan,USA[J]. Cureus, 2023, 15(8):e44189.
[31]
Zamani N, Hosseini A, Farnaghi F, et al. Blood lead level evaluation in children presenting with chronic constipation in Tehran-Iran:a cross-sectional study[J]. Sci Rep, 2023, 13(1):2301.
[32]
Senanayake J, Haji Rahman R, Safwat F, et al. Asymptomatic lead poisoning in a pediatric patient[J]. Cureus, 2023, 15(2):e34940.
[33]
Philip AT, Gerson B. Lead poisoning—Part I. Incidence, etiology,and toxicokinetics[J]. Clin Lab Med, 1994, 14(2):423-444.
[34]
Shields JB, Mitchell HH. The effect of calcium and phosphorus on the metabolism of lead[J]. J Nutr, 1941, 21(6):541-552.
[35]
Ettinger AS, Wengrovitz AM. Guidelines for the identification and management of lead exposure in pregnant and lactating women[EB/OL]. (2010-11-01) [2024-04-29]. https://www.semanticscholar.org/paper/Guidelines-for-the-identification-and-management-of-Ettinger-Wengrovitz/77165af35a01bd1077013fd26c589d4aaffc5945.
[36]
Lanphear BP, Hornung R, Khoury J, et al. Low-level environmental lead exposure and children's intellectual function:an international pooled analysis[J]. Environ Health Perspect, 2005, 113(7):894-899.
[37]
Zhang N, Baker HW, Tufts M, et al. Early childhood lead exposure and academic achievement:evidence from detroit public schools, 2008-2010[J]. Am J Public Health, 2013, 103(3):e72-e77.
[38]
Needleman H. Lead poisoning[J]. Annu Rev Med, 2004(55):209-222.
[39]
Reuben A, Ward R, Rothbaum AO, et al. Who tests for lead and why? a 10-year analysis of blood lead screening, follow-up and CNS outcomes in a statewide US healthcare system[J]. Occup Environ Med, 2024, 81(2):101-108.
[40]
Jill Ryer-Powder. Blood Lead Reference Value:Recommendation to LEPAC. 2021.
[41]
Wengrovitz AM, Brown MJ. Recommendations for blood lead screening of Medicaid-eligible children aged 1-5 years:an updated approach to targeting a group at high risk[J]. MMWR Recomm Rep, 2009, 58(RR-9):1-11.
[42]
Sargent JD, Dalton MA. Rethinking the threshold for an abnormal capillary blood lead screening test[J]. Arch Pediatr Adolesc Med,1996, 150(10):1084-1088.
[43]
Bunch D, Pyle-Eilola AL. Lead poisoning:clinical and laboratory considerations[J]. Adv Clin Chem, 2023(117):209-222.
[44]
Carl Baum, Marissa Hauptman, Nick Newman, et al. Recommendations on Management of Childhood Lead Exposure. 2021.
[45]
Kim HC, Jang TW, Chae HJ, et al. Evaluation and management of lead exposure[J]. Ann Occup Environ Med, 2015(27):30.
[46]
Pediatrics AAO. Treatment guidelines for lead exposure in children[J]. Pediatrics, 1995(96):155-160.
[47]
Centers for Disease Control and Prevention. Managing elevated blood lead levels among young children:recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention.2002.
[48]
Chisolm JJ Jr. The use of chelating agents in the treatment of acute and chronic lead intoxication in childhood[J]. J Pediatr,1968, 73(1):1-38.
[49]
Piomelli S, Rosen JF, Chisolm JJ Jr, et al. Management of childhood lead poisoning[J]. J Pediatr, 1984, 105(4):523-532.
[50]
Graziano JH, Lolacono NJ, Meyer P. Dose-response study of oral 2,3-dimercaptosuccinic acid in children with elevated blood lead concentrations[J]. J Pediatr, 1988, 113(4):751-757.
[51]
Chisolm JJ Jr. Mobilization of lead by calcium disodium edetate. a reappraisal[J]. Am J Dis Child, 1987, 141(12):1256-1257.
[52]
Suarez CR, Black LE 3rd, Hurley RM. Elevated lead levels in a patient with sickle cell disease and inappropriate secretion of antidiuretic hormone[J]. Pediatr Emerg Care, 1992, 8(2):88-90.
[53]
Chisolm JJ Jr, Harrison HE. The treatment of acute lead encephalopathy in children[J]. Pediatrics, 1957, 19(1):2-20.
[54]
Réen L, Cederberg D, Radman A, et al. Low morbidity and mortality in children with severe traumatic brain injury treated according to the lund concept:a population-based study[J]. J Neurotrauma, 2023, 40(7-8):720-729.
[55]
Grände PO, Asgeirsson B, Nordström C. Aspects on the cerebral perfusion pressure during therapy of a traumatic head injury[J].Acta Anaesthesiol Scand Suppl, 1997(110):36-40.
[56]
Pinto LF, Oliveira JPS, Midon AM. Status epilepticus:review on diagnosis, monitoring and treatment[J]. Arq Neuropsiquiatr, 2022,80(5 Suppl 1):193-203.
[57]
Cantrell FL, Wardi G, O'Connell C. Propofol use for toxin-related seizures[J]. Pharmacotherapy, 2016, 36(6):702-704.
[58]
Gorelick MH, Gray MP. Neurologic emergencies. In:Shaw KN,Bachur RG, eds. Fleisher and Ludwig's Textbook of Pediatric Emergency Medicine[M]. 7th ed. Philadelphia, PA:Wolters Kluwer, 2016:914-933.
[59]
McKay CA Jr. Role of chelation in the treatment of lead poisoning:discussion of the treatment of lead-exposed children trial[J]. J Med Toxicol, 2013, 9(4):339-343.
[60]
Gurer H, Ercal N. Can antioxidants be beneficial in the treatment of lead poisoning?[J]. Free Radic Biol Med, 2000, 29(10):927-945.
[61]
Chang BJ, Jang BJ, Son TG, et al. Ascorbic acid ameliorates oxidative damage induced by maternal low-level lead exposure in the hippocampus of rat pups during gestation and lactation[J].Food Chem Toxicol, 2012, 50(2):104-108.
[62]
Shalan MG, Mostafa MS, Hassouna MM, et al. Amelioration of lead toxicity on rat liver with vitamin c and silymarin supplements[J]. Toxicology, 2005, 206(1):1-15.
[63]
Tandon SK, Chatterjee M, Bhargava A, et al. Lead poisoning in indian silver refiners[J]. Sci Total Environ, 2001, 281(1-3):177-182.
[64]
Tariq SA. Role of ascorbic acid in scavenging free radicals and lead toxicity from biosystems[J]. Mol Biotechnol, 2007, 37(1):62-65.
[65]
Takatsu H, Owada K, Abe K, et al. Effect of vitamin e on learning and memory deficit in aged rats[J]. J Nutr Sci Vitaminol (Tokyo),2009, 55(5):389-393.
[66]
Khafaji SS. Antioxidant, anti-inflammatory, and anti-reprotoxic effects of kaempferol and vitamin e on lead acetate-induced testicular toxicity in male rats[J]. Open Vet J, 2023, 13(12):1683-1695.
[67]
Liu CM, Ma JQ, Sun YZ. Protective role of puerarin on leadinduced alterations of the hepatic glutathione antioxidant system and hyperlipidemia in rats[J]. Food Chem Toxicol, 2011, 49(12):3119-3127.
[68]
Boots AW, Haenen GR, Bast A. Health effects of quercetin:from antioxidant to nutraceutical[J]. Eur J Pharmacol, 2008, 585(2-3):325-337.
[69]
Liu CM, Ma JQ, Sun YZ. Quercetin protects the rat kidney against oxidative stress-mediated DNA damage and apoptosis induced by lead[J]. Environ Toxicol Pharmacol, 2010, 30(3):264-271.
[70]
Liu CM, Zheng GH, Cheng C, et al. Quercetin protects mouse brain against lead-induced neurotoxicity[J]. J Agric Food Chem,2013, 61(31):7630-7635.
[71]
Flora SJ, Flora G, Saxena G, et al. Arsenic and lead induced free radical generation and their reversibility following chelation[J].Cell Mol Biol (Noisy-le-grand), 2007, 53(1):26-47.
[72]
Waseem N, Butt SA, Hamid S. Amelioration of lead induced changes in ovary of mice, by garlic extract[J]. J Pak Med Assoc,2014, 64(7):798-801.
[73]
Buettner C, Mukamal KJ, Gardiner P,et al. Herbal supplement use and blood lead levels of united states adults[J]. J Gen Intern Med, 2009, 24(11):1175-1182.
[74]
Kianoush S, Balali-Mood M, Mousavi SR, et al. Comparison of therapeutic effects of garlic and d-penicillamine in patients with chronic occupational lead poisoning[J]. Basic Clin Pharmacol Toxicol, 2012, 110(5):476-481.
[75]
Shukla PK, Khanna VK, Khan MY, et al. Protective effect of curcumin against lead neurotoxicity in rat[J]. Hum Exp ToxicolWHO,2003, 22(12):653-658.
[76]
Navas-Acien A, Guallar E, Silbergeld EK, et al. Lead exposure and cardiovascular disease--a systematic review. environ health perspect[J]. 2007, 115(3):472-482.
[77]
Balza J, Bikomeye JC, Flynn KE. Effectiveness of educational interventions for the prevention of lead poisoning in children:a systematic review[J]. Rev Environ Health, 2024.
[78]
Del Rio M, Obeng A, Galkaduwa B, et al. An interdisciplinary team-based approach for significantly reducing lower-level lead poisoning in U.S. children[J]. Toxicol Rep, 2022(10) :76-86.
No related articles found!
阅读次数
全文


摘要