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儿童期铅中毒：暴露和预防

Authors
Dean A Lee, MD, PhD
Richard L Hurwitz, MD
Section Editors
Donald H Mahoney, Jr, MD
Michele M Burns, MD, MPH
Jan E Drutz, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
李秀清, 副主任医师

引言

清除环境中的铅，对铅中毒及其后遗症的预防至关重要。一级预防措施着重于清除环境中的铅，从而使铅暴露不能发生。二级预防措施旨在最大程度地减少对铅的吸收及铅在矿化组织中的沉积，后者是慢性铅暴露的一个来源。三级预防通过使暴露个体的血液和软组织中的铅经螯合作用排出，从而降低铅中毒相关的并发症发生率。螯合剂可降低与急性铅摄入相关的即时毒性作用，但其逆转慢性铅暴露对神经认知的影响的能力有限[1]。一级预防是降低铅中毒对神经认知功能的影响的唯一方法。

积极的环境整治，可能通过减少儿童的铅暴露而使儿童获益。然而，积极环境整治的效果在很大程度上还未经证实，这些方法存有争议，且成本较高。此外，还存在对于环境整治的政治和经济方面的考虑，这超出了本专题的讨论范围。但是，认为完全清除儿童环境中铅是唯一有效的预防措施[2]。

儿童期铅暴露的来源，以及对暴露的一级预防和二级预防策略，将总结在此。铅中毒的临床表现、诊断和治疗将单独讨论。 (参见“儿童铅中毒：临床表现和诊断”和“儿童期铅中毒：处理”)

暴露

儿童暴露于铅的途径有多种。自从汽油无铅化后，含铅涂料已经成为美国儿童铅暴露的主要来源。其他重要的儿科暴露因素包括：在妊娠和母乳喂养期间母体血铅水平(blood lead level, BLL)升高，以及土壤、食物或水受到污染和玩具中的铅超标。

出生前铅暴露 — 胎儿发育期间的铅暴露原因可能为：母体过去因为铅暴露而储存于骨骼中的铅动员入血和/或妊娠期间急性或慢性的环境铅暴露引起母体BLL直接升高[3]。子宫内铅暴露与出生后神经发育损害有关，发生发育迟滞、IQ降低和行为异常的风险均增加[3]。

                       

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-16.
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