与牙科汞合金填充物汞暴露相关的健康不良影响：毒理学原因还是心理学原因？

Adverse health effects related to mercury exposure from dental amalgam fillings: toxicological or psychological causes?

作者信息

Bailer J, Rist F, Rudolf A, Staehle H J, Eickholz P, Triebig G, Bader M, Pfeifer U

机构信息

Department of Clinical Psychology, Central Institute of Mental Health, Mannheim, Germany.

出版信息

Psychol Med. 2001 Feb;31(2):255-63. doi: 10.1017/s0033291701003233.

DOI:10.1017/s0033291701003233

PMID:11232913

Abstract

BACKGROUND

Possible adverse health effects due to mercury released by amalgam fillings have been discussed in several studies of patients who attribute various symptoms to the effects of amalgam fillings. No systematic relation of specific symptoms to increased mercury levels could be established in any of these studies. Thus, a psychosomatic aetiology of the complaints should be considered and psychological factors contributing to their aetiology should be identified.

METHODS

A screening questionnaire was used to identify subjects who were convinced that their health had already been affected seriously by their amalgam fillings (N = 40). These amalgam sensitive subjects were compared to amalgam non-sensitive subjects (N = 43). All participants were subjected to dental, general health, toxicological and psychological examinations.

RESULTS

The two groups did not differ with respect to the number of amalgam fillings, amalgam surfaces or mercury levels assessed in blood, urine or saliva. However, amalgam sensitive subjects had significantly higher symptom scores both in a screening instrument for medically unexplained somatic symptoms (SOMS) and in the SCL-90-R Somatization scale. Additionally, more subjects from this group (50% versus 4.7%) had severe somatization syndromes. With respect to psychological risk factors, amalgam sensitive subjects had a self-concept of being weak and unable to tolerate stress, more cognitions of environmental threat, and increased habitual anxiety. These psychological factors were significantly correlated with the number and intensity of the reported somatic symptoms.

CONCLUSIONS

While our results do not support an organic explanation of the reported symptoms, they are well in accord with the notion of a psychological aetiology of the reported symptoms and complaints. The findings suggest that self-diagnosed 'amalgam illness' is a label for a general tendency toward somatization.

摘要

背景

在一些研究中，对汞合金填充物释放的汞可能对健康产生的不良影响进行了讨论，这些研究的对象是将各种症状归因于汞合金填充物影响的患者。在这些研究中，均未发现特定症状与汞水平升高之间存在系统性关联。因此，应考虑这些症状的心身病因，并确定导致其病因的心理因素。

方法

使用一份筛查问卷来识别那些确信自己的健康已受到汞合金填充物严重影响的受试者（N = 40）。将这些对汞合金敏感的受试者与对汞合金不敏感的受试者（N = 43）进行比较。所有参与者均接受了牙科、一般健康、毒理学和心理检查。

结果

两组在汞合金填充物数量、汞合金表面面积或血液、尿液或唾液中评估的汞水平方面没有差异。然而，在医学上无法解释的躯体症状筛查工具（SOMS）和SCL - 90 - R躯体化量表中，对汞合金敏感的受试者症状评分显著更高。此外，该组中患有严重躯体化综合征的受试者更多（50% 对 4.7%）。在心理风险因素方面，对汞合金敏感的受试者自我概念较弱，无法承受压力，对环境威胁的认知更多，习惯性焦虑增加。这些心理因素与所报告的躯体症状的数量和强度显著相关。