Hefazi Mehrdad, Attaran Davoud, Mahmoudi Mahmoud, Balali-Mood Mahdi
Medical Toxicology Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Inhal Toxicol. 2005 Oct;17(11):587-92. doi: 10.1080/08958370591000591.
Mustard gas or sulfur mustard (SM) is an alkylating chemical warfare agent that was widely used during the World War I and in the Iran-Iraq conflict. We aimed to study late toxic effects of SM on the respiratory system of severely intoxicated Iranian veterans. Respiratory examination, spirometry, arterial blood gas (ABG) analysis, and high resolution computed tomograpghy (HRCT) of the chest were performed on all severely SM-poisoned veterans in the province of Khorasan, Iran. HRCT abnormalities were classified into four grades based on the number of lung lobes involved. ABG and spirometric results were compared with each other, as well as, with the severity grades of HRCT abnormalities, using Spearman's rank correlation test. Forty male subjects with confirmed SM poisoning 16 to 20 years ago, were studied. Main respiratory complications were diagnosed as chronic obstructive pulmonary disease (COPD) (35%), bronchiectasis (32.5%), asthma (25%), large airway narrowing (15%), pulmonary fibrosis (7.5%), and simple chronic bronchitis (5%) patients. While there was a significant correlation (p<0.05) between ABG and spirometric results, the severity grades of HRCT abnormalities revealed a significant correlation (p<0.05) only with PaO2. We concluded that SM-induced respiratory complications tend to progress over the years. While spirometry is a valuable diagnostic tool for evaluation of pulmonary impairment during regular follow-ups, ABG and HRCT are more objective and should be more considered for evaluation of the severity and for diagnosis of the respiratory complications.
芥子气或硫芥（SM）是一种烷基化化学战剂，在第一次世界大战和两伊冲突中被广泛使用。我们旨在研究硫芥对重度中毒的伊朗退伍军人呼吸系统的晚期毒性作用。对伊朗霍拉桑省所有重度硫芥中毒退伍军人进行了呼吸检查、肺活量测定、动脉血气（ABG）分析和胸部高分辨率计算机断层扫描（HRCT）。根据受累肺叶数量将HRCT异常分为四个等级。使用Spearman等级相关检验将ABG和肺活量测定结果相互比较，以及与HRCT异常的严重程度等级进行比较。研究了40名16至20年前确诊为硫芥中毒的男性受试者。主要呼吸并发症被诊断为慢性阻塞性肺疾病（COPD）（35%）、支气管扩张（32.5%）、哮喘（25%）、大气道狭窄（15%）、肺纤维化（7.5%）和单纯慢性支气管炎（5%）患者。虽然ABG和肺活量测定结果之间存在显著相关性（p<0.05），但HRCT异常的严重程度等级仅与动脉血氧分压（PaO2）显示出显著相关性（p<0.05）。我们得出结论，硫芥引起的呼吸并发症多年来有进展趋势。虽然肺活量测定是定期随访期间评估肺损伤的有价值诊断工具，但ABG和HRCT更客观，在评估严重程度和诊断呼吸并发症时应更多考虑。
