因摄入含铅鸦片导致的铅中毒：对患者影像学表现的诊断性研究。
Lead poisoning due to ingestion of lead-contaminated opium: A diagnostic study on patients' imaging findings.
机构信息
Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
出版信息
J Trace Elem Med Biol. 2019 Sep;55:26-32. doi: 10.1016/j.jtemb.2019.04.016. Epub 2019 Apr 25.
OBJECTIVES
Our study attempts to determine if for patients following ingestion of lead-contaminated opium, radiographs [plain X-ray (KUB)] or unenhanced computed tomography (CT scan) of the abdomen may be predictive of lead poisoning.
METHODS
Our study is concerned with patients of >21 years with elevated lead concentrations, who had undergone KUB or CT. Patients with other toxicities who had undergone similar imaging profiles but who had low blood lead level (BLL) were enrolled as controls.
RESULTS
We evaluated a total of 79 cases and 79 controls with median [IQR] BLLs of 126 [97.4, 160] μg/dL and 8.7 [5.5, 15] μg/dL. All cases and eleven controls (13.9%) were addicted to oral opium, and of these cases, anemia (94.9%) and abdominal pain (92.4%) were the two most common clinical manifestations. Two radiologists reviewed the X-ray and non-contrast CTs. Fifty (63.3%) and 53 (67.1%) cases and controls underwent CT scanning with 34 (68%) vs. 6 (11.3%) positive CTs (P < 0.001) while 43 (54.4%) and 39 (43.3%) underwent X-rays with 21 (48.8%) vs. 4 (11.8%) positive X-rays, respectively (P < 0.001). Positive CT is associated with BLL between 10 and 45 μg/dL with a specificity of 96.9%, 88.7% and positive predictive value of 97.5% and 85% respectively.
CONCLUSIONS
In suspected cases of lead exposure due to ingested opium, and if BLL is not readily available, a positive imaging result may guide radiologists and physicians to consider lead poisoning.
目的
本研究旨在确定对于摄入含铅鸦片的患者，腹部 X 光片（KUB）或平扫 CT 是否可预测铅中毒。
方法
我们的研究对象是 21 岁以上血铅浓度升高且已行 KUB 或 CT 检查的患者。我们招募了血铅水平（BLL）较低但具有类似影像学特征且存在其他毒性的患者作为对照组。
结果
我们共评估了 79 例病例和 79 例对照，两组患者的中位 [IQR]BLL 分别为 126 [97.4，160]μg/dL 和 8.7 [5.5，15]μg/dL。所有病例和 11 例对照（13.9%）均有口服鸦片成瘾史，其中病例最常见的临床表现为贫血（94.9%）和腹痛（92.4%）。两名放射科医生对 X 光片和非增强 CT 进行了复查。50 例（63.3%）和 53 例（67.1%）病例和对照分别进行了 CT 扫描，阳性 CT 分别为 34 例（68%）和 6 例（11.3%）（P<0.001），而 43 例（54.4%）和 39 例（43.3%）分别进行了 X 光检查，阳性 X 光分别为 21 例（48.8%）和 4 例（11.8%）（P<0.001）。阳性 CT 与 10 至 45μg/dL 之间的 BLL 相关，其特异性为 96.9%、88.7%，阳性预测值分别为 97.5%和 85%。
结论
在怀疑因摄入鸦片而导致铅暴露的情况下，如果无法立即获得 BLL，阳性影像学结果可能会指导放射科医生和医生考虑铅中毒。
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