Slavin R E, Swedo J, Cartwright J, Viegas S, Custer E M
Department of Pathology, University of Texas Medical Branch, Galveston 77550.
Hum Pathol. 1988 Feb;19(2):223-35. doi: 10.1016/s0046-8177(88)80353-8.
Bullet wounds causing lead synovitis in the wrist and knee are reported in two patients, one of whom also developed clinical plumbism. Very high lead levels in the synovial fluid are believed to be responsible for toxicity changes that occurred in the synovium and bone. Ultrastructurally, these alterations included the formation of nuclear lead inclusions, dilation, and degranulation of the rough endoplasmic reticulum and deposition of crystalline precipitates in the matrix of the mitochondria in macrophages, osteoclasts, and synoviocytes, as well as the development of cytoplasmic lead inclusions in osteoclasts. Energy-dispersive x-ray elemental analysis (EDXEA) indicated that the nuclear inclusions contained only lead, whereas precipitates within the mitochondria and elsewhere in the cytoplasm were composed of complexes containing lead, calcium, and phosphorus. Similarly constituted extracellular complexes were incorporated into newly formed trabecular bone laid down as a physiologic response to the bullet lodged within the wrist bones. This bone subsequently exhibited defects in bone resorption, which were characterized by depressed osteoclastic function and a unique lesion termed incomplete osteocytic osteolysis. The genesis of this latter lesion is uncertain. The sequestration of the partially degraded bone fragments containing lead complexes into the marrow and eventually into the joint spaces and synovium permitted the recycling of bone lead, and this may have played an important role in inducing clinical plumbism in one of the patients in this study.
据报道，两名患者因枪伤导致手腕和膝盖出现铅中毒性滑膜炎，其中一名患者还出现了临床铅中毒症状。滑膜液中极高的铅含量被认为是导致滑膜和骨骼发生毒性变化的原因。在超微结构上，这些改变包括核内铅包涵体的形成、粗面内质网的扩张和脱颗粒、巨噬细胞、破骨细胞和滑膜细胞线粒体基质中结晶沉淀物的沉积，以及破骨细胞中细胞质铅包涵体的形成。能量色散X射线元素分析（EDXEA）表明，核内包涵体仅含铅，而线粒体和细胞质其他部位的沉淀物由含铅、钙和磷的复合物组成。类似组成的细胞外复合物被整合到新形成的小梁骨中，这是对嵌入腕骨内子弹的一种生理反应。随后，这块骨头出现了骨吸收缺陷，其特征是破骨细胞功能下降和一种称为不完全骨细胞性骨溶解的独特病变。后一种病变的起源尚不确定。含有铅复合物的部分降解骨碎片被隔离到骨髓中，并最终进入关节间隙和滑膜，从而使骨铅得以循环，这可能在本研究的一名患者中诱发临床铅中毒方面发挥了重要作用。
