Landrigan P J, Todd A C
Department of Community Medicine, Mount Sinai School of Medicine, New York, New York 10029.
West J Med. 1994 Aug;161(2):153-9.
Lead poisoning is the most common disease of environmental origin in the United States today. Adult lead poisoning results primarily from exposure by inhalation in the workplace. Pediatric lead poisoning results principally from the ingestion of lead from environmental media, including paint chips, dust, soil, drinking water, ceramics, and medications. Lead is toxic to many organ systems, among them developing erythrocytes, the kidneys, and the nervous system. Lead-induced toxicity to the central nervous system causes delayed development, diminished intelligence, and altered behavior. In young children, this effect has been demonstrated convincingly to occur at blood lead levels between 10 and 20 micrograms per dl. The Centers for Disease Control and Prevention has recommended that a blood lead level of 10 micrograms per dl or higher be considered evidence of increased lead absorption, and the National Academy of Sciences has concurred in that recommendation. Unresolved issues in need of further study include the frequency of screening young children for lead, the question of whether women should be offered screening for lead before conceiving a pregnancy, the role of x-ray fluorescence analysis in assessing lead in bone, and the appropriate legislative response of the United States government to lead-based paint abatement.
铅中毒是当今美国最常见的环境源性疾病。成人铅中毒主要源于工作场所的吸入暴露。儿童铅中毒主要是由于摄入环境介质中的铅,包括油漆碎片、灰尘、土壤、饮用水、陶瓷和药物。铅对许多器官系统有毒,其中包括发育中的红细胞、肾脏和神经系统。铅对中枢神经系统的毒性会导致发育迟缓、智力下降和行为改变。在幼儿中,这种影响已被令人信服地证明在血铅水平为每分升10至20微克时就会出现。疾病控制与预防中心建议,血铅水平达到每分升10微克或更高应被视为铅吸收增加的证据,美国国家科学院也认同这一建议。需要进一步研究的未解决问题包括对幼儿进行铅筛查的频率、女性在怀孕前是否应接受铅筛查的问题、X射线荧光分析在评估骨铅中的作用以及美国政府对含铅油漆减排的适当立法回应。