Liebelt E L, Shannon M, Graef J W
Division of Emergency Medicine, Children's Hospital, Boston, MA 02115.
J Pediatr. 1994 Feb;124(2):313-7. doi: 10.1016/s0022-3476(94)70326-4.
To compare the response to oral meso-2,3-dimercaptosuccinic acid (DMSA) treatment in children with an initial blood lead (BPb) concentration less than versus more than 2.17 mumol/L (45 micrograms/dl).
Retrospective cohort study.
Regional referral lead treatment program in an urban children's hospital.
Thirty consecutive children, median age 34 months (range, 5 to 161 months), with an initial BPb concentration 0.97 to 2.90 mumol/L (20 to 60 micrograms/dl) selected for DMSA use. Reasons for DMSA use included BPb concentration > 2.17 mumol/L (11 children), complications with penicillamine therapy (11), chronic renal failure (1), and compassionate use (7). All patients received required environmental hazard reductions before drug administration.
Group 1 (n = 23) had a mean BPb concentration of 1.50 mumol/L (31 micrograms/dl), and group 2 (n = 7) had a mean BPb concentration of 2.41 (51 micrograms/dl). Sixteen patients (70%) in group 1 and five patients (71%) in group 2 had had previous chelation therapy (p value not significant). No significant difference was found in the mean percentage of the reduction of BPb concentration during treatment of group 1 (60%) versus group 2 (58%). The mean BPb concentration in group 1 rebounded to 70% of pretreatment values by mean day 41; the BPb concentration in group 2 rebounded to 69% by day 37 (p value not significant). Prior chelation therapy did not result in a significant difference in either the percentage reduction of BPb concentration or the percentage of rebound BPb.
DMSA is equally effective in acutely lowering BPb concentration in children with BPb concentrations less than and greater than 2.17 mumol/L.
比较初始血铅（BPb）浓度低于和高于2.17μmol/L（45μg/dl）的儿童口服中-2,3-二巯基丁二酸（DMSA）治疗的反应。
回顾性队列研究。
城市儿童医院的区域转诊铅治疗项目。
连续入选30名儿童，中位年龄34个月（范围5至161个月），初始BPb浓度为0.97至2.90μmol/L（20至60μg/dl），选择使用DMSA。使用DMSA的原因包括BPb浓度>2.17μmol/L（11名儿童）、青霉胺治疗并发症（11名）、慢性肾衰竭（1名）和同情用药（7名）。所有患者在给药前均进行了必要的环境危害降低措施。
第1组（n = 23）的平均BPb浓度为1.50μmol/L（31μg/dl），第2组（n = 7）的平均BPb浓度为2.41（51μg/dl）。第1组16名患者（70%）和第2组5名患者（71%）曾接受过螯合治疗（p值无统计学意义）。第1组（60%）和第2组（58%）治疗期间BPb浓度降低的平均百分比无显著差异。第1组的平均BPb浓度在第41天平均反弹至治疗前值的70%；第2组的BPb浓度在第37天反弹至69%（p值无统计学意义）。既往螯合治疗在BPb浓度降低百分比或BPb反弹百分比方面均未产生显著差异。
DMSA在急性降低BPb浓度方面，对BPb浓度低于和高于2.17μmol/L的儿童同样有效。
