Glotzer D E
Department of Pediatrics, Boston City Hospital/Boston University School of Medicine, Massachusetts.
Drug Saf. 1993 Aug;9(2):85-92. doi: 10.2165/00002018-199309020-00002.
2,3-Dimercaptosuccinic acid (DMSA) is an orally active chelating agent used in the treatment of lead and other heavy metal poisonings. In animals, DMSA chelates lead from soft tissues, including the brain, without clinically evident adverse effects or histopathological changes. In lead-poisoned children and adults, DMSA significantly increases urinary lead excretion, and, at least transiently, reduces the blood lead concentration. The safety profile of DMSA in both children and adults is encouraging, with few clinically apparent or biochemical adverse effects reported. However, clinical experience with DMSA is limited, and is not sufficient to exclude the possibility that other more serious drug-related adverse events including hypersensitivity or idiosyncratic reactions may occur. No data currently exist to determine whether drug-enhanced lead excretion with DMSA (or any other chelating agent) is beneficial in reducing lead-related neurotoxicity. The efficacy of DMSA in reducing neuropsychological morbidity, and additional safety data, are key areas requiring additional study before DMSA can be clearly recommended as the chelating agent of choice for the treatment of lead-poisoned children.
二巯基丁二酸（DMSA）是一种口服有效的螯合剂，用于治疗铅中毒及其他重金属中毒。在动物实验中，DMSA能螯合包括脑在内的软组织中的铅，且无明显的临床不良反应或组织病理学改变。对于铅中毒的儿童和成人，DMSA能显著增加尿铅排泄，并且至少在短期内能降低血铅浓度。DMSA在儿童和成人中的安全性令人鼓舞，报告的临床明显不良反应或生化不良反应很少。然而，DMSA的临床经验有限，不足以排除可能发生其他更严重的药物相关不良事件（包括过敏或特异反应）的可能性。目前尚无数据确定使用DMSA（或任何其他螯合剂）促进药物排铅是否有利于降低铅相关的神经毒性。在能够明确推荐DMSA作为治疗铅中毒儿童的首选螯合剂之前，DMSA在降低神经心理发病率方面的疗效以及更多的安全性数据是需要进一步研究的关键领域。
