Gyvsidabrio ir švino druskų jonų paplitimas ir jų sukeltų klinikinių skirtumų ypatumų apžvalga

Gyvsidabrio ir švino druskų jonų paplitimas ir jų sukeltų klinikinių skirtumų ypatumų apžvalga

Raktažodžiai: gyvsidabris, švinas, sunkieji metalai, apsinuodijimas, klinikiniai atvejai.

Santrauka

Gyvsidabris ir švinas priklauso nuodingųjų metalų aplinkos teršalų grupei, jų įvairiavalentingumo paplitimas aplinkoje ir pažeidimo pobūdžiai yra skirtingi. Gyvsidabris blokuoja sulfihidrilines grupes, sukeldamas nervų sistemos pažeidimus iki paralyžiaus. Švinas, dėl ypatingų savybių (minkštumo), gamtoje paplitęs plačiau negu gyvsidabris. Patekęs į ląsteles, švinas blokuoja gyvybei svarbius metalus – cinką ir magnį. Taip pat blokuoja gliutamino rūgštį, sukeldamas įvairias vegetacines nervų sistemos disfunkcijas. Gydymo taktiką lemia skirtinga patogenezė ir klinika.

Įvadas

Visi sunkieji metalai ir jų cheminiai junginiai (atrasta apie 117) yra gamtos teršalų sudedamoji dalis. Jie turi savybę kauptis ir per vandenį migruoti iš vienos sistemos į kitą. Labai mažos metalų dozės gali kauptis ir per ilgą laiką pažeisti žmogaus organizmą. Vieni jų yra gyvybiškai svarbūs gyvam organizmui egzistuoti (pvz., cinkas, magnis, selenas), o kita metalų grupė (litis, silicis) yra santykinai svarbūs gyvybei palaikyti ir, tik viršijus jų normą, jie tampa nuodingi. Trečioji sunkiųjų metalų grupė, tokia kaip gyvsidabris, švinas, arsenas ir talis, yra nuodai. Patekę į ląstelę, jie blokuoja sulfidrilines grupes (SH), trikdo baltymų ir rūgščių metabolizmą, pažeidžia organų funkcijas (smegenų, inkstų, kepenų).

Apsinuodijimas gyvsidabriu

 Gyvsidabris (Hg) (lot. mercurio, hydragyrum, planeta Merkurijus taip pavadintas dėl sidabrinio atspalvio) yra blizgus, lakus ir kambario temperatūroje skystas metalas, neturintis skonio ir kvapo. Jo atominė masė – 200,59a. m. v., tankis – 13,55 g/cm3, virimo taškas – 356,73 ºC, garavimo – 38,8 ºC. Kuo didesnė aplinkos temperatūra, tuo intensyviau gyvsidabris garuoja. Jo valentingumas priklauso nuo orbitoje esančių elektronų kiekio. Metalinis gyvsidabris elektronų neturi (Hgº), yra neaktyvus ir cheminių junginių nesudaro. Jis yra neutralus ir, patekęs per burną, pasišalina su išmatomis (pavyzdys iš asmeninės patirties: moteris, siekdama nusižudyti, susileido į veną apie 5 ml metalinio gyvsidabrio. Jis vienodai pasiskirstė plaučių audinyje, buvo matomas atlikus rentgenogramą, bet kvėpuojant atviros ventiliacijos metu išgaravo, nepalikęs jokių aiškių organizmo pažeidimų). Pažymėtina, kad pakaitinus metalinį neutralų gyvsidabrį (būtinai uždarytoje patalpoje), jis tampa mirtinai pavojingu cheminiu elementu. Patekęs pro kvėpavimo takus, jis gali susikaupti parenchiminiuose organuose, smegenyse ir kauluose. Iš organizmo išsiskiria lėtai su šlapimu, seilėmis, prakaitu, motinos pienu. Didelė gyvsidabrio garų koncentracija, patekusi į plaučius, pažeidžia alveolių kraujagyslių sieneles, sutrikdo deguonies difuziją, sukelia hipoksemiją su širdies veiklos sustojimu.

Vienvalentis gyvsidabris (Hg+) sudaro neorganinius junginius su chloru – kalomelį (HgCl), sublimatą (HgCl2), anksčiau naudotą medicinoje. Dvivalentis gyvsidabris (Hg++) su organinėmis grupėmis (metil-, etil-) sudaro cheminius junginius, kurie yra mirtinai pavojingi[7]. Pavyzdžiui, etilmerkurchloridas yra universalus dezinfektorius, naikinantis virusus, mikrobus ir grybelius, plačiai naudojamas žemės ūkyje derlingumui pagerinti. Juo užterštas dirvožemis pavojingas ne tik sausumos (kiškiams), bet ir oro (vabzdžiams ir paukščiams), vandens (žuvims, vėžiams, varlėms) gyvūnams. Tirpdamas riebaluose, jis mažina moterų galimybę pastoti, sukelia persileidimus, neišnešiotumą ir apsigimimus su įgimtomis smegenų ydomis (cerebriniu paralyžiumi, mikrocefalija ir hidrocefalija) [2]. Išaugintas derlius (uogos ir vaisiai) ir naminių gyvūnų mėsa tampa pavojingi ir žmogui. Civilizuotuose kraštuose etilmerkurchloridas yra uždraustas naudoti žemės ūkyje.   Gyvsidabrio paplitimo cirkuliavimo schema – oras, vanduo, dirvožemis, bioterpė, pavaizduota 1 pav.

 

Iš gyvsidabrio šaltinio (medicininė aparatūra, kasyklos, laboratorijos, elektrifikacijos sistemos, pramonė) metalas garuoja į atmosferą. Kuo didesnė temperatūra, tuo daugiau garų, kuriuose su kietosiomis atmosferos dalelėmis lietaus lašų pavidalu gyvsidabrio junginiai patenka į dirvožemį, vandens telkinius. Aprašoma atvejų, kai Floridoje per metus su krituliais galėjo iškristi apie 8 tonos metalinio gyvsidabrio. Užfiksuotas unikalus reiškinys – kritusių paukščių (balandžių ir varnų) „lietus“ Australijoje ir Jungtinėse Amerikos Valstijose. Teksaso Valstijoje buvo nukritę tūkstančiai negyvų balandžių ir žvirblių. Neaiškią paukščių mirtį galėjo lemti toksinių medžiagų poveikis. Žuvyse randama nuo 0,05 mg/kg iki 3,7 mg/kg gyvsidabrio. Gyvsidabrio junginiai, patekę iš dirvožemio per virškinimo traktą, pažeidžia kepenų, smegenų, inkstų funkcijas. Virškinimo trakte, veikiant fermentams, cheminiai gyvsidabrio junginiai virsta fosfatais, acetatais, laktatais. Dalis jų pasišalina su ekskrementais, o dalis rezorbuojasi ir kaupiasi smegenyse ir inkstuose. Toksiniai gyvsidabrio junginių jonai, patekę į ląstelę, blokuoja SH, trikdo glutaciono ir ląstelės metabolizmą. Kliniškai pasireiškia termoreguliacijos sutrikimu, galvos skausmu, anoreksija, svorio kritimu, kalbos ir mąstymo sutrikimu ir toninio pobūdžio paralyžiais. Gyvsidabris šalinamas iš organizmo su ekskrementais ir šlapimu, pažeidžiant inkstų parenchimos ląsteles.

Pavyzdys iš asmeninės patirties. 8 metų mergaitė, gyvenanti šalia Akmenėje esančios geležinkelio stoties, kur buvo kraunami ir sandėliuojami chemikalai (etilmerkurchloridas). Tėvas iš jų. Mergaitės akivaizdoje, žiurkėms darydavo masalą. Praėjus tam tikram laikui, mergaitė neteko apetito, atsirado pilvo skausmai. Dėl jų chirurgai mergaitei net atliko apendektomiją, kurios metu apendicito pokyčių nenustatyta. Mergaitės būklė negerėjo: pradėjo lūžinėti plaukai, trupėti dantys, nagai, prasidėjo dažnas šlapinimasis, karščiavimas ir svorio kritimas. Mergaitei diagnozuotas pielonefritas, sepsis, pneumonija, trečiojo laipsnio išsekimas. Nepaisant aktyvaus gydymo antibiotikais, būklė negerėjo. Mergaitė iš rajoninės ligoninės buvo perkelta į klinikinę ligoninę Vilniuje. Atvykus pacientės būklė buvo ypač sunki: sąmoninga, temperatūra iki 39 ºC, labai liesa, išsekusi, sutrikusi kalba, plaukai trumpi, trapūs, suskilinėję. Nustatytas dešinės pusės toninis paralyžius: padidėjęs raumenų tonusas, patelariniai ir pado klonusai, aukšti sausgysliniai refleksai, jutimo, rijimo sutrikimai. Kraujyje anemija (hemoglobinas – 80 g/l, leukocitozė – 15×109/l, su leukocitų formulės nuokrypiu į kairę, C reaktyvusis baltymas – 85 mg/l). Kraujo mikrobiologiniuose pasėliuose bakterijų neišauginta. Šlapime pilnas regėjimo laukas leukocitų, pavieniai eritrocitai ir cilindrai. Šlapime rasta gyvsidabrio pėdsakų. Gydant padidėjo iki 1 mg/l (norma – iki 0,5 mg/l). Akių dugne pastebėtas lengvas paburkimas, bet galvos kompiuterinėje tomogramoje patologinių pokyčių nenustatyta. Remiantis anamneze (neabejotinas kontaktas su organinio gyvsidabrio junginiais), ligos vangia klinikine eiga, išreikštu išsekimu ir klinika, diagnozuotas sunkus lėtinis apsinuodijimas gyvsidabriu, toksinis encefalopoliradikoneuritas, hemiparezė, toksinis inkstas ir trečiojo laipsnio išsekimas. Gydymas. Remiantis apsinuodijimo gyvsidabrio garais patogenezės ypatumais, blokuojančiais SH ląstelėje, skirti tiolo grupės preparatai (DMPS – dimerkaptopropansulfatai, etilendiamintetracto rūgščių druskos, natrii hiposulfurozum), intraveninė detoksikacinė lašinė skysčių infuzija, maitinimas per zondą iki rijimo atsikūrimo, fizioterapinės priemonės ir stiprinamoji terapija. Skiriant antidotus, buvo laikomasi trumpo gydymosi režimo (10 dienų) su 1–2 mėnesių pertrauka. Pacientė gydyta 4 mėnesius. Individualia slauga rūpinosi motina.

Apsinuodijimas švinu

 Švinas (Pb) (lot. pliumbum, saturnum) yra nuodingas elementas, žinomas dar prieš 5000 mūsų eros metų, liejimo metu išgaunamas iš sidabro amalgamo. Romoje buvo gaminami vandentiekio vamzdžiai ir glazūruoti moliniai indai vynui gaminti. Ir tik XX amžiuje švinas pradėtas plačiau naudoti prekyboje akumuliatorių gamyboje, elektros laidams izoliuoti, transporto srityje, statyboje ir pan. Hipokrato laikais buvo žinomi jo sukelti pilvo skausmai, pavadinti colica saturnica.

Švino ypatumai: atominė masė – 207,2 a. m. v., tankis – 13,55 g/cm3, lydosi 327 ºC, o garuoja 400–500 ºC. Priklausomai nuo jo elektronų kiekio atomo orbitoje, jis yra polivalentinis ir polimorfinis metalas (Pb++, Pb++++). Dėl silpno tarpmolekulinio ryšio jis yra minkštas, lengvai atsiplėšia, tampa dulkėmis, lengvai garuoja ir migruoja aplinkoje. Dėl išvardytų savybių švinas labiau paplitęs aplinkoje nei gyvsidabris. Švinas yra aktyvus tik rūgščioje aplinkoje (žemas Ph). Šioje aplinkoje sudaro toksinius junginius – acetatus, chloridus, laktatus, fosfatus. Molekulinės jo atplaišos lengvai sudaro aerozolius, garus ar dulkes atmosferoje, teršia orą, dirvožemį ir vandenį [4]. Pagrindinis žmogaus apsinuodijimo švinu šaltinis yra maistas ir vanduo. 5 pav. pateikti pagrindiniai švino teršalų šaltiniai.

Švino paplitimo mastas yra daug didesnis už gyvsidabrio. Prie intensyvaus eismo kelių (iki 50 m atstumu) švino koncentracija dirvožemyje yra 1,8 karto didesnė nei įprasta. Žuvyse randama nuo 0,4 mg/kg iki 2,1 mg/kg švino. Užterštumas vakariniuose Lietuvos rajonuose yra daug didesnis nei rytiniuose ir siekia 8,76 mg/m3 [5, 6].

Mūsų aplinkos švino teršalų šaltiniai: sąvartynai, senų pastatų konstrukcijos, statybos, apdailos medžiagos, balti aliejiniai dažai, dezinfekuojamosios priemonės (geležies(III) oksidas), metalo apdirbimo priemonės, automobilių servisai, spaustuvės, plastmasių pramonė, įskaitant žaislus, konservų talpos, automobilių transportas ir pan. Švino jungtis su angliavandeniais sudaro toksišką, stabilų vadinamąjį tetraetilbenziną (junginys, patekęs į dirvožemį, nesuyra iki 20 metų), naudojamą transporto kuro kokybei pagerinti. Pagrindinis švino patekimo į žmogaus organizmą kelias yra kvėpavimo takai, maistas ir vanduo. Veikiant fermentams virškinimo trakte, susidaro įvairūs švino cheminiai junginiai (chloridai, fosfatai, laktatai). Esant silpnai žarnų peristaltikai (vidurių užkietėjimui) ir mažam kalcio ir geležies kiekiui žarnų turinyje, švino rezorbcija yra intensyvesnė. Dalis švino pasišalina su ekskrementais, o kita dalis, patekusi per kraują, kaupiasi smegenyse, kauluose ir minkštuosiuose audiniuose. Švinas pasišalina iš organizmo su šlapimu, prakaitu, seilėmis ir per plaukus. 6 pav. pateikta švino absorbavimo ir eliminavimo schema.

Proc. – švino absorbcijos ir eliminavimo svarbiausiais keliais vidutinis dalių svoris procentais, d. ir m. – švino žymėtųjų molekulių pasišalinimo laikas iš įvairių organizmo audinių dienomis ir metais [72b, 189 ir 419].

 

Patekęs į ląstelę, švinas dėl elektronų nesuderinamumo su organizmo cheminiais procesais, blokuoja gyvybei svarbius metalus (cinką, geležį, magnį, seleną). Intoksikacijos metu cinko sumažėja iki < 100 mkg/l (norma – 400–500mkg/l), iškreipiant ląstelės metabolizmą. Pažeidimų klinikiniai simptomai pasireiškia:

  • vegetacinės nervų sistemos disfunkcijos reiškiniais (neurotosikoze), skausmais įvairiose kūno vietose (galvoje, pilve, širdyje), galvos svaigimu, pykinimu, kartais vėmimu, termoreguliacijos sutrikimais, profuziniu prakaitavimu, nuovargio epizodais, alpimo priepuoliais, mąstymo ir atminties susilpnėjimu, pusiausvyros ir koordinacijos sutrikimais. Gydoma D-metilcisteinu, sudėtingas baltymų rūgščių kompleksas vadinamas kupreniliu. Preparatas, iš organizmo šalindamas šviną, atkuria blokuotus, gyvybei svarbius metalus, reguliuoja gliutationo apykaitą, grąžina ląstelės metabolizmą. Papildomai skiriama gliutamino rūgštis ir mikroelementų (cinko, magnio, seleno) iki 50 mg/p. Taip pat reguliuojamas dietinis ir darbo režimas, vandens apykaita.

Pavyzdys iš praktikos. Berniukas V. P. – 16 metų, dvyliktokas, pirmūnas. Gimė ir augo sveikas. Berniuko hobis yra susijęs su motociklų rekonstrukcija, akumuliatorių surinkimu, vairavimo pratybomis. Prieš mėnesį pakilo temperatūra – 37,3 ºC, pasireiškė galvos skausmas, svaigimas, pykinimas, naktinis prakaitavimas, skausmas širdies plote, troškulys, sumažėjo apetitas. Apžiūrėjus berniuką, nustatyta: būklė vidutinė, kiek intoksikuotas, pablyškęs, oda švari, bet drėgna, ypač delnai ir pėdos, liežuvis storai padengtas apnašu, hipogonadizmas, vidaus organų būklė be matomų pakitimų. Ryškus vokų ir pirštų tremoras +++, sutrikusi koordinacija, pirštų nosies mėginiai teigiami (PN++), sutrikusi pusiausvyra (svyruoja į visas puses), sausgysliniai refleksai sunkiai išgaunami, platus raudonas dermografizmas. Laboratoriniai tyrimai: kraujyje hemoglobino – 117 g/l, šlapime rasta 12 mmg/l švino (norma – 1,6 mg/l). Akių dugne išsiplėtęs kraujagyslių tinklas, elektroencefalogramoje pastebimi bioaktyvumo pokyčiai. 7 pav. pateikiama paciento elektroencefalograma prieš gydymą antidotais, 8 pav. – normali elektroencefalograma.

 

Remiantis anamneze, klinika ir dideliu kiekiu švino šlapime, diagnozuota lėtinė intoksikacija švinu, neurotosikozė – autonominis, vegetacinis nervų sistemos disfunkcijos sindromas, hipogonadizmas. Paskirtas atitinkamas antidotinis gydymas. Užteko vieno 15 dienų gydymo kurso, ir berniukas pasveiko: praėjo visi negalavimai, po metų pasivijo lytinė branda, sėkmingai baigė mokyklą ir įstojo į konservatoriją. 9 pav. pateikiama paciento V. P. elektroencefalograma pasveikus;

 

 

  • tam tikrais atvejais, dėl įgimtų žmogaus savybių švino šalinimui mažėjant su šlapimu ir prakaitu, intensyvėja jo šalinimas su plaukais, jie pradeda slinkti. Apsinuodijus sunkiaisiais metalais, pasireiškia židininiu ar bendru kūno nuplikimu su mažai išreikštais neurotoksikozės reiškiniais.

1990 metais su urbanizacijos pakilimu (transportas, statyba, gamyba ir pan.) padaugėjo ir elektromagnetinių spinduliuočių taškų – televizijos, radijo ir mobiliųjų telefonų bokštai, internetas, kompiuteriai, išmanieji telefonai. Jų elektromagnetinis laukas neigiamai veikia sunkiaisiais metalais apsinuodijusį žmogaus organizmą.

Pirmas atvejis iš klinikinės patirties. 25 metų vairuotojas, skundėsi plikimu (apie 20 cm) aplink ausį dėl dažno mobiliojo telefono laikymo prie dešinės ausies, o vėliau ir prie kairės ausies. Ištyrus paciento plaukus, rasta 8 μg/g švino (norma – 0,5 μg/g). Pakoregavus darbo režimą, paskyrus antidotinį gydymą su cinko elementais, žmogus pasveiko.

Antrasis atvejis. Baltupių mikrorajone 2016 metais kovo mėnesį viename gyvenamajame name nupliko 2 trečiokės mergaitės: iškrito galvos, antakių, blakstienų plaukai (10 pav. matomas totalus plikis apsinuodijus švinu). Švinas, patekęs į organizmą, pažeidžia plaukų svogūnėlį, sutrinka svogūnėlio kraujo apykaita, todėl nutrūksta plauko mityba. Atsiradus elektromagnetinių spinduliuočių poveikiui, plaukas iškrinta kartu su jame sukauptu švinu (11 pav. matomas plaukų slinkimas apsinuodijus švinu).

 

 

Trečiokių bioterpėje rasta 7 kartus daugiau švino nei norma (0,5 mg/l). Mergaičių būklė stebima toliau. Atlikus tyrimus, jų bute rastas padidėjęs elektromagnetinis laukas. Stebint sergančius alopecija vaikus, teko ištirti 20 vaikų elektromagnetinį lauką plikių vietoje. 18 iš jų buvo padidėjusi elektromagnetinė spinduliuotė. Mokslininkų nuomone, elektromagnetinės spinduliuotės poveikis sukelia audinių šilumos pakilimą, pažeidžia DNR ryšį, keičiasi baltymų struktūra ir jonų judėjimas nervinių signalų taškuose. Mokslininkai siūlo vengti elektromagnetinių spinduliuočių iki 16 metų, šalinti visus mobiliųjų telefonų bokštus nuo mokyklų, darželių ir gyvenamųjų namų [1].

Trečiasis atvejis. 10 metų mergaitė P. L. gimė ir augo normaliai. Būdama 7 metų, pablogėjus bendrai savijautai, tapo irzli, nervinga, sutriko miegas, kartais jusdavo skausmą pilve. Galvos odoje atsirado 5 x 5 cm plikė. Po dermatologo paskirto tepalo plikė užaugo. Po metų plaukai ėmė slinkti kuokštais – išpliko galva, antakiai ir blakstienos. Plikei koreguoti pritaikytas perukas, kad galėtų vaikščioti į mokyklą. Buvo tirta endokrinologijos skyriuje, kuriame plaukų slinkimo priežastis nenustatyta. Patekus pas toksikologą, mergaitės būklė buvo vidutinio sunkumo: pablyškusi, nevalgi, oda švari, nuplikusi, liežuvis pasidengęs pilkomis apnašomis, delnai drėgni. Vidaus organai be ypatingų požymių. Akių dugne pastebėti edemos reiškiniai, nustatytas nedidelis pusiausvyros sutrikimas ir vokų tremoras. Ištyrus šlapimą, rasta 3 μg/l švino (norma – 0,5 μg/l), cinko – 210 μg/l (norma – 400 μg/l). Elektroencefalogramoje ryškūs bioaktyvumo pokyčiai (12 pav.).

 

Remiantis klinika, padidėjusiu švino kiekiu šlapime, sumažėjusiu cinko kiekiu, diagnozuotas lėtinis apsinuodijimas sunkiaisiais metalais, totalinė alopecija su neryškiais neurotoksikozės reiškiniais. Paskirtas gydymas – dieta, dienos režimas, mikrocirkuliacijos nuplikusių regionų atkūrimas (gilus masažas, vonios, pirtys, vanojimas), švinui pašalinti skirtas kuprenilis (10 dienų su 2 mėnesių pertrauka). Po poros savaičių visi neurologiniai simptomai išnyko, mergaitės savijauta pagerėjo, pradėjo valgyti, ramiai miegoti, dingo vokų tremoras, susireguliavo pusiausvyra, bet plaukai neaugo. Plaukai pradėjo augti tik tuomet, kai bioterpėse atsistatė sunkiųjų metalų kiekis. Šiuo metu vaikas sveikas, peruko nešioti nereikia. Iki subrendimo vaiką būtina stebėti, kontroliuoti sunkiųjų metalų kiekį. Tik atsiradus sunkiųjų metalų kieko padidėjimui, nesulaukus plaukų slinkimo, skiriamas antitoksinis gydymas;

 

  • norėtume aptarti apsinuodijimo sunkiaisiais metalais klinikinius ypatumus ikimokyklinio amžiaus vaikams. Jų pažeidimo simptomų pasireiškia nuo 12–18 mėnesių, atsiradus artimesniam kontaktui su aplinka, pradėjus ropoti, graužti plastmasinius žaislus, kontaktuoti su nešvarumais. Vaikų bioterpėse nustatomi ne tik didelis švino kiekis, bet ir kitų sunkiųjų metalų kiekio padidėjimas (cinko, magnio, chromo, vario) [2]. Žvelgiant kliniškai, dominuoja aktyvumo ir dėmesio sutrikimas, nervingumas, piktumas, kalbos ir socialinių įgūdžių sutrikimai [3], vadinamasis psichomotorinis vystymosi sutrikimas, psichiatrų pavadintas autizmo spektro sutrikimu. Gydymui paskyrus D-metilcisteiną (be mikroelementų), ilgesnį laikotarpį vartojant  gliutamino rūgštį, visais atvejais pasveikstama.

Klinikinis atvejis. Berniukas K. N. gimė ir augo normaliai. Nuo 1,5 metų išsivystė aktyvumo ir dėmesio sutrikimas, piktumas, nervingumas, sutriko kalba ir socialiniai įgūdžiai. Kai berniukui buvo 3 metai, psichoterapeutas diagnozavo autizmo spektro sutrikimą. Po toksikologo konsultacijos, ištyrus paciento šlapimą, rastas švino – 19 μg/l (norma – 0,5 μg/l), cinko – 1 100 μg/l (norma – 400μg/l), vario – 75 μg/l (norma – 8 μg/l). Remiantis tyrimų duomenimis, paskirtas antidotinis gydymas kuprenilio ir gliutamino rūgšties preparatais. Tėvai, nesutikę su diagnoze ir paskirtu gydymu, kreipėsi pagalbos į užsienį. Lenkijoje pacientui nustatytas virškinimo trakto užteršimas, plautas virškinimo traktas. Pablogėjus vaiko būklei, tėvai kreipėsi į Prancūzijos toksikologus. Diagnozė buvo patvirtinta – psichomotorinis vystymosi sutrikimas, sukeltas apsinuodijus sunkiaisiais metalais. Prancūzų medikai paskyrė antidotinį gydymą, kuris pasiūlytas prieš 3 metus Lietuvoje. Vaikas į Lietuvos kliniką sugrįžo būdamas 6 metų. Berniukas buvo stambus, nekontaktiškas, svetimų neatskyrė nuo savų, nekalbėjo, neturėjo socialinių įgūdžių. Atnaujintas gydymas teigiamo efekto nedavė, nes, mūsų nuomone, buvo paskirtas per vėlai.

 

Apibendrinimas

 

  • Gyvsidabris ir švinas yra sunkieji metalai, kurių esama mūsų aplinkos teršaluose.
  • Mažos abiejų metalų dozės kaupiasi bioterpėse, sukeldamos skirtingą lėtinio sunkiųjų metalų apsinuodijimo kliniką.
  • Gyvsidabris, patekęs į organizmą, blokuoja SH, sukelia gilius centrinės nervų sistemos pažeidimus (encefalopoliradikolioneuritą).
  • Švino jonai, patekę į ląstelę, blokuoja gyvybei svarbius metalus ir sukelia gliutationo apykaitos sutrikimus, pasireiškiančius nesunkiais neurotoksikozės reiškiniais (vegetacinės nervų sistemos disfunkciniu sindromu).
  • Ikimokyklinio amžiaus vaikų apsinuodijimai švinu sutrikdo psichomotorinį vystymąsi.
  • švino apsinuodijimo atvejais dominuoja plaukų slinkimas su silpnai išreikštais neurotoksikozės požymiais.
  • Daugeliu atvejų (iki 95 proc.) gyvsidabrio šalinimasis iš organizmo pažeidžia inkstų funkciją. Pasireiškia vadinamasis toksinis inkstas.
  • Švino apsinuodijimo atvejais inkstų funkcijos sutrikimų nebūna.
  • Remiantis skirtinga metalų patogeneze, skiriamas gydymas: apsinuodijus gyvsidabriu, taikomi tiolo grupės preparatai, b) apsinuodijus švinu, skiriamas baltymų ir rūgščių kompleksas D-metilcisteinas (kuprenilis). Visais apsinuodijimo atvejais skiriami gliutamino rūgšties preparatai.

Keywords: Mercury, lead, heavy metals, poisoning, clinical case.

 Summary

Mercury and lead belong to a group of toxic metals that is kept under environmental pollutant category. Their pervasion in the environment and health effects are different. Mercury blocks sulfhydryl (SH), leading the nervous system to paralysis. Lead due to its special characteristics (softness) is more common in nature than mercury. Lead enters cells, blocking life-important metals – zinc and magnesium. It also blocks the glutamic acid, causing different vegetative dysfunctions of nervous system. Treatment varies according to the pathogenesis and clinical manifestations.

 

Marija Ramanauskaitė

Tarandės šeimos klinika

 

Renata Ptašekaitė-Kilšauskienė

Tarandės šeimos klinika

 

Ingrida Tomaševskienė

Lietuvos medicinos biblioteka

Literatūra

  1. Fraser F, Muckle G, Depres C. Relationship between lead exposure, motor function, behaviour in preschool children. Neurotoxycology, teratology. 2006;66-67 (2-3):77-86.
  2. Yasuda H., Yasuda Y., Tsutsui T. Estimation of autistic children by metalloid-mix analysis. Sci Rep. 2013;3:1199,83.
  3. Ramanauskaitė M., Kilšauskienė R. Ikimokyklinio amžiaus vaikų, apsinuodijusių sunkiaisiais metalais, elgsenos, psichomotorinio ir psichoemocinio vystymosi sutrikimas (autizmas). Pediatrija. 2014;66-67(2-3):77-86.
  4. Strumylaitė L., Abdrachmanovas O. Sunkieji metalai ir sveikata. Kardiologijos praktika. 2016;6:20-25.
  5. Sunkiųjų metalų atmosferos iškritose tyrimai pagal EMEP ir ICP IM programas. www.gamta.lt, 2006-11-27.
  6. Sunkiųjų metalų ir policiklinių aromatinių angliavandenilių ore bei atmosferos iškritose tyrimai. www.gamta.lt, 2008-02.
  7. Urbienė, S., Kemežienė G. Gyvsidabris ir jo toksiškumas. www.manoukis.lt 2017-01-11.

Straipsnio paveikslėlius žiūrėkite leidinyje.


127 mintys apie “Gyvsidabrio ir švino druskų jonų paplitimas ir jų sukeltų klinikinių skirtumų ypatumų apžvalga

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