Blood lead can best reflect the actual situation
Regarding the current detection of lead content, Director Sun said that there are generally two kinds of lead detection: hair lead detection and blood lead detection. Hair lead is easily polluted by lead in the external environment, rather than a reflection of lead load in the body. At present, there is no specimen processing method to distinguish which part of lead in hair is endogenous and which part is exogenous. In addition, the lead content in different parts of hair is different, and the lead level in hair is also related to many uncontrollable factors such as gender, skin color and frequent shampoo. Therefore, hair lead can only be used as a reference index, not as a diagnostic index.
On the one hand, the content of lead in blood is ingested from the outside, on the other hand, it is released from bone tissue. Therefore, the blood lead level can only reflect the recent lead exposure. Under the stable low-level lead exposure, blood lead level is an internationally recognized index, and it is also the most practical and irreplaceable index in clinic at present.
Eating kelp, seaweed and black dates can lead to.
Director Sun introduced that blood lead testing is divided into screening and diagnosis. "Screening" is just a standard. It can only check whether a person's blood lead content exceeds the standard, but it can't measure how much blood lead content exceeds the standard, whether it is first-degree poisoning or second-degree poisoning. Therefore, it is irresponsible to prescribe lead-expelling drugs only based on the screening results. Their blood lead detection method is anodic stripping voltammetry, and YY 100 1 intelligent trace element detection analyzer is adopted, which can accurately measure the specific value of a person's blood lead level, and then carry out targeted treatment according to this value.
What should children do with high blood lead? Director Sun suggested that patients with blood lead level 1-3, that is, blood lead is less than 45ug/di, should adopt non-drug lead elimination methods, including washing hands frequently, cleaning frequently and eating less lead-containing food. Secondly, use some health products with the function of removing lead, such as sea cucumber, kelp, laver, black dates, onions, wheat bran, oolong tea, Rosa roxburghii, kiwi fruit and so on. And foods such as dietary fiber also have the function of discharging lead.
Lead-expelling drugs can also expel calcium, iron and zinc.
Don't blindly use drugs to expel lead. This is because lead-expelling drugs have great toxic and side effects, and trace elements such as calcium, iron and zinc will be discharged during treatment, and even hypocalcemia will occur in severe cases, leading to convulsions and even death. Therefore, children's lead poisoning is generally treated with non-drugs. Under normal circumstances, drug treatment is only carried out in the case of occupational poisoning.
Lead poisoning is divided into five grades according to international standards.
Blood lead level
The first level is less than 10(Ug/dI).
Middle school 10~ 19(Ug/dI)
Level 3: 20~44 (μ g/day)
Grade 4, 45 to 69 (μ g /dI)
Grade 5 is higher than 70 (μ g/dyspepsia index)
Prevention of lead poisoning:
You don't need the first drop of tap water in the morning.
● In the air inhaled by children through the lungs, 50% of lead comes from automobile exhaust.
The blood lead level and lead poisoning rate of children increase with the increase of family smoking and the extension of smoking time.
● It is best not to eat the first drop of tap water in the morning or use it for cooking. Although the lead content in tap water is not high, it will accumulate a lot of lead after overnight accumulation. So, get up in the morning and let the tap water run for 3~5 minutes to prevent lead poisoning.
● Eat less foods with high lead content, such as preserved eggs, fried French fries made with bad dyes, popcorn, and spoiled moon cakes (the lead content will exceed the standard in the production process of molding).
● Don't drink wine or drinks that have been placed in lead-containing containers (such as wine glasses, plates, etc.). ) too long. Avoid contact with lead-containing substances (such as paint, batteries, leaded gasoline, colored crayons, etc.). ), stay in busy traffic areas and industrial production areas polluted by lead, wash your hands before meals, don't bite toys and school supplies, and use less cosmetics. /bbs/showthread.asp？ ThreadID = 59&Go to = Next
The following is a special website about this.
/Class/xqjc/
Blood lead test
Instrument: blood lead detector (ESA products imported from the United States, FDA certification).
Principle: anodic stripping voltammetry.
Blood collection method: finger blood collection, no fasting.
Reporting time: about 1 hour.
Venue: 9th Floor, Outpatient Building, Nutrition Center, Pediatric Research Institute.
Inspection fee: 60 yuan/person-time.
Lead poisoning in children
1. What is lead?
Lead is a heavy metal element widely existing in nature. Soft texture, silver gray, low melting point, corrosion resistance. Its compounds can show pink, yellow and other colors. Widely used in battery, power electronics, printing, petrochemical, paint, pigment, plastic, rubber and even food industries. Lead is a kind of toxin to our human body. Once it enters the body, it will have toxic effects on various systems and organs of the whole body. At present, the average annual consumption of lead in all walks of life in developing countries is as high as 500,000 tons. Therefore, if environmental protection is not done well, these lead will pollute our daily living environment and industrial waste gas, waste water, waste residue and other ways, endangering each of us. At present, lead poisoning is one of the important public health problems in developing countries (the lead pollution period in developed countries occurred before 1970s and has passed). Children are a special group of people, who are in the growth and development period, and are more sensitive to lead toxicity than adults, so lead poisoning is more harmful to children, and its toxic damage will affect their lives, so attention should be paid to it. Therefore, many industries are inseparable from lead. It can be said that lead is a necessity in our daily life. It not only brings us benefits, but also pollutes our living environment and harms our health.
2. The occurrence and prevalence of lead poisoning in children.
According to the international standard of lead poisoning, that is, blood lead is greater than or equal to 10 μ g/dl. According to the epidemiological survey of lead poisoning among children in China in 2004, the average incidence of lead poisoning among children in China was about 10%, and the average blood lead was about 6 μg/dl, which was significantly lower than that before 10. Different areas have different incidence rates due to different environmental pollution levels, but the difference is not significant.
At present, the incidence of lead poisoning among children in the United States is 4.4%. In fact, the problem of lead pollution in the United States has also experienced a very serious period. In 1960s and 1970s, the incidence of lead poisoning in children aged 1-5 was 85-97%, which was very high. After the intervention of the government and the health department, leaded gasoline and paint were banned, and the problem of lead poisoning was obviously controlled in the 1990s, down to the current 4.4%.
3. The harm of lead to children and its clinical manifestations.
Once lead enters the body, it first combines with red blood cells and then transfers to bones for deposition. In the body, 80%-90% of lead is stored in bones, and the lead in blood reaches various systems and organs of the body with blood flow, such as brain, liver, kidney and immune organs. , thus causing harm, so its characteristics are varied. For children, the common symptoms are mainly manifested in the nervous system and growth and development: inattention, hyperactivity, poor academic performance or decline. There is a negative correlation between blood lead level and IQ. Every time blood lead level increases 10 μg/dl, IQ decreases by 2-3 points. Some children will show temperament and behavior problems, such as bad temper, irritability, biting fingers, playing truant, playing truant and so on. Some children show that their physical growth and development are affected (not thin) and trace elements such as zinc, calcium and iron are lacking. Some show common cold, low immunity, abdominal pain, leg pain and so on. More serious manifestations, such as renal damage, encephalopathy (coma) and multiple organ failure, are rare in children, mainly in lead-exposed workers.
4. Diagnosis of lead poisoning in children
The diagnosis of lead poisoning in children is to carry out blood lead examination according to some of the above symptoms and manifestations. Generally, blood lead ≥ 10 μg /dl is lead poisoning, regardless of the corresponding clinical manifestations or biochemical changes. This is an international unified standard, which is applicable to both adults and children. Lead poisoning can be divided into the following four levels:
-Mild lead poisoning: blood lead level 10-24.9 μ g/dl. Clinical manifestations include inattention, hyperactivity and lack of trace elements and minerals such as calcium and zinc.
—— Moderate lead poisoning: the blood lead level is 25-44.9 μ g/dl. Clinical manifestations include inattention, hyperactivity, learning difficulties, temper tantrums, decreased IQ, lack of trace elements and minerals such as calcium and zinc, anemia, unexplained abdominal pain, growth retardation, and low immunity.
—— Severe lead poisoning: the blood lead level is 45-69.9 μ g/dl. Clinical manifestations include short temper, irritability, aggressive behavior, headache, mental retardation, abdominal cramps, deficiency of trace elements and minerals such as calcium and zinc, anemia, visual and hearing impairment, hypertension, arrhythmia and so on.
-Extremely severe lead poisoning: blood lead level ≥ 70μ g/dl. Clinical manifestations include liver, kidney, heart and other organ damage, leading to encephalopathy and even death.
If the blood lead level is between 10- 19 μ g/dl, then return to the clinic within 1-3 months; If the blood lead is between 20-44.9 μg/dl, follow-up should be done within 1 considerate 1 month; If the blood lead is above 45 μg/dl, you need to return to the clinic within 48 hours or immediately, and use venous blood.
Usually, parents should pay attention to observe whether their children have some of the above performances, such as inattention, hyperactivity, change of temper and personality, short stature and emaciation. If so, they should take their children for a blood lead test. It should also be said here that some children's blood lead has exceeded the standard, but their performance is often not obvious, or their parents' observation is not enough to find out. Therefore, even if there is no obvious clinical manifestation, children should be tested for blood lead regularly, usually once every six months to once a year.
5. Blood lead is greater than or equal to 10 μg/dl, which is the diagnostic limit of lead poisoning, so is it safe to be lower than 10 μg/dl?
Strictly speaking, the ideal blood lead level should be close to 0 μ g/dl, but in fact, we live in a lead-polluted environment and it is impossible to maintain 0 μ g/dl blood lead. Studies have shown that even if the blood lead is lower than 10 μg/dl, there will be tissue, cell and even gene damage, but the clinical manifestations are only slight. However, studies have shown that the increase of blood lead from 0 μg/dl to 10 μg/dl has a greater impact on children's IQ (IQ drops by 5-6 points) than from 10 μg/dl to 20 μg/dl (IQ drops by 2-3 points). When the blood lead of pregnant women is lower than 10 μg/dl, it can also affect the development of the fetus, and it is easy to miscarry. Therefore, there is no ideal blood lead threshold at present, and it is harmless to the body below this threshold. At present, the average blood lead level of American children is 2.7 μ g/dl. Therefore, it is generally believed that the ideal blood lead level of children should be controlled below 5 μg/dl to minimize the harm.
6. Detection method of lead poisoning
Blood lead test is usually used. Blood lead detection methods can be divided into direct method and indirect method:
Among the direct methods, atomic absorption graphite furnace method and anodic stripping voltammetry are more sensitive and accurate, and anodic stripping voltammetry is the most accurate.
Indirect method is mainly used to determine red blood cell zinc protoporphyrin (ZPP). When the blood lead is high, the erythrocyte zinc protoporphyrin tends to increase, so the blood lead level can be indirectly reflected by measuring zinc protoporphyrin. This method has basically been abandoned because of many influencing factors and inaccuracies.
Besides blood lead, hair lead, urine lead, bone lead and tooth lead can also be measured, but some of these methods are complicated, time-consuming and inaccurate, and cannot be popularized and applied. At present, the recognized test method for diagnosing lead poisoning is blood lead.
7. Causes and high-risk factors of lead poisoning in children
Lead in children mainly comes from polluted air in the living environment, daily contact with lead-containing items and food.
* Polluted air includes the whole atmospheric environment polluted by automobile exhaust and the indoor air environment polluted by home decoration materials. These lead dust floating in the air are ingested into the body through the respiratory tract.
* Children's daily exposure to high lead mainly includes painted toys and school supplies, batteries, newspapers, books and other printed materials. One of the characteristics of children is that their hands and mouth move more or bite these things directly with their mouths, so lead will also enter the body.
* Food and diet are also a way to ingest lead. Foods with high lead content mainly include preserved eggs, vegetables and fruits contaminated by pesticides, canned food, popcorn exploded by old-fashioned iron furnace, puffed food and so on. Some crystal and patterned ceramic tableware often contains lead, which will be released into food after encountering heat and acid. Drinking water pollution is also worthy of attention.
* For infants under 1 year old, there is another source of lead in their bodies, that is, the mother, which is mainly transmitted to the fetus and infants through the placenta during pregnancy and the milk of the lactating mother after birth.
Therefore, if we pay attention to and prevent these links, we can reduce lead intake and effectively avoid lead poisoning.
8. Treatment of lead poisoning in children
The treatment plan of lead poisoning in children should be based on blood lead level, and different treatment measures should be taken according to different levels.
The basic principles of treating lead poisoning in children are: prevention first, nutrition intervention. No matter what degree of lead poisoning, we should first carry out health education, improve the environment, wash our hands frequently, avoid eating food with high lead content and have a balanced diet.
Mild and moderate lead poisoning: health education and environmental intervention are the main measures to avoid lead pollution by washing hands frequently; At the same time, nutritional intervention treatment was carried out, and minerals, trace elements and vitamins such as calcium and zinc were supplemented when necessary. Review regularly.
Severe and extremely severe lead poisoning: dimercaprol (BAL), disodium calcium edetate (CaNa2EDTA) and dimercaptosuccinic acid (DMSA) should be used to expel lead. Pay attention to the side effects of these drugs, which are harmful to heart, liver, kidney and other organs, and also cause disorders of minerals, trace elements and water electrolytes. Therefore, when using these drugs, you must be hospitalized, monitor the changes of liver, renal function, electrocardiogram, water electrolyte and trace elements, pay attention to protecting the functions of liver, kidney and heart, correct the disorder of water electrolyte in time, and supplement minerals and trace elements such as calcium, zinc and iron.
9. Diet and nutrition intervention treatment of lead poisoning in children.
(1) health food and nutrition drugs.
Professional and targeted health food for removing lead only appeared in recent years. Its main components are amino acids, vitamins, minerals, trace elements, pectin and cellulose extracted from food or wild plants. Lead can be discharged by preventing intestinal absorption of lead, replacing lead in tissues and resisting oxidation. Zinc, calcium, iron and other minerals and trace elements, like lead, are divalent cations, which are mutually antagonistic and inhibitory in absorption and function. Lead poisoning is often accompanied by the lack of these elements, so some trace element preparations can also be used as lead-expelling therapy.
Note: At present, there is no scientific basis for TCM treatment, so please use it with caution.
② How to treat lead poisoning with diet?
The purpose of dietotherapy is to get rid of lead by regulating the intake of nutrients such as fat, protein, minerals and vitamins. The increase of fat intake can promote the absorption of lead; Protein can combine with lead to replace lead in tissues and reduce the toxic effect of lead. Vitamins C, E and B can resist the oxidative damage of lead. Cellulose and pectin can combine with lead to form gel in the intestine and inhibit absorption; However, minerals such as zinc and calcium can antagonize and replace lead during and after intestinal absorption, thus inhibiting the absorption and toxicity of lead.
Therefore, for children with lead poisoning, we must first achieve a balanced diet. Eat less fatty, fried and greasy foods, and increase the intake of protein and vitamins appropriately. Eat foods rich in protein (such as milk, bean products, fish, lean meat, beef, etc.). ), fresh vegetables and fruits, hard-shell nuts (walnuts, peanuts, pistachios, etc.). ), and black fungus. But it should be noted that vegetables and fruits should be washed and peeled, because pesticides often contain lead. At the same time, drink plenty of water to promote lead excretion.
Prevention of lead poisoning.
Lead poisoning in children is completely preventable, which can be prevented from two levels, namely, primary prevention and secondary prevention.
The primary prevention is mainly to carry out health education, develop good hygiene habits, wash hands frequently, avoid contact with articles with high lead content, avoid eating foods with high lead content, and at the same time, eat a balanced diet every day, as mentioned above. If parents are engaged in lead-related industries, they should take a bath after work, put on work clothes and go home to avoid taking lead home. In addition, home decoration should also pay attention to avoid using paint, pigments and other materials with high lead content. More importantly, the whole society should strengthen environmental awareness to keep our living environment clean.
Secondary prevention is mainly to give children blood lead tests regularly, which can be included in routine physical examination. This is conducive to the early detection and treatment of lead poisoning and reduce the damage to health.
In addition, for couples who are going to have children, blood lead should be measured before pregnancy, and both husband and wife should do it, because if the father's lead is high, the sperm quality will be affected; If the lead content in the mother's body is high, lead can be passed to the fetus through the placenta during pregnancy, or passed to the baby through the milk after birth, which leads to an increase in the blood lead of the baby. Therefore, blood lead should be tested before pregnancy. If the blood lead is high, wait until it comes down. Don't use cosmetics and hair dye.
In view of the high incidence of lead poisoning in children, parents should pay attention to it, but don't panic. If we develop good hygiene habits in our daily life, wash our hands frequently, improve the environment, avoid eating foods with high lead content and eat a balanced diet every day, then we can avoid or reduce the occurrence of lead poisoning. Of course, the most fundamental way to prevent lead poisoning is environmental protection, production and use of green products, which requires the participation of many departments, the formulation of relevant laws and regulations, and the joint efforts of everyone.
Beijing Children's Hospital Lead Poisoning Prevention Center
Beijing Children's Hospital Pediatric Institute Nutrition Center
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