摘要
目的
探讨亚急性正己烷中毒引起的周围神经病的临床特征、诊断和及治疗。
创新点
亚急性正己烷中毒主要表现为多发性周围神经病,其特点为隐匿性、潜伏期较长、易造成误诊。根据我们一系列病例分析,我们建议医生在遇到有运动和感觉功能障碍临床表现的患者时,除了考虑神经系统疾病外,还应考虑正己烷中毒的可能性。此外,病人的职业也是正确诊断不可忽视的信息。
方法
回顾分析职业性亚急性正己烷中毒患者八例,大多表现为行动无力和四肢麻木。所有患者都曾在当地医院接受过治疗,而误诊率高达87.5%(7/8)。因正己烷无特殊解毒剂,通过皮质激素、神经营养药物等支持性治疗,以及康复训练和针灸治疗后,患者大多预后良好,神经电生理有所改善。
结论
正己烷中毒可引起周围神经受损症状,患者电生理表现明显异常,经积极治疗后,其临床预后良好。
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References
DeCaprio AP, Kinney EA, LoPachin RM, 2009. Comparative covalent protein binding of 2,5-hexanedione and 3-acetyl-2,5-hexanedione in the rat. J Toxicol Environ Health A, 72(14):861–869. https://doi.org/10.1080/15287390902959508
Feng MX, Li YN, Ruan WS, et al., 2018. Predictive value of the maximum serum creatinine value and growth rate in acute paraquat poisoning patients. Sci Rep, 8:11587. https://doi.org/10.1038/s41598-018-29800-0
Jiang JK, Fang W, Gu LH, et al., 2016. Early changes of peripheral blood lymphocyte subpopulations in patients with occupational 2,4-dinitrophenol poisoning. Biomed Environ Sci, 29(12):909–914. https://doi.org/10.3967/bes2016.122
LoPachin RM, DeCaprio AP, 2004. γ-Diketone neuropathy: axon atrophy and the role of cytoskeletal protein adduction. Toxicol Appl Pharmacol, 199(1):20–34. https://doi.org/10.1016/j.taap.2004.03.008
LoPachin RM, Ross JF, Reid ML, et al., 2002. Neurological evaluation of toxic axonopathies in rats: acrylamide and 2,5-hexanedione. Neurotoxicology, 23(1):95–110. https://doi.org/10.1016/s0161-813x(02)00003-7
LoPachin RM, Jortner BS, Reid ML, et al., 2003. γ-Diketone central neuropathy: quantitative morphometric analysis of axons in rat spinal cord white matter regions and nerve roots. Toxicol Appl Pharmacol, 193(1):29–46. https://doi.org/10.1016/j.taap.2003.07.005
Lu YQ, 2018. HIV and paraquat poisoning: fighting fire with fire?. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 19(2): 168–170. https://doi.org/10.1631/jzus.b1700567
Opanashuk LA, He DK, Lehning EJ, et al., 2001. γ-Diketone peripheral neuropathy: III. Neurofilament gene expression. Neuro Toxicology, 22(2):215–220. https://doi.org/10.1016/s0161-813x(00)00011-5
Pan JH, Peng CY, Lo CT, et al., 2017. n-Hexane intoxication in a Chinese medicine pharmaceutical plant: a case report. J Med Case Rep, 11:120. https://doi.org/10.1186/s13256-017-1280-9
Pannangrong W, Sirichoat A, Wongsiri T, et al., 2019. Valproic acid withdrawal ameliorates impairments of hippocampalspatial working memory and neurogenesis. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 20(3):253–263. https://doi.org/10.1631/jzus.B1800340
Pastore C, Izura V, Marhuenda D, et al., 2002. Partial conduction blocks in n-hexane neuropathy. Muscle Nerve, 26(1):132–135. https://doi.org/10.1002/mus.10183
Prieto MJ, Marhuenda D, Roel J, et al., 2003. Free and total 2,5-hexanedione in biological monitoring of workers exposed to n-hexane in the shoe industry. Toxicol Lett, 145(3): 249–260. https://doi.org/10.1016/s0378-4274(03)00302-3
Public Health England, 2016. n-Hexane incident management. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/566787/n-hexane_incident_management.pdf [Accessed on Nov. 25, 2020].
Sendur OF, Turan Y, Bal S, et al., 2009. Toxic neuropathy due to n-hexane: report of three cases. Inhal Toxicol, 21(3): 210–214. https://doi.org/10.1080/08958370802311169
Wang C, Chen SJ, Wang ZT, 2014. Electrophysiological follow-up of patients with chronic peripheral neuropathy induced by occupational intoxication with n-hexane. Cell Biochem Biophys, 70(1):579–585. https://doi.org/10.1007/s12013-014-9959-7
Wang HR, Pan J, Shang AD, et al., 2017. Time-dependent haemoperfusion after acute paraquat poisoning. Sci Rep, 7:2239. https://doi.org/10.1038/s41598-017-02527-0
Xia LH, Yan YJ, 2018. Interpretation of clinic pathway for occupational chronic n-hexane poisoning. J Chin Res Hosp, 5(4):66–71 (in Chinese). https://doi.org/10.19450/jxnki.jcrh.2018.04.012
Xu YG, Lu YQ, 2019. Systematic review and meta-analysis of the efficacy and safety of immunosuppressive pulse therapy in the treatment of paraquat poisoning. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 20(7):588–597. https://doi.org/10.1631/jzus.B1800640
Acknowledgments
This research was supported by the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine (No. 2017-XK-A36), China.
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Xiaping ZHANG performed the research and data analysis, and wrote and edited the manuscript. Yaling TONG performed data analysis. Yuanqiang LU contributed to the study design, data analysis, and writing and editing of the manuscript. All authors have read and approved the final manuscript and, therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Xiaping ZHANG, Yaling TONG, and Yuanqiang LU declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
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Zhang, X., Tong, Y. & Lu, Y. Peripheral nerve injury in patients exposed to n-hexane: an analysis of eight cases. J. Zhejiang Univ. Sci. B 22, 248–252 (2021). https://doi.org/10.1631/jzus.B2000601
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DOI: https://doi.org/10.1631/jzus.B2000601