摘要
儿童高血压多为继发性高血压,病因包括肾实质疾病、肾血管狭窄、嗜铬细胞瘤等,其中,汞中毒是导致高血压的少见原因之一。本文报告一例以严重高血压、高血压脑病与红斑肢痛为主要临床表现的汞中毒,以提高对汞中毒的认识。患儿为10岁5个月女孩,因反复皮疹2个月,抽搐伴发作性意识障碍一个半月入院。体检：血压170/120mmHg（1mmHg=0.133kPa）,患儿表情痛苦,双手红肿疼痛,需要冰袋持续冷敷。生化检查发现持续低钾血症（血钾为2.83～3.25mmol/L,参考值为3.5～5.5mmol/L）,血肾素、血管紧张素与醛固酮水平均显著升高。头颅核磁共振成像（MRI）显示双侧额、顶、颞、枕叶皮层下flair像异常高信号。尿汞水平显著升高,尿汞0.171mg/L（参考值〈0.01mg/L）。给予二巯基丙醇磺酸钠125mg肌肉注射1次后,复查尿汞升高至1.408mg/L。追问病史,患儿病前有多次双手玩耍水银史,班级内有多位同学因玩水银发病。因此,对于表现为严重高血压伴红斑肢痛的患者,应警惕汞中毒。
Mercury intoxication is a rare cause of severe hypertension. A case of mercury intoxication presented with severe hypertension and erythromelalgia was reported. A 10-year-and-5-month-old girl presented with recurrent rash and painful hands for 2 months, with seizure attack and episodic loss of consciousness for one hand half months. The girl was found to have red painful hands, a blood pressure 170/120 mm Hg（1 mm Hg=0.133 kPa）, tachycardia and hypokalemia （2.83-3.25 mmol/L, reference value 3.5-5.5 mmol/L）. An extensive investigation ensued. Elevated renin-angiotensin and aldosterone were demonstrated in plasma. Cranial MRI T2 weighed images showed widespread white matter signal abnormalities, which particularly involved parietal, occipital and frontal lobes. With hypertension controlled, white matter signal abnormalities weakened. Other symptoms included insomnia, nausea and paroxysmal abdominal pain. The girl was found to have a raised concentration of mercury in urine （0.171 mg/L, reference value 〈0.01 mg/L）, and she had been exposed to elemental mercury for several days. After chelating therapy, the girl’s blood pressure returned to normal, erythromelalgia ameliorated, all other symptoms disappeared. So, mercury intoxication should be considered in the differential diagnosis of hypertension with erythromelalgia.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2007年第4期377-380,共4页
Journal of Peking University:Health Sciences
关键词
汞中毒
高血压
红斑性肢痛病
Mercury poisoning
Hypertension
Erythromelalgia
