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NEJM：慢性铅中毒的Burton线-病例报道

2018-11-08 xing.T MedSci原创

慢性铅中毒Burton线腹痛便秘
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Burton线是慢性铅中毒的标志，当铅与口腔细菌代谢产物发生反应时就会形成这种标志。然后患者承认有10年的咀嚼鸦片史。对患者的鸦片样本进行分析，发现每1g鸦片中铅浓度为17mg。铅有时可能会添加到鸦片中以增加其重量。

患者为一名39岁的男性，因急性腹痛和便秘加剧4周而到急诊就诊。

腹部体格检查和腹部成像结果，包括超声检查和计算机断层扫描，显示正常。实验室检查显示血红蛋白水平为12.5g/dL（正常范围为14.0-17.5）。上消化道内镜检查和结肠镜检查结果正常。由于胃肠道症状的原因尚不清楚，因此检查了卟啉症相关实验室指标。24小时尿液检测显示δ氨基乙酰丙酸的排泄水平为每天545μmol（正常范围<49），并且血液中的铅水平显著升高至136μg/dl（6.55μmol/L）。



重复体格检查，并注意到沿着下牙龈边缘的灰线（称为Burton线）（如箭头所示）。Burton线是慢性铅中毒的标志，当铅与口腔细菌代谢产物发生反应时就会形成这种标志。然后患者承认有10年的咀嚼鸦片史。对患者的鸦片样本进行分析，发现每1g鸦片中铅浓度为17mg。铅有时可能会添加到鸦片中以增加其重量。

该患者接受了螯合剂治疗，并被告知口腔卫生的重要性；他也停止了咀嚼鸦片。在开始治疗后7个月的随访中，患者的腹痛和便秘已经消退，Burton线明显减轻。

原始出处：

Friederike Helmich,et al. Burton’s Line from Chronic Lead Intoxication.N Engl J Med 2018;https://www.nejm.org/doi/full/10.1056/NEJMicm1801693

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1780481, encodeId=35041e804812d, content=<a href='/topic/show?id=d6f43e9765' target=_blank style='color:#2F92EE;'>#Burton线#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3797, encryptionId=d6f43e9765, topicName=Burton线)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/0EDD6BA8A8C6A0C23E8ABC8BA5331A25/100, createdBy=d37d2500154, createdName=ms5106640509429053, createdTime=Sat Aug 17 23:01:00 CST 2019, time=2019-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=352172, encodeId=f0493521e2f7, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmhead/Q3auHgzwzM6P57Bs8gOPaY1cQP9lIia0lmZOEXraGaoicqNToIslXDKw/0, createdBy=7a041951742, createdName=衣带渐宽, createdTime=Sat Nov 10 14:27:11 CST 2018, time=2018-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319098, encodeId=f5fa131909895, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Fri Nov 09 22:01:00 CST 2018, time=2018-11-09, status=1, ipAttribution=)]
    2019-08-17 ms5106640509429053

    #Burton线#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1780481, encodeId=35041e804812d, content=<a href='/topic/show?id=d6f43e9765' target=_blank style='color:#2F92EE;'>#Burton线#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3797, encryptionId=d6f43e9765, topicName=Burton线)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/0EDD6BA8A8C6A0C23E8ABC8BA5331A25/100, createdBy=d37d2500154, createdName=ms5106640509429053, createdTime=Sat Aug 17 23:01:00 CST 2019, time=2019-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=352172, encodeId=f0493521e2f7, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmhead/Q3auHgzwzM6P57Bs8gOPaY1cQP9lIia0lmZOEXraGaoicqNToIslXDKw/0, createdBy=7a041951742, createdName=衣带渐宽, createdTime=Sat Nov 10 14:27:11 CST 2018, time=2018-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319098, encodeId=f5fa131909895, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Fri Nov 09 22:01:00 CST 2018, time=2018-11-09, status=1, ipAttribution=)]
    2018-11-10 衣带渐宽

    学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1780481, encodeId=35041e804812d, content=<a href='/topic/show?id=d6f43e9765' target=_blank style='color:#2F92EE;'>#Burton线#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3797, encryptionId=d6f43e9765, topicName=Burton线)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/0EDD6BA8A8C6A0C23E8ABC8BA5331A25/100, createdBy=d37d2500154, createdName=ms5106640509429053, createdTime=Sat Aug 17 23:01:00 CST 2019, time=2019-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=352172, encodeId=f0493521e2f7, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmhead/Q3auHgzwzM6P57Bs8gOPaY1cQP9lIia0lmZOEXraGaoicqNToIslXDKw/0, createdBy=7a041951742, createdName=衣带渐宽, createdTime=Sat Nov 10 14:27:11 CST 2018, time=2018-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319098, encodeId=f5fa131909895, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Fri Nov 09 22:01:00 CST 2018, time=2018-11-09, status=1, ipAttribution=)]
    2018-11-09 mashirong

    #中毒#

    0