邓秋琼 王蓓刘华 李颖 王玮璐 吴慧（上海市静安区中心医院神经内科 上海 200040）

降糖保健品致汞砷中毒性周围神经病3例报道

邓秋琼 王蓓*刘华 李颖 王玮璐 吴慧
（上海市静安区中心医院神经内科 上海 200040）

摘 要目的：分析3例汞砷中毒性周围神经病的临床特点，总结重金属中毒周围神经病的诊疗经验。方法：回顾3例口服同一种降糖保健品（汞砷超标）引起中毒性周围神经病患者的临床诊疗情况。结果：3例患者发病前口服摩柯复合片数月，亚急性起病，病情进行性加重，以四肢末梢型感觉和运动障碍为主要表现，神经电生理检查均提示多发性运动和（或）感觉周围神经损害，轴索损害为主。1例呼吸困难者应用激素和丙种球蛋白后疗效差，其他2例应用激素后均有缓解。结论：激素和丙种球蛋白对重金属中毒所致周围神经病的疗效有差异，临床需重视既往药物和保健品的使用史。

关键词汞中毒 砷中毒 周围神经病 轴索损害

Three cases of report on the peripheral neuropathy with mercury and arsenic poisoning from an oral hypoglycemic health product

DENG Qiuqiong, WANG Bei*, LIU Hua, LI Ying, WANG Weilu, WU Hui
(Department of Neurology, Jin’an District Centre Hospital, Shanghai 200040, China )

ABSTRACTObjective: To analyze the clinical feature of three cases of peripheral neuropathy occurred with mercury and arsenic poisoning and summarize the clinic experience of the diagnosis and therapy for peripheral neuropathy with heavy metal poisoning. Methods: Three cases of patients with toxic peripheral neuropathy caused by orally taking a hypoglycemic health product with excessive levels of mercury and arsenic were retrospectively analyzed. Results: Subacute onset occurred in three cases of patients after they have taken the oral hypoglycemic health product for several months and the disease was progressively aggravated, in which limb peripheral-type sensory and motor deficits were as the main performance. Neurophysiological examinations suggested the impairment of multiple motor or sensory peripheral nerve mainly with axonal damage. Among them, one case of patient with respiratory difficulty could not be recovered after immunoglobulin and glucocorticoid therapy and the others were relieved after glucocorticoid therapy. Conclusion: The efficacy of immunoglobulin and glucocorticoid therapy on the peripheral neuropathy with heavy metals (mercury and arsenic) poisoning are varied and great attention should be paid to the history of the use of medicines and health products in patients.

KEY WORDSmercury and arsenic poisoning; peripheral neuropathy; axonal damage

早在20世纪80年代初国外已有学者提出汞可以损害大鼠的周围神经系统[1]。重金属中毒可导致多系统损害，其中，周围神经病变并不少见。2013年我科连续收治3例中毒性周围神经病患者。3人均口服同一种保健品（汞砷超标）。通过回顾性分析其临床特点及诊疗经过，总结重金属中毒周围神经病的诊疗经验。

1 病例资料

1.1 病例A

男性，35岁，个体经营者。主诉：进行性四肢麻木无力，伴言语不清，呼吸困难1月。患者2013年6月下旬无明显诱因开始出现右侧肢体麻木乏力，行走无力，持物困难。……