造血因子与急性放射病

Hematopoietic growth factors and acute radiation sickness

近十余年来,应用细胞因子来改善辐射造血损伤获得了良好的疗效,积 累了不少经验。然而,细胞因子治疗急性辐射损伤的用药对象、剂量、时机及合理的配 伍应用等问题尚未解决,疗效并非尽善尽美,短效、无效者绝非罕见,甚至出现滥用现 象。本文作者实验治疗研究结果表明,造血因子对急性辐射损伤有明显的治疗作用, 但宜尽早给药,极期给药的疗效不如早期给药好。使用细胞因子治疗的时间应有一个 时限,而不是越长越好。单纯应用rhTPO不能促进粒系造血恢复。单纯应用rhG-CSF不能促进巨核系造血的恢复,未见增加肿瘤细胞染色体畸变率,重复给药和二次 照射的结果未促进造血干/祖细胞库耗竭。rhGM-CSF促进粒细胞恢复的作用不如 rhG-CSF。rhIL-11可促进辐射损伤三系造血的恢复,以巨核系的恢复更为明显。在骨 髓型急性放射病的治疗中联合使用造血细胞因子,rhG-CSF+rhIL-11不失为较理想的 方案,可作为骨髓型急性放射病患者临床治疗的首选药物。

In more than ten years, hematopoietic factors have been approved to be effective in the treatment of radiation sickness. But there are still some problems in the clinical application, such as suitable cases, dosage, administrative timing, and drug combination. Due to those problems, the efficacy was undermined. Our experimental treatment study showed that hematopoietic factors should be administered early after the radiation exposure. The efficacy of early administration group is better than the one treated in acute phase of radiation sickness. There is also a limit of application duration but not the longer the better. RhTPO along can not induce the granulocytopoiesis and rhG-CSF can not improve the recovery of megakaryopoiesis. Hematopoietic factors do not increase the chromosome mutation rate of tumor cells. We did not observe bone marrow stem cell or progenitor cell exhaustion after we treated those animals for a second cycle of hematopoietic factors or exposed those treated animals to radiation again. RhG-CSF is more effective in the recovery of granulocytopoiesis than rhGM-CSF. RhIL-11 can increase the recovery of three cell lines of bone marrow, especially megakaryopoiesis. We recommended the combination of hematopoietic factors in the treatment of acute radiation sickness. RhG-CSF plus rhIL-11 is a preferred combination.