山东“10·21”辐射事故2例放射病患者肾功能的变化

Studies on renal function injured by an accidental ^(60)Co irradiation in Shandong province

目的研究山东济宁辐射事故2例放射病患者血清中反映肾功能损伤程度的血清尿素氮(BUN)、肌酐(Cre)、β2-微球蛋白(β2-MG)和尿酸(UA)浓度的变化情况,以评估2例放射病患者肾功能损伤的情况。方法血清BUN采用尿素酶法,血清肌酐浓度和UA采用酶促反应动力学方法,β2-微球蛋白采用免疫比浊法。结果辐射事故后,2例受照者(病例A受照剂量在20～25Gy,病例B受照剂量在9～15Gy)照后血清BUN浓度都有不同程度的升高,而且有逐渐升高的趋势。受照剂量愈大,血清BUN浓度升高愈早。与血清BUN的升高类似,2例受照者的血清Cre浓度也有逐渐升高的趋势。受照剂量愈大,血清Cre浓度升高幅度愈大,升高时间愈早。与正常参考值比较,辐射事故后2例受照者的血清尿酸浓度都在正常范围,但在此范围内都有几个增高期;血清β2-MG浓度呈逐渐升高的趋势,受照剂量愈大,浓度升高愈早。结论射线直接作用于肾脏,可直接造成肾脏组织细胞的放射性损伤;射线作用于人体的其他组织器官,也可引起机体大量的组织细胞变性坏死,毒物和变性坏死细胞的分解产物大量增加,加重了肾脏的负担,使肾功能严重受损。

Objective To study the radiation effects on the serum concentration of urea nitrogen （BUN）, creatinine （Cre）, β2- microglobulin （β2-MG） and uric add （UA）, and to evaluate the injuries to renal function induced by a ^60Co irradiation accident in Shandong province. Methods The concentrations of urea nitrogen, serum creatinine and serum uric acid were determined by enzymatic methods. The concentrations of serum β2-microglobulin were determined by the immunoturbidity methods using HITACHI 7170s automatic biochemical analyzer. Results The serum concentrations of BUN and Cre of 2 patients increased significantly after irradiation, and the serum concentration of UA in the two cases elevated too after irradiation, but didn＇t reach the normal value. The serum concentrations of β2- microglobulin also increased significantly after irradiation. In case A which received 20- 25Gy irradiation, the concentrations of serum BUN, creatinine and β2-microglobulin increased to 41. 63mmol/L, 364μmol/L and 9. 2mg/L, respectively. In case B which received 9- 15Gy irradiation, the concentration of serum BUN, creatinine and β2-cmicmglobulin increased to 52. 2mmol/L, 199μmol/L and 11.3mg/L, respectively. There seemed a dosage-dependent effect on the BUN, Cre and β2-micmglobulin concentration. Conclusion ^60Co may irradiate the tissues of kidney directly, and irradiate the cells of other tissues and organs, lead to necrosis and degenerations accordingly on the tissues of kidneys and other organs. In the process of necrosis and degenerations, a large amount of metabolic products was released which is poisonous to the kidney. The present results showed the concentrations increased of all the four renal serum markers mentioned above. It is supposed that the renal cells might be damaged by the Cobalt γ ray irradiation.