山东“10·21”辐射事故2例急性放射病患者超敏C-反应蛋白的测定及临床意义

Detection and clinical significance of serum high-sensitivity C-reactive protein in two patients diagnosed as acute radiation sickness

目的观察血清超敏-C反应蛋白(hs-CRP)在急性放射病患者中的的变化及其临床意义。方法2例病人分别被诊断为极重度急性骨髓性放射病(病例B)和肠型急性放射病(病例A)。hs-CRP采用比浊法全自动定量测定。结果hs-CRP升高贯穿于2例患者疾病的全过程,患者出现严重细菌感染时hs-CRP均快速、大幅度升高升高,但当有效治疗后sCRP会快速下降。病例A共有3个hs-CRP高峰期,其hs-CRP最高升至188.8mg/L。病例B有4个hs-CRP高峰期,hs-CRP最高达377.2mg/L。此外,病人合并脏器功能损伤和严重的皮肤组织损伤时hs-CRP也会轻度升高,但幅度较小较轻。结论hs-CRP对判断急性放射病患者合并细菌感染及判断其感染轻重和治疗效果有重要意义,感染越重sCRP升高越明显,但放射损伤等也会有hs-CRP轻度升高。

Objective To observe the changes of serum high-sensitivity C-reactive protein （hs-CRP） in 2 patients diagnosed as acute radiation sickness, and to evaluate its clinical significance. Methods Two victims from Shandong province, China were accidentally received a ^60Co irradiation from a dropped ^60Co source in 2004. They were exposed to more than 20Gy （patient A） and 9Gy （patient B） of X-ray irradiation respectively. The patient A was diagnosed as extremely severe bone marrow form of acute radiation sickness （ARS）, and patient B was diagnosed as having developed intestinal form of ARS. The two patients successfully got HLA-haploidentical （patient A） and HLA-identical （patient B） peripheral blood stem cell transplantation, and their hematopoiesis recovered, but they cached serious bacterial irffection in whole clinical course. Hs-CRP was quantitatively detected by automatically immunoturbidimetric assay. Result The serum level of hs-CRP in the two patients elevated quickly when they suffered from serious bacterial infection, and declined markedly when the irffection was controlled effectively. The serum level of hs-CRP also increased slightly when the patients suffered from severe damage on organs or skin function. There existed 3 peak values of hs-CRP level in patient A when kept in the hospital, with a highest value of 188. 8mg/L; there existed 4 peak values of hs-CRP level in patient B when kept in the hospital, with the highest value of 377. 2mg/L. Conclusion The present results suggested that hs-CRP may be a good indicator to acute radiation sickness complicated with serious bacterial infection, for the hs-CRP levels may fluctuate following the bacterial infection and effectively controlling.