全身(全淋巴)照射后100例医源性急性放射病的临床分析

Clinical analysis of patients with acute radiation syndrome due to total body irradiation or total lymphatic irradiation

在造血干细胞移植治疗肿瘤过程中用全身照射（ＴＢＩ）或全淋巴照射（ＴＬＩ）预处理，研究受照不同剂量患者发生医源性急性放射病严重程度，治疗方法和造血恢复及相关合并症。方法１００例患者（白血病９１例，其他肿瘤９例）接受５００～１０００ｃＧｙＴＢＩ或ＴＬＩ和超大剂量化疗作预处理。结果均发生医源性急性放射病，白细胞降至（０～０．１５）×１０９／Ｌ，骨髓空虚，合并各种感染和出血。经造血干细胞移植，抗感染，应用ＧＭ－ＣＳＦ或Ｇ－ＣＳＦ积极支持治疗及保护隔离措施，９２例造血恢复，８例死于不同感染和出血。结论造血干细胞的移植起主要治疗作用，不同造血因子用于治疗急性放射病。

Objective To study the severity of iatrogenic acute radiation syndrome, treatment,hematopoietic recovery and related complications in patients subjected to total body irradiation (TBI) or total lymphatic irradiation (TLI) prior to hematopoietic stem cell transplantation. Methods 100 tumor patients (91 with leukemia and 9 with other tumors),after receiving 500～1000cGy (in an average of 738 6cGy) of TBI or TLI with super high dose chemotherapy as conditioning regimen during the process of hemopoietic stem cell transplantation,developed severe or even extremely severe,mainly bone marrow form acute radiation syndrome. Results The patients' white blood cell count once dropped to (0～0 15)×10 9/L,platelet count fell to (1～17)×10 9/L,bone marrow was depleted with only a few non hemopoietic cells and rare hemopoietic cells,and a high risk of complicating with infection and hemorrage was observed.Treated with a variety of measures including protective isolation,supportive care,administration of growth factors such as GM CSF or G CSF,blood component transfusion and effective antibiotics, 92 cases restored their normal hemopoiesis,while 8 cases died of infection or hemorrage.The clinical course of these patients indicated that a majority of the patients with severe and extremetly severe,iatrogenic acute radiation syndrome involving bone marrow could restore their normal hemopoiesis,and hemopoietic stem cell transplantation played an important role in the treatment. Conclusion Hemopoietic stem cell transplantation and administration of growth factors are very useful for the treatment of acute radiation syndrome.