上海“6.25”^(60)Co源辐射事故中5例重、中度骨髓型急性放射病18个月的随访观察报告

Follow up observation of five cases of severe or moderate degree bone marrow form of acute radiation sickness in ^(60)Co radiation accident in Shanghai.

目的１９９０年发生在上海的“６．２５”６０Ｃｏ源辐射事故所致的骨髓型急性放射病重度２例，中度３例急性期救治获临床治愈，在事故后１８个月进行了随访。方法按照“后效应临床随访研究组”的计划定期系统复查，观察迟发性的远后生物学效应。并进行相关治疗。结果１８个月早期系统随访观察显示：①血象、骨髓象、造血祖细胞培养各种数值仍偏低；②红细胞酶和膜的蛋白组分仍有异常；③免疫功能，尤其是细胞免疫功能仍不全；④染色体检查分析显示以稳定性畸变为主，早期表现的双着丝点加环改变已明显消退，且与病人辐射剂量相关；⑤双眼晶体后囊轻度混浊，眼底视网膜血管扩张；⑥甲皱与球结膜微循环仍显示舒－缩功能紊乱，与血清ＡＴ－１和ＡＴ－２水平未恢复正常相一致；⑦精液检查显示精子数量减少，活率和活力减退与病人辐照剂量相关；⑧部分内分泌功能仍未恢复正常。结论根据上述照后１８个月早期观察结果，说明，虽然这些病人从急性期获得了临床治愈，但他们的组织器官仍然存在潜在迟发性后继损害。因此必须从分子生物学、细胞学和整体观察水平，由多学科联合进行长期观察研究。

Objective\ A^(60)Co radiation accident occurred in Shanghai on June 25,1990.All the five victims including two suffering from severe degree and three from moderate degree of bone marrow form of acute radiation sickness,were clinically cured after the critical stage.They were followed up for 18 months to observe the late effect of radiation.\ Methods\ After discharge on Dec.3,1990,they were subjected to periodical systematic examination and related treatment.\ Results\ The results of the early 18 months systematic periodical survey after the accident were as follows:(1)the values of blood and bone marrow picture,number of hemopoietic progenitors were all decreased;(2)the erythrocytoplasmic enzymes and protein composition of erythrocytic membrane were abnomal;(3)the immunologic function,especially the cellular immunity,was defective;(4)the crystalline lense appeared slightly opaque and retina vessels dilated;(5) on chromosome karyotype analysis most of remaining aberrations were of stable types and offered the major evidence of dose response relationship while the yields of dicentrics plus rings of instable type declined strikingly;(6)the microcirculation of nail fold and bulbar conjunctiva showed distal contractile dysfunction,while the levels of serum AT 1 and AT 2 did not return to nomal:(7) the number of spermatozoa was decreased in the semen,with a dose dependently decreased survival rate and mobility; and (8) some endocrinologic functions did not return tonormal.\ Conclusion\ Based on the above results,it is indicated that although these patients were clinically cured from the critical stage,they should be followed up for long term observation at molecular,cellular and whole body levels by multiple disciplines.The authors suggest a preliminary plan for long term follow up survey to evaluate biological effects of radiation.