1例多种放射性核素体内、体外污染患者长期医学随访及生物标志物的改变

Medical Long-term Follow-up and Biomarkers Change for a Patient with Internal Contamination Combined with Skin Contamination of Several Radioactive Nuclides

目的通过对1例239Pu等7种放射性核素体内、体表污染患者的事故经过、剂量估算、临床处理、医学随访以及生物标志物的改变情况进行分析,为核事故的医学应急救治提供资料和经验。方法采用全身测量装置进行放射性监测,通过INDO 2000软件进行估算剂量;医学处理包括问诊与体检、污染部位皮肤的去污洗消及综合治疗等;医学随访内容包括每年1次在外院及本院医学观察,随访项目包括临床、肿瘤标志物及辐射遗传学指标检测等;生物标志物检测指标包括nm23-H1、gadd45等基因的表达。结果估算出当时该患者的总待积有效当量剂量为0.7Sv,骨表面的待积当量剂量为14 Sv,肝脏待积当量剂量为3 Sv。对该患者进行去污洗消及综合治疗取得了较好的疗效,29年的医学随访观察发现了一些有价值的现象。结论成功地对1例多种放射性核素体内、体表污染患者进行了剂量估算、医学处理、随访观察及生物标志物的检测。

Objectives To introduce a case of accident course and clinical characteristic about internal contamination combined with skin contamination of ^239Pu and other 6 nuclides. The dose estimation, medical treatment and their circumstances follow-up were presented as well. The information and experience in medical emergency first aid for some similar cases was provided.Methods Total body measurement equipment was used to monitor radioactivity and estimating close by INDO 2000 software; Medical treatment included asking and physical examination, decontamination of polluted skins and systemic treatment; The examinations of general items, tumor markers and radiation genetic targets were belong to medical follow-up; the biomarkers was checked,such as nm23-Hl,gadd45.Results The committed effective doses evaluated by INDO 2000 software were 0.7 Sv for the patient. And the committed effective doses of 14 Sv and 3 Sv were for his bone surface and liver separately. Decontamination and systemic treatment are effective methods and there was no obvious abnormity in medical follow-up in near 20 years. Conclusion Dose estimation, medical treatment and following-up for this patient with internal contamination combined with skin contamination by several radioactivity nuclides are successful.