放疗局部照射中全身凝血功能与白细胞减少的关系

A Study of the Relation between Systemic Blood Coagulation and Leukopenia in Local Irradiation

目的观察放疗局部照射下全身凝血功能的变化,并探讨华法令干预缓解白细胞减少的效果。方法新西兰白兔分为阴性对照组、单纯照射组、照射+抗凝组。照射前、照射后24 h检测凝血酶原时间、PT国际标准化比值、外周血白细胞计数。单纯照射组仅接受一次全胸部照射,总剂量20 Gy。照射+抗凝组照射前喂服抗凝血药华法令。照射后24 h处死动物,采取左胸第十肋骨骨髓代表照射靶区内骨髓,第三腰椎左侧横突骨髓代表靶区外骨髓,行骨髓像观察。结果单纯照射组照射前后凝血功能无明显变化,白细胞明显减少。照射+抗凝组照射前后凝血功能均被阻断,白细胞明显减少。2组动物照射靶区内骨髓有核细胞明显减少,靶区外骨髓有核细胞计数正常。结论造成白细胞减少的局部照射剂量不能够改变全身的凝血状态;完全阻断凝血所消耗的白细胞减少也不能阻断局部照射造成的白细胞减少。

Objective To observe systemic blood coagulation changes in local irradiation, and to study the influence of warfarin on leukocypenia. Methods New Zealand white rabbits were divided into negative control group, radiation group,irradia- tion ＋ anticoagulant group. Before irradiation and 24 hours after irradiation, prothrombin time, PT international normalized ratio and WBC count were detected. The radiation group only accepted a full chest irradiation of 20 Gy. In the irradiation ＋ anticoagu- lant group, rabbits was fed with the anti-clotting drug warfarin before irradiation. The animals were sacrificed in 24 hours after irra- diation, bone marrow of the tenth rib of left chest represented irradiation target region bone marrow, and the third lumbar transverse process bone marro~ ,~t,~ented target line bone marrow,and the bone marrow was examined. Results Coagulation function be- fore and after the irradiation of the radiation group had no significant change, white blood cells was significantly reduced. Irradia- tion ＋ anticoagulant group before and after irradiation coagulation were blocked, white blood cells was significantly reduced. Nu- cleated cells bone marrow of the two irradiated target area were significantly reduced, and bone marrow nucleated cells count of target line was normal. Conclusion The systemic blood coagulation is not influenced by local irradiation;and Leukopenia caused by complete clotting consumption can not block the decrease of white blood cells caused by local irradiation.