电离辐射对心脏介入患者淋巴细胞DNA损伤的影响

DNA damage in lymphocytes of patients induced by ionizing radiation in cardiac intervention

目的探讨心脏介入中的电离辐射对患者外周血淋巴细胞DNA损伤的影响。方法依据介入术式的不同将100例行心脏介入诊疗的患者分为4组:经皮冠脉介入术(PCI)组35例,经皮冠脉造影术(CAG)组31例,射频消融术(RFCA)组20例以及永久性心脏起搏器植入术(PCPI)组14例;另选取有介入手术指征但拒绝手术的40例患者作为空白对照组。分别于术前、术后2 h、术后24 h采集患者外周静脉血,应用单细胞凝胶电泳和微核实验检测尾部DNA含量(TDNA%)、尾矩(TM)和染色体微核率。记录术中患者的辐射剂量指标:面积剂量乘积(DAP)、累积皮肤表面入射剂量(CD),评估电离辐射对各组患者DNA损伤的影响。结果PCI组患者术中的DAP、CD值以及术后24 h的TDNA%、TM值均显著高于其他3组(P<0.01);各组患者术后24 h的TDNA%、TM值与DAP、CD值均呈显著正相关(P<0.01);各组患者术后2 h及24 h的微核率均较术前显著升高(P<0.05)。结论不同的介入术式,术中的电离辐射均会造成患者DNA的损伤,辐射剂量越大,DNA损伤越严重。应改善患者的防护措施,避免辐射随机性效应的发生。

Objective To explore in cardiac intervention. Methods the DNA damage in peripheral blood lymphocytes induced by ionizing radiation 100 patients types of cardiac intervention：PCI（ percutaneous with cardiac disease were divided into 4 groups according to the coronary intervention ,35 cases） , CAG（ percutaneous coronary angiography,31 cases）, RFCA （radiofrequency catheter ablation, 20 cases）, and PCPI （permanent cardiac pacemaker implantation, 14 cases） ;in addition,40 patients who had interventional indications but refused interventional operation were selected as blank control. The peripheral blood was collected before and 2 h and 24 h after interventional operation, then mieronucleus frequency of lymphoeytes were detected by mieronueleus test, TDNA% and TM values were detected by single cell gel electrophoresis （SCGE）. The cumulative skin entrance dose （CD） and the dose -ar- ea product（DAP） were also recorded. DNA damage was evaluated among these groups. Results DAP and CD values of PCI were significantly higher than the other three groups （P 〈 0. 01 ） ;TDNA% and TM values of PCI were also significantly higher than the other three groups（P 〈 0. 01 ） ;there were significantly positive correlations between TDNA% , TM, DAP and C D values after operation （P 〈 0.01 ） ; mieronucleus frequency after operation in each group was significantly higher than before （ P 〈 0. 05 ）. Conclusion Ionizing radiation in different types of intervention can definitely induce DNA damage. The higher radiation dose is, the more DNA damage is. So we should improve protective measures for patients to avoid the stochastic effects of radiation.