3例中、重度骨髓型急性放射病患者免疫系统功能15年随访观察

A 15-year follow-up observation on immune function in 3 cases of moderate to severe bone marrow form of acute radiation sickness

目的观察骨髓型急性放射病(ARS)患者免疫系统功能的远期效应。方法对河南省1999年钴-60(60Co)源辐射事故的3例中、重度骨髓型ARS患者"梅"、"天"和"旺"进行为期15年的远期效应医学随访观察。随访期间,重点询问和检查患者的临床症状和体征变化,采集周围血进行血常规、免疫球蛋白(Ig)和T淋巴细胞亚群检测。结果 "梅"、"天"和"旺"受照1个月内白细胞、中性粒细胞和淋巴细胞的计数均出现较大波动,均出现不同程度的下降,其后逐渐回升;3例患者分别于受照后4个月、45 d和42 d上述3个指标同时恢复正常水平,直至随访结束。"梅"受照后2和3个月Ig G水平升高,其后曾经恢复正常,但于受照后5、11和13年Ig G水平均升高;其补体(C)3水平在受照后10 d、6个月和2年均轻度下降。"天"于受照后2个月至随访结束时,除受照后2个月和5年Ig G轻度升高外,其余时间点的Ig A、Ig G、lg M和C3水平均正常。"旺"于受照后3个月出现一过性Ig A和lg M水平下降,受照后2个月Ig G升高,其余时间点Ig A、Ig G、lg M和C3水平均正常。3例患者受照后6个月内出现不同程度的联合分化抗原(CD)3+和CD3+CD4+的T细胞百分比下降情况,以"梅"较为明显;直至随访结束时,"天"与"旺"的CD3+和CD3+CD4+的T细胞百分比均已恢复至正常,但"梅"的上述2个指标尚未恢复正常。结论 60Co源电离辐射可导致免疫系统功能损伤,于受照后6个月内免疫功能紊乱明显。

Objective To observe the long-term effect of immune system in patients with bone marrow form aeute radiation sickness （ARS）. Methods Three moderate and severe bone marrow type ARS patients Mei, Tian and Wang were followed up for 15 years after the April 26 ^60Co radiation accident that occurred in Henan in 1999. During the period of the follow-up, the changes of clinical symptoms and signs in these patients were mainly collected. At the same time, peripheral blood samples were also collected for blood routine examination, immunoglobulin （IgG） and T-cell subpopulation test. Results Dramatic decreased cell number of peripheral white blood cell, neutrophil and lymphocytes were observed in all three patients within one month after the irradiation and recovered gradually to normal level at the 4th month, on the 45th day and the 42nd day respectively. Moreover, increased IgG was found in Mei at the 2nd and 3rd month after the irradiation and recovered to normal level in the following time. However, in the 5th, list and 13rd year after the irradiation, IgG levels were also observed higher than normal range while reduced levels of C3 was found on the 10th day, on the 6th month and 2 years after the irradiation accident in Mei. For Tian, there was normal IgG, IgA, IgM and C3 in all the time points in the following-up except increased IgG on the 2nd month and the 5th year. Wang was also found normal levels of IgA, IgG, lgM and C3 in most of the time points except transiently higher IgG on the 2nd month and lower IgA, IgM on the 3rd month. Furthermore, varying degrees of reduced percentage of CD3^＋ and CD3^＋ CD4^＋ T-cells were found in all the patients in 6 months after irradiation, which was more significant in patient Mei. Besides, CD3^＋ and CD3C CD4^＋ T-cells in Mei, but not in Tian and Wang, did not recover to normal level yet until the last day of our follow-up. Conclusion ^60Co irradiation could result in the impairment of immune system, which is most dramatic within the 6th month after irradiation.