南京“5．7”^192Ir源放射事故患者造血系统的改变

Changes in hematopoietic system of the patient exposed to ＂5.7＂ ^192Ir source accident in Nanjing

目的 通过对南京192Ir源放射事故中患者的血液系统进行观察研究,探讨造血系统损伤规律,为核与辐射事故医学应急的救治和随访提供临床资料和积累经验。方法 应用血细胞分析仪动态观察患者的白细胞计数、淋巴细胞计数、血小板计数及血红蛋白值的变化,取其双侧髂骨骨髓涂片观察骨髓象的改变,采用PCR-以测序为基础的分型技术（PCR-SBT）方法检测融合基因突变情况;分别采用流式细胞术和放射免疫分析法测定T淋巴细胞亚群百分率和血清免疫球蛋白（IgA、IgG、IgM）、补体（C3、C4）含量,评价细胞免疫和体液免疫功能。结果 患者骨髓造血轻度障碍,予以粒细胞集落刺激因子（G-CSF）治疗后,短时间内恢复正常,受照后约40 d进入恢复期;受照侧骨髓增生低下;融合基因检测未检测到突变;局部感染导致淋巴细胞计数及免疫功能下降。结论 轻度骨髓型急性放射病造血系统损伤较小,病程分期不明显,造血功能恢复较快,尚未造成免疫抑制,但局部感染可导致免疫功能下降。临床医生需注意全身治疗与局部治疗的统一。

Objective To observe and study the hematopoietic system injury to the patient exposed to 192Ir accident in Nanjing, in order to provide information and gain experience for medical treatments in nuclear and radiation accident emergencies.Methods Levels of white blood cell counts, lymphocyte counts, platelet counts and hemoglobin were determined by using blood cell analyzer. Bone marrow cells collected from bilateral iliac bone were used to access the changes in hematological system by bone marrow smear. Fusion gene or gene mutation caused by radiation were valuated by performing PCR-sequence-based typing（PCR-SBT）. While blood T cells were analyzed by flow cytometry, immunoglobulin isotypes（IgA, IgG, IgM） and complement（C3, C4） levels in serum were measured by radioimmunoassay, in order to evaluate cellular and humoral immune function. Results The patient＇s marrow hematopoietic function showed mild disorder, and returned to normal after short-time treatment with G-CSF. The patient went into recovery phase about 40 days after exposure. The fusion genes were not detected in the mutant. Local infection resulted in the decline in lymphocyte counts and immune function. Conclusions Mild bone marrow form of acute radiation sickness induced light injury of hematopoietic system. The course stage was not apparent and hematopoietic function recovered soon. Immune suppression hadn＇t been caused. However, local infection can lead to the decrease of immune function. These results indicate that combined systemic and local treatment is crucial and essential to the patients after mild radiation.