介入治疗术对先天性心脏病儿童辐射敏感组织影响的随访研究

Follow-up of radiosensitive tissues in children with congenital heart disease treated by interventional operation

目的 了解放射性介入手术对先天性心脏病（CHD）儿童甲状腺、外周血象指标和外周血淋巴细胞染色体畸变等的影响。方法 对70例2010-2013年做过放射性介入手术的CHD儿童（介入组）及23例同期行外科手术的CHD儿童（对照组）进行术后随访。随访项目包括甲状腺彩超、血常规检查和外周血淋巴细胞染色体畸变分析。结果 介入组甲状腺彩超异常率（40.0%）与对照组（43.5%）间差异无统计学意义（P〉0.05），异常以多发囊肿多见，结节少见。介入组白细胞数与对照组间差异无统计学意义（P〉0.05）。未观察到不同疾病类型及手术时间介入组甲状腺结构和白细胞数有差异（P〉0.05）。介入组淋巴细胞染色体型畸变率（0.76±0.07）%明显高于对照组的染色体型畸变率（0.25±0.07）%（Z=-3.631，P 〈 0.05），其中无着丝粒断片（ace）率和易位（t）率也明显高于对照组（Z=-2.531、-2.397，P 〈 0.05）。结论 介入治疗术对CHD儿童甲状腺和血液指标未见明显影响，但对其遗传物质的损伤仍然可见。

Objective To understand effects of the interventional operation on thyroid, peripheral blood indexes and chromosomal aberrations （CA） of peripheral lymphocyte of children with congenital heart disease （CHD）. Methods Follow-up studies were conducted in 70 child patients undergoing cardiac catheterization and 23 with open heart surgery as control from 2010 to 2013. Postoperative follow-up examinations included thyroid ultrasound, blood routine indexes and analyses of CAs. Results Difference in thyroid ultrasound abnormality rate was not statistically significant between children with cardiac catheterization and control group （40.0% vs.43.5%, P〉0.05）. There was no significant difference in white blood cell （WBC） count between interventional group and control group （P〉0.05）. The effects of disease type and operation time on thyroid ultrasound and WBC count were not observed （P〉0.05）. The frequency of chromosome aberrations, including acentric fragment, dicentrics and translocation in interventional group[（0.76±0.07）%], was higher than in control group[（0.25±0.07）%, （Z=-3.631, P 〈 0.05], and the rates of acentric fragment and translocation were also higher in interventional group （Z=-2.531, -2.397, P 〈 0.05）. Conclusions Effect of intervention therapy on thyroid structure and WBC count in children with CHD was not observed, but the genotoxic effects remain in children with cardiac catheterization.