3例中度骨髓型急性放射病患者受照后17年的医学随访观察

Medical follow up of three patients with moderate bone marrow form of acute radiation sickness seventeen years after the accident

目的对3例^60CO源事故照射所致的中度骨髓型急性放射病患者进行17年的医学随访,观察其辐射远期效应。方法按照医学随访计划观察3例患者(分别称为“明”、“军”、“磊”)血液系统、免疫系统、神经系统、生殖系统、眼晶状体和细胞遗传学等随访项目的变化。结果3例患者均有易感冒、性功能障碍和神经衰弱症状主诉。双眼慢性结膜炎,视力下降,眼晶状体点片状浑浊。血常规、肝肾功能和性激素正常。细胞免疫指标CD3、CD4、CD8和CD4/CD8下降。染色体畸变率(双着丝粒体和断片)和微核率随着时间的推移逐年降低。“明”和“军”有肌酸激酶同工酶增高和缺血性心电图改变。“明”受照后第12年患甲状腺癌,“磊”受照后第14年患甲状腺结节。结论本次随访为急性放射病患者的远期效应规律积累了材料,为患者的后期医疗干预提供了客观依据。

Objective This study aimed to observe the late effects of ionizing radiation by medical follow-up(after 17 years) of the three patients(‘Ming',‘Jun',‘Lei') moderate bone marrow form of acute radiation sickness who accidentally were exposed to 60Co. Methods Changes in hematology, immunology, neurology, reproduction, lens, and cytogenetics were measured according to the medical follow-up plan. Results All the three patients had chief complaints of being prone to cold, neurosis, and sexual dysfunction. They also had chronic conjunctivitis, decreased vision, as well as punctate and patchy opacity of ocular lens. The blood routine, liver function, renal function, and sex hormone were normal. The cellular immunity indexes CD3, CD4, CD8, and CD4/CD8 were decreased. The rate of chromosomal aberration(dicentric and fragment) and micronuclear decreased over time.‘Ming' and‘Jun' showed increased creatine kinase isoenzymes and myocardial ischemia, according to the electrocardiogram.‘Ming' had thyroid carcinoma 12 years after irradiation, and ‘Lei' had thyroid nodules 14 years after the accident. Conclusion The medical follow-up study collected data for long-term effects of acute radiation sickness patients and provided information for their late medical intervention.