河南"4.26"^60Co源辐射事故受照者照后20年医学随访

The 20-year follow-up of five victims externally exposed in"4.26"60Co radiation accident in Henan province

目的通过对1999年河南省"4.26"60Co源辐射事故受照者照后20年医学随访观察,探讨电离辐射远后效应,为放射医学研究提供实证资料。方法收集5名受照者的临床症状、体征、眼科检查及患病史;实验室检查包括常规检查项目、体液免疫和T淋巴细胞亚群指标、甲状腺功能、生殖激素水平、肿瘤标志物、辐射遗传学指标等;器械检查包括腹部彩超、甲状腺彩超、心脏彩超、颈动脉彩超、生殖系统彩超、心电图、胸部CT等。结果"梅"照后2~3年出现放射性白内障早期典型的形态特点,照后13年行左眼白内障摘除人工晶状体植入手术治疗,此次随访右眼视力眼前指数/10 cm,后囊下较厚,近似锅巴样浑浊,2019年11月行右眼白内障摘除人工晶状体植入术。"旺"、"天"、"民"、"义"均出现双眼后囊下或赤道部不同程度浑浊;"梅"照后7年至今心电图均提示心肌缺血改变,"天"照后12年确诊"冠心病",照后20年行"冠状动脉造影心脏支架植入手术",5名受照者均出现血清总胆固醇和(或)甘油三脂增高,4名受照者出现双侧(或单侧)颈总动脉粥样斑块形成;"梅"受照后11年至今促甲状腺素(TSH)水平持续偏高,"义"甲状腺球蛋白抗体(TGA)、甲状腺微粒体抗体(TMA)明显增高,甲状腺实质回声不均,"梅"、"民"照后15年发现甲状腺结节;"天"照后13年确诊为"弥漫性大B细胞非霍奇金淋巴瘤",化疗后目前病情缓解;肿瘤标志物检测"天"、"民"、"义"神经元特异性烯醇化酶(NSE)均稍偏高,"天"胸部CT提示右肺中叶小结节;5名受照者外周血淋巴细胞染色体畸变分析以易位(t)改变为主(t率≥0.5%),"旺"、"天"可见少量双着丝粒体(dic)或无着丝粒断片(ace)。结论电离辐射照射可导致受照者眼晶状体、甲状腺、心血管循环系统等不同程度的确定性效应及发生肿瘤等随机性效应,遗传损伤可长期存在于受照者体内。

Objective To investigate the late effects induced by external ionizing radiation through long-term follow-up of the victims exposed to 60Co radiation source at"4.26"accident in Henan in 1999,and to provide valuable experience in the radiological medicine.Methods Medical observations of the clinical symptoms,signs,eye lens examination and previous medical history of the five exposed victims were performed and recorded.The changes of the laboratory routine examinations,immune function,thyroid function,reproductive hormone levels,tumor markers,radiation genetic indicators as well as ultrasound examination of thyroid,cardiac,reproductive system,electrocardiogram,chest CT were systematically reviewed.Results The typical radiation-induced cataract was found in"Mei"2-3 years after 60Co accidental irradiation.13 years after irradiation,the cataract surgery and intraocular lens implantation in left eye were performed followed by the same operation in right eye in November 2019.Different degrees phacoscotasmus under the posterior capsule or equatorial part of the eyes were also found in the rest of victims.ECG result of"Mei"indicated myocardial ischemia 7 years after accident."Tian"confirmed diagnosis coronary heart disease 12 years after irradiation,and the surgery about coronary angiography heart stent implantation was taken at 20 years after irradiation.Five victims showed increased serum total cholesterol and/or triglycerides,and 4 victims showed bilateral or unilateral common carotid atherosclerotic plaque formation.Higher levels of thyroid stimulating hormone(TSH)were observed in"Mei"at 11 years after the irradiation.The thyroglobulin antibody(TGA)and thyroid microsomal antibody(TMA)were obviously increased in"Yi",accompanied by thyroid uneven found by ultrasound.The thyroid nodules in"Mei"and"Min"were observed at 15 years after irradiation.The diagnosis of diffuse large B cell lymphoma(DLBL)in"Tian"was confirmed at 13 years after irradiation.Slightly higher of Neuron-specific enolase(NSE)were found in"Tian","Min"and"Yi".A small nodule was detected from chest CT of"Tian".Most of the chromosome aberrations observed in peripheral blood lymphocytes from the victims were stable chromosomal aberration such as translocation(t)with a few dicentric chromosome(dic)and acentric fragment(ace)in"Wang"and"Tian".Conclusions Ionizing radiation can cause variable degrees of deterministic effects in lens,thyroid gland and cardiovascular circulatory system and stochastic effects such as neoplasm.The genetic damages will last long in the patients.