河南"4.26"60Co辐射事故中3例中、重度骨髓型急性放射病患者免疫系统变化的20年医学随访

A 20-year medical follow-up report on the changes in the immune systems of three patients with moderate or severe bone marrow form of acute radiation sickness in the"4.26"60 Co radiation accident in Henan province

目的观察河南"4.26"60Co辐射事故中3例中、重度骨髓型急性放射病患者免疫系统的远期效应, 总结急性辐射损伤后免疫系统长期的变化特点。方法对1999年河南"4.26"60Co辐射事故中2例中度骨髓型急性放射病患者("天"和"旺", 均为男性, 年龄分别为37岁和8岁)和1例重度骨髓型急性放射病患者("梅", 女性, 38岁)进行临床随访。采用免疫透射比浊法检测患者的外周血血清免疫球蛋白(Ig) A、IgG、IgM和补体C3的水平以评估体液免疫情况;采用流式细胞术检测患者T淋巴细胞亚群的CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)T细胞的百分比及CD3^(+)CD4^(+)/CD3^(+)CD8^(+)T细胞的比值以评估细胞免疫情况。结果随访时间截至2019年9月4日, 共随访11次。体液免疫评估结果显示, 患者"梅"在受照后半年和第2年, 补体C3水平均下降, 第5、11、13、20年, IgG水平均升高;患者"天"在受照后第3年, IgM水平下降, 第5年, IgG水平升高;患者"旺"在受照后第1、5年, 补体C3水平均升高。Ig的异常频次及延续时间表现为"梅">"天"="旺"。细胞免疫评估结果显示, 患者"梅"在受照后半年, CD3^(+)、CD3^(+)CD4^(+) T细胞的百分比及CD3^(+)CD4^(+)/CD3^(+)CD8^(+)T细胞的比值均显著下降, 第7、11年, CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+) T细胞的百分比均下降, 第15年, CD3^(+)、CD3^(+)CD4^(+) T细胞的百分比均下降;患者"天"在受照后第5、11年, CD3^(+)CD4^(+) T细胞的百分比均升高, 第7年, CD3^(+)、CD3^(+)CD8^(+) T细胞的百分比均下降;"旺"在受照后第7年, CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+) T细胞的百分比均下降。T淋巴细胞亚群的异常频次及延续时间表现为"梅">"天"> "旺"。结论急性照射对免疫系统的损伤存在长期性、剂量依赖性和可逆性。对于个体而言, 免疫系统的受损情况与受照剂量呈正相关, 年龄和性别是其可能的影响因素。

Objective To observe the long-term effects on the immune systems of three patients with moderate or severe bone marrow form of acute radiation sickness in the"4.26"60 Co radiation accident in Henan province and summarize the characteristics of long-term changes in the immune system after acute radiation injury.Methods Two patients("Tian"and"Wang";aged 37 and 8 years,respectively;both were males)with moderate bone marrow form of acute radiation sickness and one patient("Mei";female;38 years old)with severe bone marrow form of acute radiation sickness in the"4.26"60 Co radiation accident in 1999 were followed up.The levels of serum immunoglobulin(Ig)A,IgG,IgM,and complement C3 in the patients'peripheral blood were detected through immune turbidimetry and used in evaluating humoral immunity.T lymphocyte subsets(including the percentages of CD3^(+),CD3^(+)CD4^(+),and CD3^(+)CD8^(+)T-cells and the ratio of CD3^(+)CD4^(+)T-cells to CD3^(+)CD8^(+)T-cells)were analyzed through flow cytometry for the evaluation of cellular immunity.Results The follow-up time was up to September 4,2019,with a total of 11 times.Humoral immunity results showed that the complement C3 level of"Mei"decreased in half a year and in the second year,and her IgG level increased in the 5th,11th,13th,and 20th years.The IgM and IgG levels of"Tian"decreased in the third year and increased in the fifth year,respectively.As for"Wang",the complement C3 level increased in the first and fifth years after irradiation.The abnormal frequency and duration of Ig showed as"Mei">"Tian"="Wang".Cellular immunity results showed that the percentage of CD3^(+)and CD3^(+)CD4^(+)T-cells and the ratio of CD3^(+)CD4^(+)T-cells to CD3^(+)CD8^(+)T-cells of"Mei"decreased significantly half a year after irradiation,and the percentages of her CD3^(+),CD3^(+)CD4^(+),and CD3^(+)CD8^(+)T-cells decreased in the seventh and 11th years,and the percentages of her CD3^(+)and CD3^(+)CD4^(+)T-cells decreased in the 15th year.The percentages of CD3^(+)CD4^(+)T-cells of"Tian"increased 5 and 11 years after irradiation,and the percentages of his CD3^(+)and CD3^(+)CD8^(+)T-cells decreased in the seventh year.The percentages of CD3^(+),CD3^(+)CD4^(+),and CD3^(+)CD8^(+)T-cells of"Wang"decreased 7 years after irradiation.The abnormal frequency and duration of T lymphocyte subsets showed as"Mei">"Tian">"Wang".Conclusions The acute radiation-induced damage to the immune system is long term,dose-dependent,and reversible.For individuals,the damage to immune system is positively correlated with radiation dose,and age and gender are the possible influencing factors.