CAJ | 학술논문

目的通过对在山西忻州60Co源放射事故中受到意外照射而罹患外照射中度骨髓型急性放射病孕妇"芳"(孕19周)进行照后第16年的随访观察,以期了解辐射对育龄妇女的远后影响.方法采用询问病史、全面体检、实验室和影像学检查及临床相关专业科室会诊,并对其进行评估.结果 "芳"病愈后常感到乏力,易患感冒;照后9年(32岁)头发全部变白,但无脱发;16年来月经量明显减少;31岁(受照后8年)在怀孕6个月时胎儿宫内死亡.体检仅发现双侧甲状腺Ⅰ度肿大,腋毛稀疏,余无阳性体征.实验室检查结果仅显示T3、T4增高,TSH减低,抗甲状腺过氧化物酶抗体(TMAb)增高.应用荧光原位杂交(FISH)技术检测染色体稳定性畸变,用剩余染色体畸变估算的剂量为0.76 Gy.其他指标的检查结果均在正常范围.甲状腺超声检查见双甲状腺实质弥漫性病变,甲状腺右叶多发囊性结节.骨密度检查结果发现2～4腰椎骨质疏松.结论受照后8年,妊娠6个月时,胎儿宫内死亡与其既往受照有关;非癌症疾病表现明显;未发现罹患癌症证据.
목적 통과대재산서흔주60Co원방사사고중수도의외조사이리환외조사중도골수형급성방사병잉부"방"(잉19주)진행조후제16년적수방관찰,이기료해복사대육령부녀적원후영향.방법 채용순문병사、전면체검、실험실화영상학검사급림상상관전업과실회진,병대기진행평고.결과 "방"병유후상감도핍력,역환감모;조후9년(32세)두발전부변백,단무탈발;16년래월경량명현감소;31세(수조후8년)재부잉6개월시태인궁내사망.체검부발현쌍측갑상선Ⅰ도종대,액모희소,여무양성체정.실험실검사결과부현시T3、T4증고,TSH감저,항갑상선과양화물매항체(TMAb)증고.응용형광원위잡교(FISH)기술검측염색체은정성기변,용잉여염색체기변고산적제량위0.76 Gy.기타지표적검사결과균재정상범위.갑상선초성검사견쌍갑상선실질미만성병변,갑상선우협다발낭성결절.골밀도검사결과발현2～4요추골질소송.결론 수조후8년,임신6개월시,태인궁내사망여기기왕수조유관;비암증질병표현명현;미발현리환암증증거.
Objective To investigate the late effect of radiation on child-bearing women,through observing "Fang",a 19-week-pregnant woman at age of 23,who was exposed to 60Co radiation in Shanxi Xinzhou radiation accident in November,1992 and diagnosed as moderate bone marrow type acute radiation sickness and recovered after 16 year of follow-up treatment.Methods Clinical data including medical history,physical examination,laboratory data,imaging findings and consulting relevant departments were reviewed.Results The followed-up woman "Fang" often felt weak and caught cold after recovery.When she was 32 years old (9 years after radiation),her hair turned grey,but without hair loss.Her menstrual quantity was lessened since 31 years old (8 years after radiation).She was remarried and pregnant twice in the same year.At the first time she underwent artificial abortion and the second child suffered from intrauterine death after 6 months of pregnancy.The physical examination found bilateral degree Ⅰ thyroid enlargement and sparse armpit hair.The laboratory test showed the increased levels of triiodothyronine,thyroxine and anti-thyroid peroxidase antibody (TMAb) and the decreased thyroid stimulating hormone (TSH).Unstable chromosome aberrations were totally lost and stable aberrations in chromosomes were detected by fluorescence in situ hybridization (FISH).The dose estimated with the residue chromosome aberration was 0.76 Gy.Other laboratory results were normal.Ultrasonic test showed diffuse lesion in bilateral thyroid and multiple cystic nodules in right lobe of thyroid,which was considered to be nodular goiter.The examination of bone mineral density (BMD) showed osteoporosis from the second to the fourth lumber vertebra.There were no diseases associated with radiation based on the consultation from related departments.Conclusions Intrauterine death after 6 months of pregnancy might be associated with the previous exposure.There is no evidence of malignant tumor,but non-cancerous diseases are obvious.