CAJ | 학술논문

目的：观察骨髓型急性放射病（ARS）患者的远期效应。方法对河南省1999年钴-60（60 Co）源辐射事故的3例骨髓型ARS患者“梅”、“天”和“旺”进行为期15年的远期效应医学随访观察。重点观察造血系统、免疫系统、内分泌系统、生殖系统和眼科改变情况。结果3例患者受照后1个月内白细胞计数、血小板计数和血红蛋白均出现下降，于受照后6个月均恢复正常；3例患者粒细胞－巨噬细胞集落刺激因子在受照后6个月均偏低，分别于受照后1～2年恢复正常。“梅”受照后5、11和13年免疫球蛋白（ Ig） G水平均偏高，受照6个月和2年补体3水平偏低；“天”受照后5年IgG水平偏高。3例患者受照后6个月内T细胞亚群指标表面分化抗原（ CD）3＋T细胞百分比、CD3＋CD4＋T细胞百分比、CD3＋CD8＋T细胞百分比和CD3＋CD4＋／CD3＋CD8＋比值均低于正常参考值下限，受照后第2年恢复正常。“梅”受照后出现闭经；“天”受照后3个月精子数开始减少且出现死精，受照后3～7年精子数逐渐恢复至正常。“梅”和“天”受照后15年出现甲状腺结节。3例患者均出现不同程度晶状体浑浊，“梅”于受照后13年行左眼白内障摘除联合人工晶状体植入术。“梅”和“旺”周围血淋巴细胞微核率分别为3‰、1‰；染色体畸变检查显示相互易位、双着丝粒体、无着丝粒体和倒位数分别为70、8、5、3和43、2、1、1。“天”受照后12年出现冠状动脉狭窄改变，受照后13年罹患弥漫性大B细胞非霍奇金淋巴瘤。“梅”受照后7年开始心电图检查出现下壁和侧壁心肌缺血。结论60 Co源辐射事故可导致ARS患者出现造血系统、免疫系统、内分泌系统、生殖系统、眼晶状体和心脏功能不同程度的远期效应。
목적：관찰골수형급성방사병（ARS）환자적원기효응。방법대하남성1999년고-60（60 Co）원복사사고적3례골수형ARS환자“매”、“천”화“왕”진행위기15년적원기효응의학수방관찰。중점관찰조혈계통、면역계통、내분비계통、생식계통화안과개변정황。결과3례환자수조후1개월내백세포계수、혈소판계수화혈홍단백균출현하강，우수조후6개월균회복정상；3례환자립세포－거서세포집락자격인자재수조후6개월균편저，분별우수조후1～2년회복정상。“매”수조후5、11화13년면역구단백（ Ig） G수평균편고，수조6개월화2년보체3수평편저；“천”수조후5년IgG수평편고。3례환자수조후6개월내T세포아군지표표면분화항원（ CD）3＋T세포백분비、CD3＋CD4＋T세포백분비、CD3＋CD8＋T세포백분비화CD3＋CD4＋／CD3＋CD8＋비치균저우정상삼고치하한，수조후제2년회복정상。“매”수조후출현폐경；“천”수조후3개월정자수개시감소차출현사정，수조후3～7년정자수축점회복지정상。“매”화“천”수조후15년출현갑상선결절。3례환자균출현불동정도정상체혼탁，“매”우수조후13년행좌안백내장적제연합인공정상체식입술。“매”화“왕”주위혈림파세포미핵솔분별위3‰、1‰；염색체기변검사현시상호역위、쌍착사립체、무착사립체화도위수분별위70、8、5、3화43、2、1、1。“천”수조후12년출현관상동맥협착개변，수조후13년리환미만성대B세포비곽기금림파류。“매”수조후7년개시심전도검사출현하벽화측벽심기결혈。결론60 Co원복사사고가도치ARS환자출현조혈계통、면역계통、내분비계통、생식계통、안정상체화심장공능불동정도적원기효응。
Objective To observe the long-term effect of patients with bone marrow type acute radiation sickness ( ARS) . Methods We investigated the long-term effects in 3 cases (“Mei”,“Tian” and“Wang”) with bone marrow type ARS in the 1999 Co-60 ( 60 Co) source radiation accident in Henan province by clinical follow up for 15 years and focused on the alteration of hematopoietic system , immune system , endocrine system , reproductive system and ophthalmology .Results The white blood cell count , blood platelet count and hemoglobin levels of 3 patients were all decreased within one month after the irradiation and returned to normal level 6 months after the irradiation .Down-regulated granulocyte-macrophage colony stimulating was found in all 3 patients in 6 months after the irradiation and returned to normal level in 1 to 2 years. The immunoglobulin G ( IgG) level of “Mei” was increased in the 5th, 11th and 13th year while the complement 3 level was decreased compared to the normal value in the 6th month and the 2nd year after the irradiation.Similarly, the enhanced IgG level of “Tian” was indicated in the 5th year after the irradiation .The percentage of CD3 +T cell, CD3 +CD4+T cell, CD3 +CD8 +T cell and the values of CD3+CD4 +/CD3 +CD8 +in 3 patients were observed lower than normal level within 6 months after the irradiation , which recovered in the 2nd year.Amenorrhea happened in “Mei” after the irradiation, while gradually decreased numbers of sperm and dead sperm were found in “Tian” in 3 months after the irradiation, which returned to normal level in 3 to 7 years.Thyroid nodules were found in “Mei” and“Tian” in 15 years after the accident.All these 3 patients had various degree of lens turbidity and “Mei” was treated with cataract extractionin the left eye followed with crystalline lens implantation in the 13th year.Peripheral blood lymphocyte micronuclei rates of“Mei” and “Wang” were 3‰ and 1‰ respectively, while the chromosome aberration examination showed that the numbersof reciprocal translocation, dicentric, acentric body, inversion were 70, 8, 5, 3 and 43, 2, 1, 1 respectively.Thecoronary angiography of “Tian” showed coronary artery stenosis in the 12th year and diffuse large B cell non-hodgkin’slymphoma was found in the 13th year after the irradiation.Electrocardiogram of “Mei” showed inferior wall and side wallmyocardial ischemia since the 7th year after the accident.Conclusion 60 Co source radiation accident can lead to thevarying degrees of long-term effect in different systems of ARS patients, such as hematopoietic system, immune system,endocrine system, reproductive system, crystalline lenses and cardiac function.