發(fā)布時間：2018-07-18 14:54

【摘要】：目的觀察骨髓型急性放射病(ARS)患者的遠(yuǎn)期效應(yīng)。方法對河南省1999年鈷-60(60Co)源輻射事故的3例骨髓型ARS患者"梅"、"天"和"旺"進(jìn)行為期15年的遠(yuǎn)期效應(yīng)醫(yī)學(xué)隨訪觀察。重點觀察造血系統(tǒng)、免疫系統(tǒng)、內(nèi)分泌系統(tǒng)、生殖系統(tǒng)和眼科改變情況。結(jié)果 3例患者受照后1個月內(nèi)白細(xì)胞計數(shù)、血小板計數(shù)和血紅蛋白均出現(xiàn)下降,于受照后6個月均恢復(fù)正常;3例患者粒細(xì)胞-巨噬細(xì)胞集落刺激因子在受照后6個月均偏低,分別于受照后1~2年恢復(fù)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個月和2年補(bǔ)體3水平偏低;"天"受照后5年Ig G水平偏高。3例患者受照后6個月內(nèi)T細(xì)胞亞群指標(biāo)表面分化抗原(CD)3+T細(xì)胞百分比、CD3+CD4+T細(xì)胞百分比、CD3+CD8+T細(xì)胞百分比和CD3+CD4+/CD3+CD8+比值均低于正常參考值下限,受照后第2年恢復(fù)正常。"梅"受照后出現(xiàn)閉經(jīng);"天"受照后3個月精子數(shù)開始減少且出現(xiàn)死精,受照后3~7年精子數(shù)逐漸恢復(fù)至正常。"梅"和"天"受照后15年出現(xiàn)甲狀腺結(jié)節(jié)。3例患者均出現(xiàn)不同程度晶狀體渾濁,"梅"于受照后13年行左眼白內(nèi)障摘除聯(lián)合人工晶狀體植入術(shù)。"梅"和"旺"周圍血淋巴細(xì)胞微核率分別為3‰、1‰;染色體畸變檢查顯示相互易位、雙著絲粒體、無著絲粒體和倒位數(shù)分別為70、8、5、3和43、2、1、1。"天"受照后12年出現(xiàn)冠狀動脈狹窄改變,受照后13年罹患彌漫性大B細(xì)胞非霍奇金淋巴瘤。"梅"受照后7年開始心電圖檢查出現(xiàn)下壁和側(cè)壁心肌缺血。結(jié)論60Co源輻射事故可導(dǎo)致ARS患者出現(xiàn)造血系統(tǒng)、免疫系統(tǒng)、內(nèi)分泌系統(tǒng)、生殖系統(tǒng)、眼晶狀體和心臟功能不同程度的遠(yuǎn)期效應(yīng)。
[Abstract]:Objective to observe the long-term effects of acute radiation sickness (ARS) of bone marrow type. Methods three cases of bone marrow type ARS patients in Henan Province in 1999 were followed up for 15 years for long term effect of "Mei", "Tian" and "Wang". The changes of hematopoietic system, immune system, endocrine system, reproductive system and ophthalmology were observed. Results the leukocyte count, platelet count and hemoglobin decreased in 3 patients within one month after irradiation, and returned to normal 6 months after irradiation. The granulocyte-macrophage colony stimulating factor was lower in 3 patients at 6 months after irradiation. They returned to normal 1 ~ 2 years after exposure. " The levels of immunoglobulin G (Ig) G in 5, 11 and 13 years after irradiation were higher than those in the control group. The levels of complement 3 were low in 6 months and 2 years after exposure, and the percentage of CD3 CD4 T cells and CD3 CD8 were higher in 3 cases of patients with higher IgG level 5 years after exposure to "Tiantian" than in 6 months after exposure to radiation, and the percentage of CD3 CD4 T cells was higher than that of CD3 CD8 in the 6 months after exposure to radiation, and the percentage of CD3 CD4 T cells was higher than that of CD3 CD8. The percentage of T cells and the ratio of CD3 CD4 / CD3 CD8 were lower than the lower limit of normal reference value. Return to normal for the second year after exposure. " Mei "appeared amenorrhea after irradiation, spermatozoa began to decrease and spermatozoa appeared at 3 months after irradiation, and sperm number gradually returned to normal in 37 ~ 7 years after irradiation." After 15 years of irradiation, 3 patients with thyroid nodules developed lens opacity of varying degrees. Mei was treated with cataract extraction and intraocular lens implantation 13 years after irradiation. The micronucleus rate of blood lymphocytes around "Mei" and "Wang" was 3 鈥，

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