摘要目的 通过对1999年河南省发生的“4.26”60Co源辐射事故所致的4名骨髓型急性放射病患者受照后12年医学随访观察,探讨电离辐射远后效应,为核事故医学应急的救治和随访提供临床资料和积累经验.方法 采用“一对一”和“多对一”的方式采集病史,观察和记录“梅”、“旺”、“天”、“民”4名患者的临床症状和体征.实验室及器械检查包括血细胞分析、肝肾功能、甲状腺功能、体液免疫、性激素水平、肿瘤标志物及眼科检查、甲状腺彩超、腹部B超、心电图及胸部X片检查,评价其全身情况.辐射遗传学分析包括外周血淋巴细胞染色体畸变分析和微核分析.应用实时荧光定量PCR法,检测其外周血GADD45和nm23-H1基因的mRNA表达,与健康对照人群相比较.采用卡特尔16种个性因素测验(16PF)、抑郁自评量表(SDS)、焦虑自评量表(SAS),对4名患者实施心理测评.结果 4名患者受照后12年造血免疫功能基本恢复正常.“天”乙肝两对半的检查结果中,表面抗原(HBsAg)及核心抗体(HBcAb)为阳性,乙肝病毒复制转为慢性期,传染性弱.4人眼晶状体均有不同程度的混浊性改变,“梅”受照后3年即发生放射性白内障.“梅”、“天”、“民”性激素水平仍有异常.外周血淋巴细胞染色体畸变分析可见少许断片和双着丝粒,但易位率仍较高.分子生物标志物外周血GADD45和nm23-H1基因mRNA定量分析较正常对照组差异无统计学意义.心理测评发现,“梅”重度抑郁、焦虑,其余3人存在紧张、焦虑、恐慌情绪.结论 对4名骨髓型急性放射病患者进行了较为系统的医学随访观察和心理测评,为类似病例的临床救治和随访提供资料.

abstractsObjective To investigate the late effects of ionizing radiation,in order to provide information and gain experience for medical treatments in nuclear accident emergencies,by medical followup of the four cases with bone marrow form of acute radiation sickness who were exposed to 60Co accidentally in 1999.Methods Histories were taken by one or several doctors,who observed and wrote down the clinical symptoms of the patients.The general health situation was evaluated by laboratory and equipment examinations,including blood cells,liver and kidney function,thyroid function,humoral immunity,levels of sex hormones,tumor markers and ophthalmic examination,thyroid ultrasonography,abdominal ultrasound,ECG and chest X-ray examination.The radiation genetics analysis was performed by chromosome aberration and micronucleus assay (CB method).Real-time PCR was used to quantify the expressions of peripheral blood GADD45 and nm23-H1 gene mRNA,which were compared with the control group.The psychological qualities of patients were evaluated by 16PF,SDS,SAS.Results The hematopoietic system and immune function had basically returned to normal 12 years after the accident.HBV markers showed that HBsAg and HBcAb of Tian were positive,which showed that infectivity was weak.All of their eye lenses had varying degrees of turbidity changes,Mei had radiation-incuded cataract 3years after irradiation.The levels of sex hormones of Mei,Tian,Min were abnormal.Translocation could be seen by analysis of peripheral blood lymphocyte chromosome aberration.The expressions of GADD45 and nm23-H1 gene mRNA had no significant difference with the control group.Psychological tests showed that the radiation incident caused different degrees of mental disorder to the exposed individuals.Conclusions The medical follow-up and psychological evaluation of four cases with bone marrow form of acute radiation sickness are successful,which provides information for clinical treatment and medical follow-up of similar cases.