| 乔建辉,余长林,罗卫东,郭梅,王丹红,孙琪云,张石,张锡刚,李光,牛文凯,陈建魁,李晓兵,葛飞娇,艾辉胜.一例极重度骨髓型急性放射病的临床救治[J].中华放射医学与防护杂志,2007,27(1):6-10 |
| 一例极重度骨髓型急性放射病的临床救治 |
| Clinical report of an extremely severe bone marrow form of acute radiation sickness |
| 投稿时间：2006-09-18 |
| DOI： |
| 中文关键词: 极重度骨髓型急性放射病 造血干细胞移植 预处理 |
| 英文关键词:Extremely severe bone marrow form of acute radiation sickness Hematopoietic stem cell transplantation Conditioning regimen |
| 基金项目: |
| 作者 | 单位 | E-mail | | 乔建辉 | 100071 北京, 解放军第三零七医院 | | | 余长林 | 100071 北京, 解放军第三零七医院 | | | 罗卫东 | 100071 北京, 解放军第三零七医院 | | | 郭梅 | 100071 北京, 解放军第三零七医院 | | | 王丹红 | 100071 北京, 解放军第三零七医院 | | | 孙琪云 | 100071 北京, 解放军第三零七医院 | | | 张石 | 100071 北京, 解放军第三零七医院 | | | 张锡刚 | 100071 北京, 解放军第三零七医院 | | | 李光 | 100071 北京, 解放军第三零七医院 | | | 牛文凯 | 100071 北京, 解放军第三零七医院 | | | 陈建魁 | 100071 北京, 解放军第三零七医院 | | | 李晓兵 | 100071 北京, 解放军第三零七医院 | | | 葛飞娇 | 100071 北京, 解放军第三零七医院 | | | 艾辉胜 | 100071 北京, 解放军第三零七医院 | huishengai@163.com |
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| 中文摘要: |
| 目的 通过对山东济宁"10.21" 60Co源辐射事故病例B的诊治经过的回顾,积累资料,总结经验。方法 剂量估算采用染色体畸变及微核分析、物理模拟、电子自旋共振(ESR)测量并结合尸检病理。临床诊断根据受照剂量、临床过程及实验室结果进行综合分析。治疗上给予全环境保护,HLA相合的异基因外周血造血干细胞移植(PBSCT),积极抗感染及对症支持治疗,维护脏器功能。结果 病例B诊断为极重度骨髓型急性放射病,受照后7 d进行了HLA完全相合的PBSCT,移植后9 d三系造血逐步恢复,并获持续稳定的完全供者型植入,无移植排斥及移植物抗宿主病(GVHD)发生。由于病人的放射损伤继续发展,并逐渐发生严重肺部混合感染,心功能不全,照后45 d行气管切开、呼吸机辅助呼吸,75 d发生多脏器功能衰竭死亡。结论 极重度骨髓型放射病应尽早分类诊断及实施全环境保护,可经异基因PBSCT使造血重建,为延长存活奠定基础。需加强抗感染及多脏器维护;促进免疫重建及组织损伤修复是今后极重度骨髓型急性放射损伤研究的难点及重点。 |
| 英文摘要: |
| Objective To sum up the experiences from the diagnosis and treatment of patient B subjected to an accidental 60Co exposure on October 21st, 2004, in Jining, Shandong Province, China. Methods Radiation dose of B was assessed by analysis of chromosome aberration and microneucleus assay, simulation test of the accident site, autopsy and electron spin resonance (ESR). The ultimate clinical diagnosis was based on analysis of irradiation dose, clinical manifestations and laboratory results. In therapeutical aspects, total environmental protection, HLA-identical allogeneic peripheral blood stem cell transplantation(PBSCT), anti-infection and protection managements of organs were given. Results Patient B was diagnosed as extremely severe bone marrow form of acute radiation sickness (ARS). HLA-identical allogeneic PBSCT was performed on the patient from his brother on the 7th day after the accident. The hematopoietic recovery began on the 9th day after transplantation. The patient acquired permanent full donor' engraftment without graft versus host disease (GVHD). But the radiation injury was continuing and the patient complicated with polyinfection in lung, and cardiac insufficiency. On the 45th day after the accident, patient B was performed with tracheotomy and maintained ventilation with respirator. On the 75th day after the accident, patient B died of multiple organ failure. Conclusions Early triage diagnosis and total environmental protection should be performed as soon as possible for extremely severe bone marrow form of ARS. It is very important to perform a successful HLA-identical allogeneic PBSCT, in order to extend the life time of the patient. Multiple organ injuries and infections of bacteria and fungi usually occurred on this kind of patients, so intense measures of anti-infection and protection of multiple organs should be taken. The important and difficult point in the treatment of this kind ARS might be for help the immune-reconstruction and tissue repair. |
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