| 余长林,乔建辉,罗卫东,郭梅,王丹红,孙琪云,张石,陈建魁,李晓兵,艾辉胜.一例肠型急性放射病的临床报告[J].中华放射医学与防护杂志,2007,27(1):11-16 |
| 一例肠型急性放射病的临床报告 |
| Clinical report of one case of intestinal form of acute radiation sickness |
| 投稿时间：2006-09-18 |
| DOI： |
| 中文关键词: 肠型急性放射病 HLA单倍体相合 造血干细胞移植 多器官功能衰竭 |
| 英文关键词:Intestinal form of acute radiation sickness Haplo-identical HLA Stem cell transplantation Multiple organ failure |
| 基金项目: |
| 作者 | 单位 | E-mail | | 余长林 | 100071 北京, 解放军第三零七医院 | | | 乔建辉 | 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 | | | 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 | | | 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 总结2004年济宁"10.21"辐射事故患者A的受照经过、剂量估算、临床表现及诊治经过。方法 依据临床表现、现场模拟、生物剂量估算、电子自旋共振(ESR)等结果,综合估算全身受照20～25 Gy,诊断为肠型急性放射病。照后3 d入院,立即全环境保护、抗感染、HLA配型等,7 d进行同胞间单倍体异基因外周血造血干细胞移植。结果 3 d后出现顽固性腹泻,13 d出现急性腹膜炎及不全肠梗阻,经过泰能等抗感染综合治疗伴随造血功能恢复而治愈。17 d白细胞数开始上升,19 d造血重建,骨髓及外周血均获稳定植入,同时出现肺部混合感染。25 d皮肤放射损伤最严重,诊断为Ⅲ度皮肤急性放射损伤(皮肤损害面积14%)。肺部感染逐渐加重,先后出现呼吸衰竭、心功能衰竭、肾衰竭等,给予强有力抗细菌、抗真菌及全身支持等综合救治,效果不佳。30 d呼吸机辅助呼吸,33 d死于多器官功能衰竭(MOF)。结论 患者A的全身剂量20～25 Gy,诊断为肠型急性放射病。这是国内首例肠型急性放射病造血干细胞移植成功的报告。延长了患者的存活时间,获得了宝贵的临床救治经验,对今后类似病例的救治有重要指导意义。广泛严重放射性损伤、感染及MOF是死亡的主要原因。 |
| 英文摘要: |
| Objective To summarize the irradiation course, estimation of radiation dosage, clinical course, diagnosis and treatment of the patient A in a 60Co radiation accident on October 21, 2004 in Jining, Shandong Province, China. Methods According to the simulated test of the scene, chromosome aberration analysis, clinical course and tooth enamel ESR measurement, the total body dose of A was 20-25 Gy and diagnosed as intestinal form of acute radiation sickness. The patient was transferred to our hospital on day 3 post-irradiation, total environmental protection (TEP), antibiotics and emergency HLA-typing from his elder sister were given. On day 7 HLA haplo-identical peripheral blood stem cell transplantation was performed. Results On day 10 post-transplant (+10 d),the counts of WBC began to increase and up to 5.1×109/L on +12d. Bone marrow feature showed hematopoietic recovery of the three lineage blood cells. Continuous detection of the implantation ratio of donor's cells by STR-PCR showed stable 100% donor-derived chimera. On day 13, severe acute peritonitis and intestinal obstruction occurred; imipenem was much effective to control intestinal bacteria infection. Three days later, hematopoiesis reconstructed rapidly, peritonitis and intestinal obstruction were cured. On day 19, chest X-ray picture and CT scanning suggested that pulmonary mixed infection of bacteria and fungi appeared. The most severe skin irradiation burn damage occurred on day 25 which occupied the 14% of whole body skin surface. The functions of lung, heart and kidney were deteriorated sequentially. On day 30, tracheotomy had to be conducted and respirator was used. The patient died of multiple organ failure (MOF) on day 33. Conclusions Patient A was exposed to relative well-distributed high dose and high dose rate of irradiation up to 20-25 Gy. This is the first case report of successful HLA haplo-identical peripheral blood stem cell transplantation for intestinal form of acute radiation sickness in China, whose survival period prolonged to 33 days. The patient died of MOF due to excessive exposure and severe diffuse irradiation injury. The treatment of this patient was of great significance for the kind of such patients in the future. |
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