| 卞华慧,刘玉龙,王优优,等.南京“5.7”192Ir源放射事故患者局部组织的改变[J].中华放射医学与防护杂志,2016,36(5):331-335.Bian Huahui,Liu Yulong,Wang Youyou,et al.Changes of local tissue of a case who was exposed to “5.7” 192Ir source accident in Nanjing[J].Chin J Radiol Med Prot,2016,36(5):331-335 |
| 南京“5.7”192Ir源放射事故患者局部组织的改变 |
| Changes of local tissue of a case who was exposed to “5.7” 192Ir source accident in Nanjing |
| 投稿时间：2016-02-05 |
| DOI：10.3760/cma.j.issn.0254-5098.2016.05.004 |
| 中文关键词: 192Ir 放射损伤 临床观察 骨代谢 磁共振成像 |
| 英文关键词:192Ir Radiation injury Clinical observation Bone metabolism MRI |
| 基金项目:江苏省临床医学科技专项(BL2014040);江苏省卫生计生委2014-2015年度预防医学科研项目(Y2015024) |
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| 中文摘要: |
| 目的 观察1例192Ir源急性外照射致局部放射性损伤的改变,探讨局部放射损伤的诊治。方法 重点观察该例患者局部病变的临床经过;采用磁共振成像(MRI)评估局部组织损伤;采用双能X射线法检测患者骨密度;应用电化学发光法检测患者血清Ⅰ型胶原羧基端肽(β-CTx)、血清Ⅰ型前胶原氨基末端肽(PINP)和血清睾酮(T)水平。结果 受照后患者局部表现为红斑、肿胀、疼痛、水疱、溃疡、坏死,诊断为Ⅳ度急性放射性皮肤损伤,受照后383 d伤口愈合,但患者右下肢运动障碍。MRI检查显示局部损伤累及皮肤、股骨、多处肌肉及骨髓组织。骨密度检查显示患者骨量减少(-1.5~-1.1),血清β-CTx一过性升高(493.50~1 580.00 pg/ml),血清PINP出现波动(49.30~291.80 ng/ml),且血清睾酮出现波动(5.41~608.80 ng/dl)。结论 大剂量急性外照射可致局部重度放射性皮肤损伤,MRI有助于评估局部放射损伤,骨密度、骨代谢指标联合血清睾酮可用于评估骨损伤。临床医生救治局部放射损伤时应注重全身治疗和局部治疗。 |
| 英文摘要: |
| Objective To observe changes of local tissue injury caused by 192Ir external exposure and investigate the diagnosis and treatment of local radiation injury.Methods Observation was mainly focused on the clinical manifestations of local pathological changes, by using MRI to evaluate local tissue injury, using dual energy X-ray to detect bone mineral density(BMD) and using electrochemiluminescence (ECL) to assay bone metabolic biochemical indicators of β-CTx, PINP and serum testosterone levels. Results Exposed local skin was diagnosed as Ⅳ degree acute radiation injury to skin, showing erythema, swelling, pain, blisters, ulcers, and necrosis. The wound healed 383 days after exposure, but the right lower limb was dyskinetic. MRI eximanations showed that femoral injury on the right lower extremity involved skin, femur, multiple muscles and bone marrow tissue. BMD examination showed a reduction in bone mass(-1.5 to -1.1), transient increase in bone metabolism index β-CTx(493.50 to 1 580.00 pg/ml), and fluctuation in levels of PINP(49.30 to 291.80 ng/ml) and serum testosterone(5.41 to 608.80 ng/dl).Conclusions Acute external radiation exposure at high dose can lead to severe local tissue injury. MRI examinations are important for local damage assessment. BMD bone metabolism index and serum testosterone are useful in evaluation of bone injury. Both systemic and local therapy should be considered as equally important for local injury treatment. |
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