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

作　　者：余长林[1] 乔建辉[1] 罗卫东[1] 郭梅[1] 王丹红[1] 孙琪云[1] 张石[1] 陈建魁[1] 李晓兵[1] 艾辉胜[1] 

机构地区：[1]解放军第三0七医院,北京100071

出　　处：《中华放射医学与防护杂志》2007年第1期11-16,共6页Chinese Journal of Radiological Medicine and Protection

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20～25Gy，诊断为肠型急性放射病。照后3d入院，立即全环境保护、抗感染、HIJA配型等，7d进行同胞间单倍体异基因外周血造血干细胞移植。结果3d后出现顽固性腹泻，13d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。17d白细胞数开始上升，19d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。25d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。30d呼吸机辅助呼吸，33d死于多器官功能衰竭（MOF）。结论患者A的全身剂量20-25Gy，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。Objective To summarize the irradiation course, estimation of radiation dosage, clinical course, diagnosis and treatment of the patient A in a ^60 Co 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 × 10^9/L on ＋ 12 d. 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, tracbeotomy 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

关 键 词：肠型急性放射病 HIJA单倍体相合 造血干细胞移植 多器官功能衰竭 

分 类 号：R686[医药卫生—骨科学]