1例放射性皮肤损伤患者15年医学随访观察  

A 15-year-long clinical follow-up observation on a case of skin injury caused by ionizing radiation

作　　者：姜梅玲[1] 邢志伟[1] 姜恩海[1] 于程程[1] 江波[1] 赵欣然[1] 王晓光[1] 赵凤玲 吕玉民 刘金星 

机构地区：[1]中国医学科学院放射医学研究所,天津300020 [2]河南省职业病防治研究院,河南郑州450052

出　　处：《中国职业医学》2015年第1期39-42,共4页China Occupational Medicine

基　　金：卫生部行业基金(201002009);中国医学科学院放射医学研究所所立科研基金(1423);天津市放射医学与分子核医学重点实验室

摘　　要：目的了解钴-60（60Co）源辐射所致放射皮肤损伤的变化规律。方法收集1起60Co源辐射事故中发生放射性皮肤损伤的患者＂天＂住院期间和受照后15年医学随访期间的皮肤专科临床资料进行分析。结果住院期间,＂天＂右手食指于受照后15 d出现红斑,受照后20 d出现边界清楚的水泡,受照后28 d水泡吸收,局部干燥、结痂;受照后33 d硬痂脱落;受照后91 d右手食指皮肤干燥、萎缩变薄、粗糙、弹性差;临床诊断为右手食指Ⅱ度急性放射性皮肤损伤。医学随访期间,＂天＂右手食指于受照后1年出现干燥、皲裂和角化过度等慢性病变,诊断为右手食指Ⅱ度慢性放射性皮肤损伤;受照后2、5、7、9和13年右手食指受照部位反复出现溃疡,伴有干燥、脱屑、色素减退、萎缩性疤痕、指甲纵裂和右手指伸展受限等体征;受照后15年,皮肤干燥、脱屑、皲裂,色素减退,出现萎缩性瘢痕。受照后2～15年随访期间均被诊断为右手食指Ⅲ度慢性放射性皮肤损伤。结论急性放射性皮肤损伤可迁延发展成为慢性放射性皮肤损伤,其恢复过程漫长。Objective To explore the changing characteristics of skin injury caused by Co-60（60Co） ionizing radiation.Methods The dermatology clinical data of the patient ＂Tian＂who suffered skin injury from a60 Co radiation source accident was collected and analyzed during his hospital stay and the 15-year-long clinical follow up. Results During the hospital stay,red spot was observed in the right forefinger of ＂Tian ＂ on day 15 after ionizing radiation,followed by formation of vesicles with clear boundary on day 20. The vesicles absorption happened on day 28 and the local skin became dry and developed to scab,which fell off on day 33. Ninety-one days after ionizing radiation,dry skin,atrophy and getting thin,rough and poor elasticity were found in the right forefinger,which was clinically diagnosed as Ⅱ degree of acute radiation skin injury. One year after the ionizing radiation,some chronic clinical signs,such as dry,chapped skin and hyperkeratosis,were found in this forefinger with diagnosis as Ⅱ degree of chronic radiation skin damage. Frequentative ulcer,together with dry,furfuration,pigment decline,atrophic scar,longitudinal crack on the nail and limited stretch of right forefinger were observed in year 2,5,7,9,13 after ionizing radiation. In the 15 th year,the right forefinger showed dry,furfuration,chapped skin,pigment decline and atrophic scar were observed. During the following up from the 2nd to the 15 th year,＂Tian＂was diagnosed as Ⅲ degree of chronic radiation skin injury. Conclusion Acute skin radiation injury can slowly develop to chronic radiation skin injury,which needs a very long time to recover.

关 键 词：辐射事故 钴-60 放射性疾病 皮肤损伤 医学随访 

分 类 号：X591[环境科学与工程—环境工程] R816.95[医药卫生—放射医学]