碘对比剂对CT检查辐射生物学效应的影响  

Effect of iodine contrast agent on biological responses of CT examination

作　　者：李强 汪玲[2] 俞明明 王希明 姚飞荣 李盛 胡春洪[2] Li Qiang;Wang Ling;Yu Mingming;Wang Ximing;Yao Feirong;Li Sheng;Hu Chunhong(Department of Radiology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo 315040, China;Department of Radiology, First Hospital Affiliated to Soochow University, Suzhou 215006, China)

机构地区：[1]宁波大学医学院附属鄞州医院放射科,315040 [2]苏州大学附属第一医院放射科,215006

出　　处：《中华放射医学与防护杂志》2017年第11期816-820,共5页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的 评估碘对比剂对CT检查辐射效应的影响。方法 60例怀疑泌尿道系统疾病而准备行CT泌尿道造影（CTU）的患者，采用随机数表法分为对照组和试验组。对照组使用常规法CTU检查（平扫、皮质期、髓质期和排泄期），第1次仅腹部CT平扫，3 d后补充其他3期增强扫描；试验组使用分次注射法CTU检查（平扫、实质-排泄期），第1次行分次注射增强扫描（实质-排泄期），3 d后补充平扫。两组患者第1次CT扫描前后10 min内各抽取外周静脉血2 ml，分离淋巴细胞，使用免疫荧光法计数外周静脉血内淋巴细胞核的γ-H2AX焦点数目。对照分析两组患者第1次扫描的辐射剂量和扫描前后外周静脉血内淋巴细胞核内γ-H2AX焦点数目的差异。结果 共50例患者顺利完成CT扫描和免疫荧光法γ-H2AX焦点数测定（对照组24例，试验组26例），对照组和试验组患者第1次CT扫描所接受的辐射剂量分别为（4.83±1.88）和（4.55±1.66） mSv，差异无统计学意义（P〉0.05）。扫描前后两组患者外周静脉血内淋巴细胞内平均γ-H2AX焦点数分别为对照组（0.06±0.02）和（1.06±0.27）个，试验组（0.06±0.03）和（1.42±0.50）个，差值为（0.97±0.23）和（1.34±0.41）个，差异有统计学意义（t=-3.25，P〈0.05），试验组焦点增多量较对照组高38.14%。试验组和对照组扫描前后不受性别影响，但受年龄（≤ 50岁和〉50岁）影响，差异有统计学意义（t=-4.76、-8.16，P〈0.05）。但两组患者的γ-H2AX焦点变化受性别影响差异无统计学意义（P〉0.05）。结论 碘对比剂可在一定程度上增加CT辐射引起的外周血淋巴细胞DNA损伤，建议临床工作中应尽可能降低碘对比剂使用的浓度和总碘量，以降低机体的损伤。Objective To evaluate the effect of iodine contrast agent on the biological responses of CT examination. Methods A total of sixty patients with suspected urinary tract disease who underwent computed tomography urography（CTU） examination were randomly divided into control group and experimental group. The control group was treated with routine CTU, where only CT scan was performed on the first day. CTU was added after 3 days. The test group was treated with fractional injection CTU and injected with enhanced scanning agent on the first day. Before and after CT examination, the patients＇ peripheral blood was collected and the number of γ-H2AX foci in lymphocytes （mononuclear cells） was measured by immunofluorescence, and the differences of DNA damage in these two groups were observed. Results Before and after CT examination, the number of γ-H2AX foci was 0.06±0.02 and 1.06±0.27 in the lymphocytes of control group,0.06±0.03 and 1.42±0.50 in the test group, respectively. Hence, the number of γ-H2AX foci in the test group was increased by 38.14%. Moreover, the change of γ-H2AX foci in these two groups was not influenced by gender, but correlated with ages（between ≤ 50 years old and 〉50 years old） in control group （t=-4.76, P〈0.05） and in test group（t=-8.16, P〈0.05）. Conclusions The iodine contrast agent can increase DNA damage of CT examination, and therefore the use of iodine contrast agent in CT should be reduced as much as possible in clinical work.

关 键 词：计算机断层 X射线摄影 碘对比剂 辐射损伤 Γ-H2AX 

分 类 号：R816.7[医药卫生—放射医学]