一起介入治疗意外照射导致背部大面积放射性皮肤损伤患者的生物剂量估算  

Biodosimetry estimation of a case of large area back skin injury caused by accidental irradiation in interventional procedure

作　　者：韩林 张冰洁 王平 李杰 杜沙沙 毛喻萱 赵风玲 刘玉龙[3] 吕玉民 Han Lin;Zhang Bingjie;Wang Ping;Li Jie;Du Shasha;Mao Yuxuan;Zhao Fengling;Liu Yulong;Lyu Yumin(Henan Institute of Occupational Medicine,Henan Key Laboratory of Medicine on Radiobiology and Epidemiology,Zhengzhou 450052,China;Prevention and Treatment Center for Occupational Disease of Xinxiang City,Xinxiang 453003,China;Second Affiliated Hospital of Soochou University,Suzhou 215004,China)

机构地区：[1]河南省职业病防治研究院,河南省辐射生物与流行病学医学重点实验室,郑州450052 [2]新乡市职业病防治研究所,453003 [3]苏州大学附属第二医院,215004

出　　处：《中华放射医学与防护杂志》2021年第12期886-891,共6页Chinese Journal of Radiological Medicine and Protection

基　　金：河南省科技攻关计划项目(142102310086);河南省医学科技攻关计划项目(LHGJ20190815)。

摘　　要：目的对疑似因介入治疗致背部大面积皮肤损伤的患者进行生物剂量估算与重建。方法术后约7个月(2020年7月22日),采集患者外周血进行染色体畸变分析并用不同方法构建的剂量曲线估算剂量,用剂量估算的修正系数、Dolphin′s模型和Qdr方法重建患者术后短期内的受照剂量。结果基于dic半自动与dic+r人工分析及4条剂量曲线估算患者的全身平均吸收剂量为0.68~0.95 Gy,泊松分布检验结果显示u值均>1.96,患者受到局部不均匀照射,且半自动分析可明显提高剂量估算的效率。3种重建剂量方法修正后估算患者术后短期内的全身平均吸收剂量为1.80~2.86 Gy。估算的生物剂量与该患者存在放射损伤和临床诊断为局部放射性皮肤损伤Ⅳ度的结果基本一致。结论通过染色体畸变分析和生物剂量估算,确诊了1例因介入治疗致背部大面积放射性皮肤损伤的患者,非稳定性染色体畸变分析对局部不均匀照射受照者回顾性生物剂量的估算与重建有可行性。Objective To evaluate biological dose and retrospective biodosimetry of a case of large area back skin injury caused by suspected interventional procedure.Methods Peripheral blood from the patient was collected at about 7 months after interventional procedure,and the chromosomal aberrations in peripheral blood cells were analyzed to evaluate the retrospective biodosimetry using the correction factor of dose estimation,Dolphin's model and Qdr method,respectively.Results Based on the amounts of semi-automated dic and manually detected dic plus ring,the whole-body average absorbed dose of the victim was estimated to be 0.68-0.95 Gy by four different dose response curves.Over dispersion of dic or dic plus ring was also detected,and the efficiency of dose assessment was obviously increased using dic semi-automatic detection.Based on three different retrospective biodosimetry models,the estimated average absorbed dose was further corrected to be between 1.80-2.86 Gy,which was consistent with clinical diagnosis of degreeⅣradiation skin injury.Conclusions A case of suspected radiation skin injury was confirmed by chromosomal aberration analysis and it's biodosimetry was reconstructed,suggesting that the unstable chromosomal aberration analysis may be applicable to assess the retrospective biodosimetry of non-uniform local radiation exposure.

关 键 词：介入治疗 放射性皮肤损伤 非稳定性染色体畸变 生物剂量估算 剂量重建 

分 类 号：R818[医药卫生—放射医学]