Gluzman D, Imamura N, Sklyarenko L, Nadgornaya V, Zavelevich M, Machilo V
RE Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, National Academy of Sciences of Ukraine, Kyiv.
Exp Oncol. 2006 Mar;28(1):60-3.
The question as to whether the incidence of leukemias and malignant lymphomas among the Chernobyl clean-up workers increased in 20 years after the catastrophe is still a point of much controversy. Precise diagnosis of the main forms of hematopoietic malignancies according to FAB classification and new WHO classification and comparison of these data with that in the general population will be helpful in estimating the relative contribution of the radiation factor to the overall incidence of such pathologies.
The data on 218 consecutive cases of malignant diseases of hematopoietic and lymphoid tissues in Chernobyl clean-up workers diagnosed in 1996-2005 are given in comparison with the data of 2697 consecutive patients of general population of the same age group. The morphology and cytochemistry of bone marrow and peripheral blood cells were studied. Immunocytochemical techniques (APAAP, LSAB-AP) and the broad panel of monoclonal antibodies to lineage specific and differentiation antigens of leukocytes were employed for immunophenotyping leukemic cells.
Various types of oncohematological diseases developing 10-20 years after Chernobyl accident were registered in a group of clean-up workers under study including myelodysplastic syndromes (MDS), acute leukemias (ALL and AML), chronic myelogenous leukemia (CML) and other chronic myeloproliferative diseases, chronic lymphocytic leukemia (B-CLL) and other chronic lymphoproliferative diseases of B and T cell origin. MDS percentage among patients of clean-up workers group tended to exceed MDS percentage in the group of patients representing the general population examined at the same period (4.58 vs. 3.70%). Among 34 AML cases, leukemia was preceded by MDS in seven patients. The relative contribution of CML to the total number of clean-up workers with leukemia was higher than the corresponding percentage value in general population examined at the same period (9.17 vs. 6.59%). B-CLL was a predominant form of hematopoietic malignancies in clean-up workers under study (25.68%). Nevertheless, B-CLL percentage in patients of clean-up workers group did not differ significantly from that in the patients of general population. The multiple myeloma percentage (7.79%) in the group of patients belonging to clean-up workers in our study turned out to be twice as much as in the patients of general population (4.0%).
The verified diagnosis of tumors of hematopoietic and lymphoid tissue according to modern classification (EGIL, WHO) could be the prerequisite for further molecular genetic and analytical epidemiology study of leukemias that may be related to Chernobyl NPP accident consequences.
灾难发生20年后，切尔诺贝利清理工人中白血病和恶性淋巴瘤的发病率是否增加这一问题仍存在诸多争议。根据FAB分类和世界卫生组织新分类对造血系统恶性肿瘤的主要形式进行准确诊断，并将这些数据与普通人群的数据进行比较，将有助于评估辐射因素对这类疾病总体发病率的相对影响。
给出了1996 - 2005年诊断的218例切尔诺贝利清理工人造血和淋巴组织恶性疾病的连续病例数据，并与同年龄组2697例普通人群连续患者的数据进行比较。研究了骨髓和外周血细胞的形态学和细胞化学。采用免疫细胞化学技术（APAAP、LSAB - AP）以及针对白细胞谱系特异性和分化抗原的多种单克隆抗体对白血病细胞进行免疫表型分析。
在受研究的清理工人群体中，登记到切尔诺贝利事故发生10 - 20年后出现的各类血液肿瘤疾病，包括骨髓增生异常综合征（MDS）、急性白血病（急性淋巴细胞白血病和急性髓细胞白血病）、慢性粒细胞白血病（CML）和其他慢性骨髓增殖性疾病、慢性淋巴细胞白血病（B - CLL）以及其他B细胞和T细胞起源的慢性淋巴细胞增殖性疾病。清理工人群体患者中MDS的比例往往超过同期接受检查的普通人群组中MDS的比例（4.58%对3.70%）。在34例急性髓细胞白血病病例中，7例患者在患白血病之前患有MDS。慢性粒细胞白血病在清理工人白血病总数中的相对占比高于同期接受检查的普通人群中的相应百分比值（9.17%对6.59%）。B - CLL是受研究的清理工人中造血系统恶性肿瘤的主要形式（25.68%）。然而，清理工人群体患者中B - CLL的比例与普通人群患者中的比例无显著差异。在我们研究的清理工人群体患者中，多发性骨髓瘤的比例（7.79%）是普通人群患者中（4.0%）的两倍。
根据现代分类（EGIL、WHO）对造血和淋巴组织肿瘤进行准确诊断，可能是对可能与切尔诺贝利核电站事故后果相关的白血病进行进一步分子遗传学和分析性流行病学研究的前提条件。
