Yale University School of Medicine and Yale-New Haven Health-Bridgeport Hospital, USA.
Disaster Med Public Health Prep. 2011 Oct;5(3):202-12. doi: 10.1001/dmp.2011.68. Epub 2011 Oct 10.
Hematopoietic syndrome (HS) is a clinical diagnosis assigned to people who present with ≥ 1 new-onset cytopenias in the setting of acute radiation exposure. The World Health Organization convened a panel of experts to evaluate the evidence and develop recommendations for medical countermeasures for the management of HS in a hypothetical scenario involving the hospitalization of 100 to 200 individuals exposed to radiation. The objective of this consultancy was to develop recommendations for treatment of the HS based upon the quality of evidence.
English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to panel members before the meeting and updated during the meeting. Published case series and case reports of individuals with HS, published randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. In cases in which data were limited or incomplete, a narrative review of the observations was made. No randomized controlled trials of medical countermeasures have been completed for individuals with radiation-associated HS. The use of GRADE analysis of countermeasures for injury to hematopoietic tissue was restricted by the lack of comparator groups in humans. Reliance on data generated in nonirradiated humans and experimental animals was necessary.
Based upon GRADE analysis and narrative review, a strong recommendation was made for the administration of granulocyte colony-stimulating factor or granulocyte macrophage colony-stimulating factor and a weak recommendation was made for the use of erythropoiesis-stimulating agents or hematopoietic stem cell transplantation.
Assessment of therapeutic interventions for HS in humans exposed to nontherapeutic radiation is difficult because of the limits of the evidence.
造血综合征（HS）是一种临床诊断，用于诊断在急性辐射暴露情况下出现≥1 种新发生的血细胞减少症的患者。世界卫生组织召集了一组专家，评估证据并制定在假设的情况下对 100 至 200 名暴露于辐射的个体住院治疗 HS 的医疗对策建议。本次咨询的目的是根据证据质量制定 HS 的治疗建议。
在 MEDLINE 和 PubMed 中检索英文文献。检索到的文章的参考文献列表在会议前分发给小组成员，并在会议期间更新。选择了有 HS 个体的病例系列和病例报告、用于治疗非辐射个体的相关干预措施的已发表随机对照试验、辐射动物研究的报告以及主题专家的先前建议。使用分级评估、制订与评价（GRADE）系统提取研究。在数据有限或不完整的情况下，对观察结果进行了叙述性综述。没有针对与辐射相关的 HS 个体的医疗对策的随机对照试验。由于在人类中缺乏对照组，对造血组织损伤的对策进行 GRADE 分析的使用受到限制。必须依赖于在非辐射人类和实验动物中生成的数据。
根据 GRADE 分析和叙述性综述，强烈建议使用粒细胞集落刺激因子或粒细胞巨噬细胞集落刺激因子，弱建议使用促红细胞生成素刺激剂或造血干细胞移植。
由于证据的局限性，评估人类暴露于非治疗性辐射后的 HS 治疗干预措施具有一定难度。
