Baranov A E, Selidovkin G D, Butturini A, Gale R P
Institute of Biophysics, Moscow, Russia.
Blood. 1994 Jan 15;83(2):596-9.
Considerable data suggest that very high doses of acute total body radiation destroy most hematopoietic stem cells and that recovery is possible only after a bone marrow transplant. We review data from a radiation accident victim exposed to about 10-Gy or more acute total body radiation. Total dose and uniformity of distribution were confirmed by physical measurements (paramagnetic resonance), computer simulation, and biologic dosimetry (granulocyte kinetics and cytogenetic abnormalities). Treatment consisted of supportive measures, transfusions, and hematopoietic growth factors (granulocyte-macrophage colony-stimulating factor and interleukin-3). Hematopoietic recovery occurred slowly. Granulocytes were detectable throughout the postexposure period, exceeding 0.5 x 10(9)/L by day 37. There was slower and incomplete recovery of red blood cells and platelets. Increases in blood cell production were paralleled by morphologic changes in bone marrow biopsies. Gastrointestinal toxicity was moderate. Death from a probable radiation pneumonitis infection occurred on day 130. These data indicate the possibility of hematopoietic recovery after approximately 10 Gy or more acute total body radiation without a transplant. They also suggest that lung rather than gastrointestinal toxicity may be dose-limiting under these circumstances.
大量数据表明，极高剂量的急性全身辐射会破坏大多数造血干细胞，只有在进行骨髓移植后才有可能恢复。我们回顾了一名辐射事故受害者的数据，其遭受了约10戈瑞或更高剂量的急性全身辐射。通过物理测量（顺磁共振）、计算机模拟和生物剂量测定（粒细胞动力学和细胞遗传学异常）确定了总剂量和分布均匀性。治疗包括支持性措施、输血和造血生长因子（粒细胞-巨噬细胞集落刺激因子和白细胞介素-3）。造血功能恢复缓慢。在整个暴露后期间均可检测到粒细胞，到第37天时超过0.5×10⁹/L。红细胞和血小板的恢复较慢且不完全。血细胞生成的增加与骨髓活检的形态学变化平行。胃肠道毒性为中度。在第130天死于可能的放射性肺炎感染。这些数据表明，在不进行移植的情况下，遭受约10戈瑞或更高剂量急性全身辐射后造血功能有可能恢复。它们还表明，在这些情况下，肺部毒性而非胃肠道毒性可能是剂量限制因素。
