Nikiforov Y, Gnepp D R, Fagin J A
Division of Endocrinology, Cedars-Sinai Medical Center, University of California School of Medicine, Los Angeles 90048, USA.
J Clin Endocrinol Metab. 1996 Jan;81(1):9-14. doi: 10.1210/jcem.81.1.8550800.
Eight years after the Chernobyl nuclear accident, the most obvious effect is manifested by an increase in the prevalence of thyroid gland diseases in the exposed children and adolescents. In this study, we describe a comparative analysis of epidemiological, clinical, and morphological features of 92 malignant and 59 benign thyroid lesions from patients 5-18 yr of age exposed to radiation in Belarus as a result of the Chernobyl disaster. All of them were operated at the same institution during the period from September 1991 through December 1992. The highest number of patients that subsequently developed thyroid carcinomas was in the group that was less that 1 yr of age at the time of Chernobyl, and this number decreased progressively through age 12 yr. Conversely, none of the patients with benign lesions only was less than 2 yr old at the time of the accident, and an exposure age of 5-6 yr was a threshold separating significant prevalence of malignant tumors in younger children from the more frequent benign lesions in older patients (P < 0.001). Fifty-two percent of children with carcinomas and only 24% with benign lesions (P < 0.005) were residents of the Gomel region, which is the most contaminated in Belarus. The morphology of thyroid tissue adjacent to carcinomas showed a high prevalence of multinodular and diffuse changes, but not of adenomas or solitary adenomatoid nodules. There was a high prevalence of focal micropapillary hyperplasia with graded degrees of severity, which we hypothesize may correspond to precursors for papillary thyroid carcinoma in post-Chernobyl radiation-associated tumors.
切尔诺贝利核事故发生八年后，最明显的影响表现为受辐射的儿童和青少年甲状腺疾病患病率上升。在本研究中，我们描述了对92例恶性和59例良性甲状腺病变的流行病学、临床和形态学特征的对比分析，这些病变来自白俄罗斯因切尔诺贝利灾难而受辐射的5至18岁患者。他们均于1991年9月至1992年12月期间在同一机构接受手术。切尔诺贝利事故发生时年龄小于1岁的人群中，随后发生甲状腺癌的患者数量最多，且这一数量在12岁前逐渐减少。相反，仅患有良性病变的患者在事故发生时均不小于2岁，5至6岁的暴露年龄是一个阈值，将年幼儿童中恶性肿瘤的高患病率与年长患者中更常见的良性病变区分开来（P<0.001）。患有癌症的儿童中有52%，而患有良性病变的儿童中只有24%（P<0.005）是戈梅利地区的居民，该地区是白俄罗斯污染最严重的地区。癌旁甲状腺组织的形态显示多结节和弥漫性改变的患病率很高，但腺瘤或孤立性腺瘤样结节的患病率不高。存在严重程度分级的局灶性微乳头增生的高患病率，我们推测这可能与切尔诺贝利事故后辐射相关肿瘤中甲状腺乳头状癌的前体相对应。
