Case Report: Medical Treatment And 4 Years Follow-up Of Five Exposed Persons With ¹⁹²Ir Radiation Accident

ObjectiveInformations coming from medical treatment and 4 years follow-up of five exposed persons with 192Ir radiation accident help to research after-effects of ionizing radiation and provide technical preparations for nuclear accident emergency medicine.Methods1. Clinical observation: history taking and physical examination. Key observations include hematopoietic system, skin, eye lens, thyroid, gonads and other radiation-sensitive organizations.2. Dose Estimation: Biological dose was estimated by chromosome aberration analysis of peripheral blood lymphocytes.Physical dose is estimated through on-site simulation and physics calculations.3. Follow-up of indicators of radiation genetics: Including peripheral blood lymphocyte chromosome aberration analysis, G-banding analysis and micronucleus assay.4. Immune function tests: Determination of immunoglobulins and lymphocyte subsets are undergone.5. Endocrine indicators: By radio immunoassay method for measuring serum 3 triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), testosterone (Tes), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and other hormone levels.6. Detection of free radicals: By using superoxide dismutase (SOD) Detection Kit SOD activity is evaluated.7. Detection of gene expression: nm23-H1, GADD45 gene mRNA expression levels is detected though real-time fluorescence reverse transcription- polymerase chain reaction (RT-PCR) and is compared with healthy people.8. Psychological Assessment: Using the Minnesota Multiphasic Personality Inventory questionnaire and the Eysenck emotional stability test assess psychological characteristics of the exposed persons.Results1. The physical dose estimation results: ZXW: body 0.19 ~ 0.26 Gy, the right hand fingers 5.1 ~ 7.7 Gy, the right hypothenar 5 ~ 7.5 Gy, the left hypothenar 5 ~ 7.5 Gy, the left fingers 40 ~ 60 m Gy; CJ: body 0.18 ~ 0.25 Gy, the right hand 2.5 ~ 5.1 Gy, the left hand 0.9 ~ 1.7 Gy; LEJ: body 0.18 ~ 0.25 Gy, the right hand fingers 2.6 ~ 5.2 Gy, the left fingers 40 ~ 60 mGy; ZJT: body 0.12 ~ 0.34 mGy; ZSQ: no physical dose estimation. Biological Dose Estimation results: ZXW body 0.25 (0.083 ~ 0.37) Gy; CJ body 0.29 (0.11 ~ 0.42) Gy; LEJ body 0.20 (0.033 ~ 0.32) Gy; ZSQ body 0.17 (0.045 ~ 0.28) Gy; ZJT: lymphocyte chromosome aberration analysis and micronucleus assay are normal.2. ZXW, CJ, LEJ, ZSQ were diagnosed with overexposure.ZXW, CJ and LEJ had acute radiation skin injury. We take local protection measures for right ZXW, CJ and LEJ and use medicine to improve immune for all exposed persons. The blisters of ZXW remote right index finger is larger, high tension and tenderness. We puncture the blister out of fluide.3. After the accident, ZJT's workplace change, ZSQ retired, they were lost to follow.4. During four-year follow-up, we found that ZXW and CJ feel weakness.Ⅲdegree of acute radiation skin injury of ZXW right index finger and hypothenar became toⅡdegree chronic radiation-induced skin damage,Ⅲdegree of acute radiation skin injury of right hand thumb and I degree of acute radiation skin injury of facial fully restored;Ⅱdegree acute radiation skin injury of LEJ right index finger became toⅠdegree chronic radiation skin injury;3 years after radiation LEJ discovered 5×3cm2 pigmentation below the knee;Ⅱdegree acute radiation skin injury of CJ left hand and right hand fully restored. 5. Radiation Genetics indicators: the initial period after irradiation, ZXW, CJ and LEJ had higher rates of chromosome aberrations and nomal micronucleus rate.After 2 years, 3 human lymphocyte chromosome aberration rate returned to normal. 4 years after irradiation, lymphocyte chromosome G-banding analysis was normal.6. Immune function, endocrine hormone levels and plasma SOD activity: after irradiation, lymphocyte subsets of ZXW and ZSQ was imbalance, 4 years after irradiation, cellular immune function of ZXW, CJ and LEJ was abnormal. After irradiation serum immunoglobulin and thyroid function were normal. 4 years after the accident ZXW, CJ, and LEJ had no significant difference in plasma SOD activity with the control7. 4 years after lymphocytes GADD45 and nm23-H1 gene mRNA level was no statistical difference between exposed persons and 6 healthy persons (p> 0.05).8. Five persons had a certain degree of tension and anxiety. 4 years after irradiation, ZXW, CJ and LEJ were carried out Minnesota Multiphasic Personality Inventory and the Eysenck emotional stability tests, suggesting that CJ is still anxious, nervous; psychology of ZXW and LEJ is in good condition.ConclusionMedical treatment and 4 years follow-up of five exposed persons with 192Ir radiation accident are successful. We need continue to follow up to evaluate late effect of ionizing radiation.