γ-H2AX Foci as a Biomarker for Patient X-Ray Exposure in Pediatric Cardiac Catheterization Are We Underestimating Radiation Risks?
γ-H2AX Foci as a Biomarker for Patient X-Ray Exposure in Pediatric Cardiac Catheterization Are We Underestimating Radiation Risks?
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DOI：
10.1161/circulationaha.109.880385
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发表时间：
2009-11-10
期刊：
影响因子：
37.8
通讯作者：
Thierens, Hubert
中科院分区：
文献类型：
--
作者：
Beels, Laurence;Bacher, Klaus;Thierens, Hubert
背景-鉴于儿童对X射线的广泛使用和较高的放射敏感性，有必要更好地了解儿童介入心脏病学中患者的X射线剂量和相关的辐射风险。在本研究中，伽马-H_2AX焦点被用作辐射诱导效应的生物标志物。根据辐射防护中常用的线性无阈值模型和伽马-H_2AX焦点数据，评估患者的特定剂量并估计辐射风险。方法和结果-49例先天性心脏病患儿(中位年龄，0.75岁)在手术前和手术后不久采集血样。外周血T淋巴细胞检测γ-H_2AX灶。在每个患者中，观察到伽马-H_2AX病灶的净增加，代表由介入性X射线引起的DNA双链断裂。此外，还进行了针对患者的蒙特卡罗模拟，得出了个体血液、器官和组织的剂量。伽马-H_2AX焦点与血液剂量的关系图表明，低剂量超敏反应。根据国际放射防护委员会60号和103号出版物计算的有效剂量中位数分别为5.6和6.4毫西弗。根据线性无阈值模型和伽马-H_2AX焦点数据计算了癌症死亡的终生归因风险。这导致接受研究的患者群体的终身归因危险值分别为1‰和4‰。结论-伽马-H_2AX病灶作为DNA损伤的生物标志物表明，根据线性无阈值假设估计的辐射风险可能被低估了。应非常小心，最大限度地减少和优化患者的辐射暴露。(发行量。2009年；120：1903-1909。)
Background-A better knowledge of patient x-ray dose and the associated radiation risk in pediatric interventional cardiology is warranted in view of the extensive use of x-rays and the higher radiosensitivity of children. In the present study, gamma-H2AX foci were used as a biomarker for radiation-induced effects. Patient-specific dose was assessed and radiation risks were estimated according to the linear-no-threshold model, commonly used in radiation protection, and the gamma-H2AX foci data.Methods and Results-In 49 pediatric patients (median age, 0.75 years) with congenital heart disease who underwent cardiac catheterization procedures, blood samples were taken before and shortly after the procedure. gamma-H2AX foci were determined in peripheral blood T lymphocytes. In each patient, a net increase in gamma-H2AX foci, representing DNA double-strand breaks induced by interventional x-rays, was observed. In addition, a patient-specific Monte Carlo simulation of the procedure was performed, resulting in individual blood, organ, and tissue doses. Plotting of gamma-H2AX foci versus blood dose indicated a low-dose hypersensitivity. Median effective doses calculated according to the International Commission on Radiological Protection 60 and 103 publications are 5.6 and 6.4 mSv, respectively. The lifetime-attributable risk of cancer mortality was calculated from the linear-no-threshold model and the gamma-H2AX foci data. This resulted in lifetime-attributable risk values of 1 per thousand and 4 per thousand, respectively, for the patient population under study.Conclusions-gamma-H2AX foci as a biomarker for DNA damage indicate that radiation risk estimates according to the linear-no-threshold hypothesis are possibly underestimates. Great care should be taken to minimize and optimize patient radiation exposure. (Circulation. 2009;120:1903-1909.)