Radiation victim management and the haematologist in the future: Time to revisit therapeutic guidelines?
Radiation victim management and the haematologist in the future: Time to revisit therapeutic guidelines?
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DOI：
10.3109/09553001003789604
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发表时间：
2010-08-01
影响因子：
2.6
通讯作者：
Herodin, Francis
中科院分区：
文献类型：
--
作者：
Drouet, Michel;Herodin, Francis
目的：对平民人口使用核/辐射装置现在是一种现实的设想。在全身急性暴露超过2格雷（戈伊）的情况下，造血综合征是主要的治疗挑战，而在骨髓抑制患者中经常观察到烧伤和复合损伤。评分和治疗的优化是重要的goals to achieve.Conclusion：欧洲反应类别（RC）的概念是一种尝试，以综合评估血液/ extrahematological辐射诱导的病变。基于在意外/故意辐射中经常观察到的骨髓损伤的异质性，在暴露于低于致死剂量50%（造血[H]评分3-H3）后，使用粒细胞集落刺激因子刺激残留干细胞仍然是治疗标准。异基因干细胞移植适用于骨髓根除（造血评分4-H4）的情况，而髓外毒性可能决定结局。特别是在许多伤员表现出急性放射综合征的情况下，生存因子组合的管理仍然是值得怀疑的，至少作为一种姑息治疗。此外，多效细胞因子注射，如促红细胞生成素和角质细胞生长因子和移植多能间充质干细胞从暴露不足的骨髓区域或脂肪组织-可以提出，以防止多器官衰竭综合征的发展。应准备多学科团队来管理此类患者。
Purpose: The use of nuclear/radiation devices against the civilian population is now a realistic scenario. Haematopoietic syndrome is the primary therapeutic challenge in the case of whole body acute exposure over 2 Grays (Gy) whereas burns and combined injuries would be frequently observed in myelo-suppressed patients. Optimisation of scoring and treatments are important goals to achieve.Conclusion: The European Response Category (RC) concept represents an attempt to integratively assess haematological/ extrahematological radiation-induced lesions. Based on the frequently observed heterogeneity of bone marrow damage in accidental/intentional irradiations, the stimulation of residual stem cells using granulocyte Colony-stimulating factor remains the therapeutic standard after exposure to less than the lethal dose 50 % (Haematopoietic[H] score 3-H3). Allogeneic stem cell transplantation is indicated in case of medullary eradication (Haematopoietic score 4-H4) whereas extramedullary toxicity may determine the outcome. Especially in case of numerous casualties exhibiting acute radiation sydrome, the administration of survival factor combinations remains questionable, at least as a palliative treatment. In addition pleiotropic cytokines injection such as erythropoietin and keratinocyte growth factor and grafting multipotent mesenchymal stem cells from underexposed bone marrow areas or fat tissues -could be proposed to prevent multiple organ failure syndrome development. Multi-disciplinary teams should be prepared to manage such patients.