ASSESSMENT OF RADIATION DAMAGE-THE NEED FOR A MULTIPARAMETRIC AND INTEGRATIVE APPROACH WITH THE HELP OF BOTH CLINICAL AND BIOLOGICAL DOSIMETRY
ASSESSMENT OF RADIATION DAMAGE-THE NEED FOR A MULTIPARAMETRIC AND INTEGRATIVE APPROACH WITH THE HELP OF BOTH CLINICAL AND BIOLOGICAL DOSIMETRY
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DOI：
10.1097/hp.0b013e3181b97306
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发表时间：
2010-02-01
期刊：
影响因子：
2.2
通讯作者：
Meineke, Viktor
中科院分区：
文献类型：
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作者：
Riecke, Armin;Ruf, Christian G.;Meineke, Viktor
意外暴露于电离辐射会对生物体的生物组织造成不同程度的损害。根据辐照条件，如辐射的性质、时间和受影响的器官和器官系统，辐射损伤的临床终点和由此产生的急性和慢性辐射综合症可能有很大的不同。暴露情况从纯粹的局部辐射情景和部分身体暴露到全身暴露不等。因此，临床表现从局部辐射损伤到辐射引起的多器官受累和衰竭的极端情况各不相同，需要立即、密集和跨学科的医学治疗。这些完全不同和复杂的临床情况不仅在临床诊断和治疗方面表现出最大的不同，而且由于潜在的生物损伤水平不同，影响的生物指标可能在很大程度上不同。这一事实意味着，只有在考虑到临床和不同的生物指标时，才能对个别患者的辐射损伤程度进行准确评估。在临床指标中，常规实验室参数，如血细胞计数和临床体征和症状的记录（使用METREPOL系统等方法）是关键参数，但双中心测定法（生物剂量测定的金标准）和其他正在开发的方法，如γ-H2 AX焦点测定法或放射敏感基因的基因表达分析，也必须考虑在内。每种方法在不同的情况下提供最佳结果，或者换句话说，存在在特定的暴露条件下或在给定的检查时间下更好地工作的方法（例如，曝光后的时间）。一些方法可以立即显示结果;其他方法需要几天到几周的时间，直到结果可用于临床决策。因此，为了提供最佳的分类和规划基础，并在意外辐射照射后提供医疗，必须采用不同的独立诊断程序，将所有临床方面以及不同的生物指示物结合起来。这种多参数方法是在最近的辐射事故后提出的，但需要在全世界范围内采用和标准化。提出并讨论了一种新的综合概念。健康物理98（2）：160-167; 2010
Accidental exposure to ionizing radiation leads to damage on different levels of the biological organization of an organism. Depending on exposure conditions, such as the nature of radiation, time and affected organs and organ systems, the clinical endpoint of radiation damage and the resulting acute and chronic radiation syndromes may vary to a great extent. Exposure situations range from purely localized radiation scenarios and partial-body exposures to whole-body exposures. Therefore, clinical pictures vary from localized radiation injuries up to the extreme situation of radiation-induced multi-organ involvement and failure requiring immediate, intensive, and interdisciplinary medical treatment. These totally different and complex clinical situations not only appear most different in clinical diagnostic and therapeutic aspects, but also, due to different levels of underlying biological damage, biological indicators of effects may vary to a wide extent. This fact means that an exact assessment of the extent of radiation damage within individual patients can only be performed when taking into consideration clinical as well as different biological indicators. Among the clinical indicators, routine laboratory parameters such as blood counts and the documentation of clinical signs and symptoms (using such methods as the METREPOL system) are the key parameters, but dicentric assay, the gold standard for biological dosimetry, and other methods under development, such as the gamma-H2AX focus assay or gene expression analysis of radiosensitive genes, must also be taken into account. Each method provides best results in different situations, or, in other words, there are methods that work better in a specific exposure condition or at a given time of examination (e.g., time after exposure) than others. Some methods show results immediately; others require days to weeks until results are available for clinical decision-making. Therefore, to provide the best basis for triage and planning and to provide medical treatment after accidental radiation exposure, different and independent diagnostic procedures integrating all clinical aspects as well as different biological indicators have to be applied. This multiparametric approach has been suggested after recent radiation accidents but needs to be adopted and standardized worldwide. A new integrative concept is shown and discussed. Health Phys. 98(2):160-167; 2010