Hematological malignancies among Chernobyl Liquidators

我们发现切尔诺贝利事故后，维捷布斯克地区（1，423，000人口）的清理者中急性白血病的发病率很高。在基辅的乌克兰放射医学中心（主任Bebeshko），Klimenko教授每年检查12万名清算人。它们被设定为低于25 mSv的辐照剂量，然而，据推测，其中一些被暴露超过100 mSv。我参与了对这些清理者的诊断，直到1993年，我发现了141名白血病患者。其中，86例患者被诊断为急性白血病。1993 ~ 1995年共收治恶性血液病42例。急性髓细胞白血病16例，按FAB分型：AMLM 1 2例，AMLM 2 2例，AMLM 3 2例，AMLM 4 5例，AMLM 5 4例。我们发现2例急性淋巴细胞白血病（ALL L2：FAB）。同时发现慢性粒细胞白血病8例，慢性淋巴细胞白血病8例。我们分析了AML病例的DNA，发现由于p53基因突变，p53抑癌基因的外显子5和外显子6缺失。我们调查了居住在第聂伯罗彼得罗夫斯克（21，906人），第聂伯罗彼得罗夫斯克（26，506人）和恰尔科夫（28，314人）地区的清算人中白血病和恶性淋巴瘤的发病率。经性别配对统计分析，发现1986年和1987年的清算人患恶性淋巴瘤的相对危险度分别为0.02和0.05，而1986年和1987年的清算人患恶性淋巴瘤的相对危险度分别为0.35和0.75。根据这些发现，我们认为血液系统恶性肿瘤的发展是依赖于辐射剂量。提示近年来清理人员白血病包括骨髓增生异常综合征的发病率有上升趋势。

We had found high incidence of acute leukemias in liquidators in Vitebsk region (1,423,000 population) after Chernobyl accident. In Ukrainian Center of Radiation Medicine in Kiev (Director Bebeshko), Prof. Klimenko has been examining 120,000 liquidators in every year. They were set to be lower than 25 mSv irradiation dose, however, it was speculated that some of them were exposed more than 100 mSv . I co-investigated to diagnose those liquidators and found 141 patients with leukemia until 1993. Among them, 86 patients were diagnosed as acute leukemia. During from 1993 to 1995, we found 42 patients with hematological malignancies. They were 16 cases of acute myelogenous leukemia, which were classified as AML M1 (2 cases), AML M2 (2 cases), AML M3 (2 cases), AML M4 (5 cases), AML M5 (4 cases) according to FAB classification, respectively. We found 2 cases of acute lymphoblastic leukemia (ALL L2: FAB). We also found 8 patients with chronic myelogenous leukemia and 8 patients with chronic lymphocytic leukemia. We analysed DNA from cases of AML and found that deletion of exon 5 and exon 6 of p53 suppressor oncogene due to p53 gene mutation.We investigated the incidence of leukemias and malignant lymphomas among liquidators living in the regions, Dnepropetrovsk (21,906 person), Dnetsk (26,506), and Charkov (28,314). By sex-matched statistical analysis, we found that the relative risk was 0.02 and 0.05, for liquidators of 1986 and 1987, respectively.The relative risk for malignant lymphomas was 0.35 and 0.75, for 1986 and 1987 liquidators, respectively. On the bases of these findings, we suggest that the development of hematological malignancies is dependent on radiation dose. It is suggested that the incidence of leukemia including myelodysplastic syndrome among liquidators is increasing tendency, recently.