【摘要】 目的了解钴-60(60Co)源辐射事故对受照者生殖及内分泌功能的远期效应。方法对河南省1999年4月26日60Co源辐射事故6名受照者进行为期15年的生殖及内分泌功能远期效应医学观察。重点询问受照者婚育史及女性月经史;采用彩色多普勒超声诊断仪(以下简称"彩超")检查受照者子宫、卵巢和甲状腺;检测其周围血血清生殖激素和甲状腺功能指标,并检测男性受照者精液常规。结果成年女性"梅"受照后出现放射性闭经,受照后2年子宫和卵巢明显缩小,生殖激素雌二醇和孕酮水平下降,卵泡刺激素(FSH)和黄体生成素(LH)水平升高。8岁男童"旺"受照后随访期间生殖器官发育正常,精液常规和生殖激素水平正常,婚后生育1健康男孩。成年男性"天"、"勇"、"民"和"义"受照后性欲无明显改变,受照后3个月精子均明显减少或缺乏,精子活动率下降,受照后6个月和1年精子均为0,受照后2年开始恢复;受照后1年"天"、"民"、"义"FSH均出现一过性升高,"民"LH出现一过性升高,但该时间点上述4名成年男性受照者睾酮均正常。有5名受照者于受照后15年进行彩超检查,其中"梅"、"天"和"民"检出甲状腺结节,"旺"和"义"甲状腺正常。"梅"受照后11、13和15年促甲状腺素水平升高,三碘甲状腺原氨酸和甲状腺素水平正常;其他5名受照者甲状腺功能正常。结论 60Co源电离辐射可损害受照者生殖能力,导致其甲状腺功能改变。性腺和甲状腺急性放射病患者远期随访观察应重点关注的靶器官。更多还原

【Abstract】 Objective To explore the long-term effects of radiation on reproductive and endocrine function in persons exposed to60 Co in the radiation source accident. Methods Fifteen-year-long long-term medical follow-up observation on the reproductive and endocrine function was performed in six victims exposed to the April 2660 Co radiation accident in Henan province in 1999. 1) Obstetrical history and female menstrual history were particularly inquired; 2) the morphology and size of thyroid gland,uterus and ovary were examined via color Doppler ultrasound; 3) the level of reproductive hormone,thyroid function,and semen routine of male were detected in the radiation accident victims. Results Case Mei,a 38-year-old married female,was observed the amenorrhea induced by radiation 2 years after the exposure. And the obvious shrinkage of uterine and ovarian size, the significantly decreasing sex hormones levels of estradiol and progesterone,and the obviously increasing follicle-stimulating hormone( FSH) and luteinizing hormone( LH),were all found 2 years after the irradiation in the victim. Case Wang,an 8-year-old boy,of whom the development of reproductive organ,semen routine and reproductive hormone levels were all normal after radiation,and a healthy infant boy was born after his marriage. Case Tian,Yong,Min and Yi,were four adult males,of whom no significant change was observed in sexual desire after exposure,but their sperm counts and sperm motility significantly decreased 3 months after the radiation.The sperm number further fell to zero 6 months and 12 months later,and gradually began to recover 2 years after the radiation. Reproductive testosterone hormone levels were all at normal range in the four adult male victims,but the levels of temporarily elevated FSH in Tian,Min and Yi while the levels of temporarily elevated LH in Min were detected 1 year after the exposure. There were 5 victims examined by color Doppler ultrasound 15 years after radiation,Mei Tian and Min were diagnosed as the thyroid nodule,while Wang and Yi were normal. Higher levels of thyroid stimulating hormone( TSH) in Mei were observed at year 11,13,and 15 after irradiation,while T3 and T4 were normal,and normal TSH,T3 and T4 were observed in other 5 cases. Conclusion The60 Co ionizing radiation exposure can damage the victims ’reproductive function and cause the changes of their thyroid gland function. Both the gonads and thyroid gland are important target organs for long-term medical follow-up to patients with acute radiation sickness.更多还原