Chelyabinsk State University, Chelyabinsk, Russia
Russian Federation
Purpose: To describe early symptoms of chronic radiation syndrome (CRS) which is of utmost importance for diagnosing this rare radiation pathology in man. Material and methods: The paper presents the findings of retrospective analysis of early clinical manifestations of chronic radiation syndrome (CRS) based on the data of a long-term medical follow up of the residents of the Techa riverside communities. Mean doses of postnatal exposure to red bone marrow in patients with CRS calculated with TRDS-2016D were 698.8±18.2 mGy, maximum doses were 3 603.9 mGy. Results: Clinical picture of the CRS at the early stage was characterized by a set of non-specific changes including hematological, immune, neurological, and endocrine ones, as well as impairment of functions of a number of internal organs. The above-mentioned CRS symptoms developed in a certain sequence and depended on dose rate and absorbed dose to the organs. Prior to the development of a full-scale CRS clinical picture patients had a decrease in olfactory and taste thresholds, in vibration sensitivity, and changes in systemic immunity. Impairment of hematopoiesis, nervous and endocrine systems were also noted even at the early stage of CRS. Initial CRS changes were moderate and transient. The analysis of early CRS symptoms allows assuming that early CRS stage is a dysregulation pathology that is caused initially by radiation-induced disorders of immunohematopoiesis, nervous and endocrine systems. Visceral changes at the early CRS stage are secondary and functional. If exposure is terminated, they are reversible. However, if exposure continues at doses high enough to cause morphological changes in organs and tissues (dystrophy, fibrosis, hypoplasia, etc.), CRS course worsens and becomes irreversible. Conclusion: It was demonstrated that CRS diagnosis at the early stage is very complicated. The key issue is to analyze the relationship of specific CRS symptoms development and dose rate and absorbed organ doses.
chronic radiation syndrome, diagnosis, symptoms, dose, dose rate
1. Gus'kova A.K. Hronicheskaya luchevaya bolezn' ot ravnomernogo oblucheniya // V kn.: «Radiacionnye porazheniya cheloveka». M.: Slovo. 2007. S. 85-102.
2. Kurshakov N.A. Hronicheskaya luchevaya bolezn' // Byulleten' radiacionnoy mediciny. 1956. № 4. S. 3-20.
3. Glazunov I.S., Blagoveschenskaya V.V., Malahova V.V. Osnovnye itogi nauchnyh issledovaniy po radiacionnoy nevrologii // Byulleten' radiacionnoy mediciny. 1959. № 1a. S. 3-15.
4. Baysogolov G.D., Springish V.N. Funkcional'noe sostoyanie krovetvoreniya v periode posledstviy hronicheskoy luchevoy bolezni // Byulleten' radiacionnoy mediciny. 1960. № 1a. S. 96-98.
5. Kireev P.M. Osobennosti klinicheskogo techeniya hronicheskoy luchevoy bolezni v zavisimosti ot haraktera radiacionnogo vozdeystviya // Byulleten' radiacionnoy mediciny. 1962. № 2a. S. 6-10.
6. Akleev A.V. Hronicheskiy luchevoy sindrom u zhiteley pribrezhnyh sel reki Techa. Chelyabinsk: Kniga. 2012. 464 s.
7. Akleuev A.V. Chronic radiation syndrome. Berlin Heidelberg: Springer; 2014. 410 r.
8. Glagolenko Yu.V., Drozhko E.G., Mokrov Yu.G. i soavt. Vosstanovlenie parametrov istochnika sbrosov zhidkih radioaktivnyh othodov radiohimicheskogo proizvodstva v r. Techa. Soobschenie 1. Razrabotka metodiki i osnovnye rezul'taty // Voprosy radiacionnoy bezopasnosti. 2008. Spec. vyp. S.76-91.
9. Marey A.N. K voprosu o predel'nyh urovnyah soderzhaniya stronciya-90 v organizme cheloveka // Byulleten' radiacionnoy mediciny. 1961. № 2a, S. 25-39.
10. Kossenko M.M., Akleyev A.V., Degteva M.O., et al. Analysis of chronic radiation sickness cases in the population in the Southern Urals. Bethesda: AFRRI. 1994. 91 p.
11. Degteva M.O., Napier B.A., Tolstykh E.I., et al. Enhancements in the Techa river dosimetry system: TRDS-2016D code for reconstruction of deterministic estimates of dose from environmental exposures // Health Phys. 2019. Vol. 117. No. 4. P. 378-387.
12. Alekseeva O.G., Vyalova N.A., Grebeneva A.A. i soavt. Klinika hronicheskoy luchevoy bolezni, vyzvannoy produktami deleniya urana // Byulleten' radiacionnoy mediciny. 1962. № 1a. S. 108-112.
13. Muksinova K.N. Kletochnye i molekulyarnye osnovy perestroyki krovetvoreniya pri dlitel'nom radiacionnom vozdeystvii. M.: Energoatomizdat. 1990. 161 s.
14. Ivanov V.A., Severin S.F., Yarcev E.I. i soavt. Sostoyanie zdorov'ya lyudey v blizhayshie gody posle prekrascheniya kontakta s produktami deleniya urana // Byulleten' radiacionnoy mediciny. 1963. № 3a. S. 78-85.
15. Alekseeva O.G., Vyalova N.A., Grebeneva A.A. i soavt. Dinamicheskoe nablyudenie za sostoyaniem zdorov'ya lyudey, podvergshihsya vozdeystviyu produktov deleniya urana // Byulleten' radiacionnoy mediciny. 1963. № 1a. S. 47-52.
16. Ivanov V.A. Rezul'taty medicinskogo nablyudeniya za lyud'mi, podvergshimisya vozdeystviyu produktov deleniya urana // Byulleten' radiacionnoy mediciny. 1971. № 2. S. 12-20.
17. Ivanov V.A. Rezul'taty medicinskogo nablyudeniya za lyud'mi, prozhivavshimi v rayonah, zagryaznennyh produktami deleniya. M.: Diss. dokt. med. nauk. 1968. 544 s.
18. Akleev A.V., Kosenko M.M. Obobschenie rezul'tatov mnogoletnego izucheniya immuniteta u obluchennogo naseleniya Yuzhnogo Urala // Immunologiya. 1991. №.6. S. 4-7.
19. Vyalova N.A. K voprosu ob izmeneniyah krovi u lyudey, imeyuschih kontakt s poloniem -210 // Byulleten' radiacionnoy mediciny. 1959. № 3a. S. 59-63.
20. Mediko-biologicheskie i ekologicheskie posledstviya radioaktivnogo zagryazneniya reki Techi / Pod red. A.V. Akleeva, M.F. Kiseleva. M: Medbioekstrem.2001. 531s.
21. Akleev A.V., Akleev A.A., Andreev S.S. i soavt. Posledstviya radioaktivnogo zagryazneniya reki Techi. Pod red. A.V. Akleeva. Chelyabinsk: Kniga. 2016. 390s.
22. Verbenko A.A., Chusova V.N. Ob izmeneniyah v polovoy sfere zhenschin pri hronicheskoy luchevoy bolezni // Byulleten' radiacionnoy mediciny. 1967. № 3. S. 67-74.
23. Ostroumova E.V. Osobennosti klinicheskogo techeniya i ishodov hronicheskoy luchevoy bolezni u lic, podvergshihsya dlitel'nomu radiacionnomu vozdeystviyu v ante- i postnatal'nom periodah. Tyumen': Diss. kand. med. nauk. 2004. 154 s.
24. Akleyev A.V. Normal tissue reactions to chronic radiation exposure in man // Radiation Protection Dosimetry. 2016. Vol. 171. No. 1. R. 107-116.
25. Osovec S.V., Azizova T.V., Bannikova M.V. Ocenka vliyaniya dozovyh harakteristik na period formirovaniya i dlitel'nost' hronicheskoy luchevoy bolezni // Medicinskaya radiologiya i radiacionnaya bezopasnost'. 2011. T. 56. № 4. S.17-23.
26. Akleyev A.V., Kossenko M.M., Silkina L.A., et al. Health effects of radiation incidents in the Southern Urals // Stem Cells. 1995. Vol. 13. No. 1. P. 58-68.
27. Akleev A.V. Hronicheskiy luchevoy sindrom u naseleniya basseyna reki Techa // Radiacionnaya biologiya. Radioekologiya. 2015. T. 55. № 5. S. 453-466.
28. Akleev A.V., Akushevich I.V., Dimov G.P. i soavt. Reakcii krovetvornoy sistemy na hronicheskoe obluchenie u zhiteley pribrezhnyh sel reki Techi // Medicinskaya radiologiya i radiacionnaya bezopasnost'. 2011. T. 56. № 5. S. 10-20.
