Abstract:
Acute radiation syndrome encompasses a spectrum of pathological manifestations resulting from exposure to high doses of ionizing radiation. This syndrome typically progresses through three stages with a prodromal phase, a latency phase and a critical phase. Each of them varies in intensity and duration depending on the absorbed dose of radiation. Predominantly affecting the bone marrow, skin, and gastrointestinal tract, its clinical implications are profound and multiorgan failure must be considered. Radiation doses below 2 Gray generally result in insignificant clinical consequences, while exposures surpassing 12 Gray exceeds current therapeutic capacities. Survival outcomes for patients within this therapeutic range depend on their ability to withstand radiation-induced aplasia, compounded by an increased risk of bleeding and infection due to skin, gastrointestinal, and potentially combined radiation injuries. Assessing the degree of radiation exposure plays a pivotal role in tailoring patient management strategies and is based on a combination of clinical, biological, and physical parameters. Treatment approaches primarily include intensive hematologic support to manage symptomatic manifestations and etiologic treatment is now based on the administration of growth factors. The role of hematopoietic stem cell transplant (HSCT) will be carefully considered on an individual basis, especially for patients who do not respond following 3 weeks of cytokine therapy. This review highlights the pathophysiological mechanisms, assessment modalities, and therapeutic interventions crucial for managing acute radiation syndrome aiming to optimize patient outcomes and guide clinical practice.
摘要:
急性辐射综合征包括由于暴露于高剂量的电离辐射而导致的一系列病理表现。这种综合征通常进展到三个阶段,一个前驱阶段,延迟阶段和关键阶段。它们中的每一个的强度和持续时间根据辐射的吸收剂量而变化。主要影响骨髓,皮肤,和胃肠道,其临床意义是深远的,必须考虑多器官衰竭。低于2格雷的辐射剂量通常会导致微不足道的临床后果,而超过12格雷的暴露量超过了目前的治疗能力。在此治疗范围内的患者的生存结果取决于他们抵抗辐射诱导的发育不全的能力。由于皮肤出血和感染的风险增加,胃肠,和潜在的联合辐射伤害。评估辐射暴露程度在定制患者管理策略中起着关键作用,并且基于临床,生物,和物理参数。治疗方法主要包括强化血液学支持以控制症状表现,而病因治疗现在基于生长因子的施用。造血干细胞移植(HSCT)的作用将在个人基础上仔细考虑,特别是对于细胞因子治疗3周后无反应的患者。这篇综述强调了病理生理机制,评估方式,和治疗干预措施对于管理急性放射综合征至关重要,旨在优化患者预后和指导临床实践。