放射性皮肤损伤的临床治疗(文献综述)

随着核能技术的广泛应用,在原子工业生产、辐照加工、医疗和科研等方面使用核能技术的过程中,由于工作人员防护不严,操作失误所引起的事故或放射治疗过程中发生的放射性皮肤损伤病例逐渐增多.因此,有关放射性皮肤损伤的临床治疗越来越为各国有关专家所重视.本文就有关放射性皮肤损伤的临床治疗作一综述,重点讨论严重放射性皮肤损伤的外科处理.     

复方维生素B12治疗放射性与非放射性皮肤损伤的研究

本文观察了复方维生素例水、油, 霜剂治疗放射性(不同时期)及非放射性皮肤损仿386例。其中采B₁₂水剂治疗急性放射性皮肤损伤49例, 非放射性浅I°烧伤50例, 油剂治疗慢性放射性皮肤损伤37例, 非放射性慢性皮肤溃疡75例复方例霜剂对放射及非放射性皮肤损伤恢复期有保护性治疗作用, 该组观察了175例均收到满意的效果。     

细胞早衰对放射性皮肤损伤中伤口愈合的影响及机制研究

医疗照射、职业性暴露、应急照射均可引起放射性皮肤损伤, 相关的研究大多集中在放射性皮肤损伤的预防与治疗措施方面, 但相关分子尚未完全阐明。研究表明, 辐射诱导的细胞早衰在放射性皮肤损伤发生发展中发挥重要作用。本文从放射性皮肤损伤机制及细胞早衰促进放射性皮肤损伤的发生发展, 电离辐射诱导的细胞早衰信号通路, 及细胞早衰在伤口愈合中的作用3个方面进行综述, 探讨辐射诱导的细胞早衰与放射性皮肤损伤的关系。     

康复新液联合美皮康泡沫敷料治疗头颈部肿瘤放疗后的皮肤损伤

头颈部肿瘤由于放疗时间长、剂量大,引起放射性皮肤损伤发生率高,轻者皮肤脱屑、渗液,3~4级放射性皮肤损伤属于较重的皮肤损伤^[1],既增加患者痛苦,又影响疗效。因此,及时有效地治疗3级以上放射性皮肤损伤是首要问题。对头颈部肿瘤放疗致皮肤损伤采用康复新液、美皮康泡沫敷料治疗,取得满意效果,现报道如下。     

实尔新软膏对放射治疗所致皮肤损伤的预防作用

放射治疗是肿瘤治疗的主要手段之一.在放射治疗过程中,放射线除对肿瘤细胞有杀伤作用外,同时对正常组织也有损伤.放射性皮肤损伤尤为多见,是放射治疗中最为常见的并发症之一.因此,许多学者都在努力寻找防治放射性皮肤损伤的有效药物.本研究采用实尔新制剂,观察其对放疗病人放射性皮肤损伤的预防作用.     

肤生软膏对慢性放射性皮肤损伤的治疗作用和毒性实验

肤生软膏对慢性放射性皮肤损伤的治疗作用和毒性实验吴淑荣陈强纪辉慢性放射性皮肤损伤在肿瘤放疗中常见，多为急性损伤治疗无效或处理不当继发感染所致。损伤形成溃疡，周围组织广泛纤维化，局部微循环障碍致使损伤经久不愈。本研究就肤生软膏对慢性放射性皮肤损伤的疗效...     

皮肤放射性损伤治疗42例疗效观察

随着放射性材料的应用及放射性治疗方法的发展,经常看到皮肤放射性损伤患者。现报告我院治疗放射性皮肤损伤的经验如下。1 对象与方法1.1 对象 1986年12月至2003年12月,我院共收治皮肤放射性损伤患者42例,其中男性18例,女性24例。年龄27～64岁,受伤后时间:1个月～16年。其中1例女性因乳腺癌行乳房切除术后放射治     

外照射放射性皮肤损伤救治进展

皮肤在放射生物学中有着特殊的地位,它是接受外照射的必经途径.放射性皮肤损伤具有长期性、持久性、潜在性和进行性作用特征.放射性皮炎治疗手段主要有药物、物理和手术治疗等.该文介绍外照射放射性皮肤损伤救治进展.     

外照射放射性皮肤损伤救治进展

皮肤在放射生物学中有着特殊的地位,它是接受外照射的必经途径.放射性皮肤损伤具有长期性、持久性、潜在性和进行性作用特征.放射性皮炎治疗手段主要有药物、物理和手术治疗等.该文介绍外照射放射性皮肤损伤救治进展.     

MEBO预防核素治疗后放射性皮肤损伤的临床体会

目的 观察湿润烧伤膏（MEBO）预防放射性核素32P敷贴治疗皮肤血管瘤后出现的放射性损伤的临床效果.方法 将100例患儿随机分为两组,治疗组（ MEBO组）50例和对照组（龙胆紫组）50例分别采取换药治疗,比较MEBO处理放射性皮肤损伤和1％龙胆紫外涂处理放射性皮肤损伤的疗效.结论 使用湿润烧伤膏能有效地预防和减少放射性损伤的发生,放射性核素32P敷贴治疗血管瘤的效果较常规处理明显提高了血管瘤的治愈率.     

Mechanisms of radiation-induced skin injury and implications for future clinical trials

Abstract

Purpose: To summarize current knowledge regarding mechanisms of radiation-induced skin injury and medical countermeasures available to reduce its severity. Advances in radiation delivery using megavoltage and intensity modulated radiation therapy have permitted delivery of higher doses of radiation to well-defined tumor target tissues. Although skin is not a radiation dose-limiting tissue, injury to skin poses substantial morbidity risks in the curative treatment of cancers, especially when radiation is administered in combination with chemotherapy. In the continuum of radiation-induced skin injury, late effects are most severe being characterized by sub-cutaneous fibrosis and morbidity. The principal pathogenesis is initiated by depletion of acutely responding epithelial tissues and damage to vascular endothelial microvessels. Emerging concepts of radiation- induced skin injury suggest that the recovery of stromal stem cells and tissue repair remain chronically impaired by long-lived free radicals, reactive oxygen species, and pro-inflammatory cytokines/chemokines resulting in progressive damage after radiation exposure.

Conclusions: As pathways underlying the cellular and molecular mechanisms of radiation-induced skin injury are becoming better understood, novel approaches are being developed for mitigating or treating the associated pathogenesis.     

自制中药油外涂预防放射性皮肤损伤的效果观察

目的：观察自制中药油外涂预防放射性皮肤损伤的效果。方法将99例接受放射治疗的头颈部肿瘤患者按随机数字法分为A组（34例）、B组（33例）、C组（32例）。照射前,A组用自制中药油外涂于照射野皮肤上,照射后继续用药3 d,3次/d,直至放疗结束;B组采用医用射线防护喷剂;C组采用湿润烧伤膏。B组和C组的用药方法均同A组。结果 A组放射性皮肤损伤的发生率为14.7%,B组为21.2%,C组为46.9%,A、B两组之间的差异无统计学意义（χ2＝0.4822,P〉0.05）;A、C两组之间的差异有统计学意义（χ2＝8.0772,P＜0.01）;B、C两组之间的差异有统计学意义（χ2＝4.7786,P＜0.05）。结论自制中药油对放射性皮肤损伤的预防效果同医用射线防护喷剂,明显优于湿润烧伤膏,具有疗效好、操作简单、方便等优点,且价格明显低于医用射线防护喷剂,值得推广应用。     

解毒疏络法对肺癌放疗减毒作用的临床研究

 目的 观察解毒疏络法对肺癌放疗不良反应的影响.方法 设立单纯放疗组(简称对照组)53例,放疗加解毒疏络法组(以下简称治疗组)55例.以放疗后血象、肝肾功能、免疫功能、放射性肺损伤的评定及分级、放射治疗毒性反应、中医疗效评定标准为指标进行临床疗效观察.结果 治疗组血象、肝肾功能、免疫功能、放射性肺损伤的评定及分级、放射治疗毒性反应、中医疗效评定标准优于对照组(P＜0.05).结论 解毒疏络法可一定程度地减轻放疗的不良反应.     

Investigations of antioxidant-mediated protection and mitigation of radiation-induced DNA damage and lipid peroxidation in murine skin

Abstract

Purpose: Radioprotection and mitigation effects of the antioxidants, Eukarion (EUK)-207, curcumin, and the curcumin analogs D12 and D68, on radiation-induced DNA damage or lipid peroxidation in murine skin were investigated. These antioxidants were studied because they have been previously reported to protect or mitigate against radiation-induced skin reactions.

Methods: DNA damage was assessed using two different assays. A cytokinesis-blocked micronucleus (MN) assay was performed on primary skin fibroblasts harvested from the skin of C3H/HeJ male mice 1 day, 1 week and 4 weeks after 5 Gy or 10 Gy irradiation. Local skin or whole body irradiation (100 kVp X-rays or caesium (Cs)-137 γ-rays respectively) was performed. DNA damage was further quantified in keratinocytes by immunofluorescence staining of γ-histone 2AX (γ-H2AX) foci in formalin-fixed skin harvested 1 hour or 1 day post-whole body irradiation. Radiation-induced lipid peroxidation in the skin was investigated at the same time points as the MN assay by measuring malondialdehyde (MDA) with a Thiobarbituric acid reactive substances (TBARS) assay.

Results: None of the studied antioxidants showed significant mitigation of skin DNA damage induced by local irradiation. However, when EUK-207 or curcumin were delivered before irradiation they provided some protection against DNA damage. In contrast, all the studied antioxidants demonstrated significant mitigating and protecting effects on radiation-induced lipid peroxidation at one or more of the three time points after local skin irradiation.

Conclusion: Our results show no evidence for mitigation of DNA damage by the antioxidants studied in contrast to mitigation of lipid peroxidation. Since these agents have been reported to mitigate skin reactions following irradiation, the data suggest that changes in lipid peroxidation levels in skin may reflect developing skin reactions better than residual post-irradiation DNA damage in skin cells. Further direct comparison studies are required to confirm this inference from the data.     

放射性皮肤纤维化的研究进展

放射性皮肤纤维化是电离辐射作用于皮肤组织后的晚期效应,是放射性核事故和肿瘤放疗等之后常见的晚期并发症,严重影响患者的生活质量。放射性皮肤纤维化表现为皮肤外观的改变、皮肤弹性消失与挛缩、皮肤坚硬难以捏起折痕,可伴发毛细血管扩张、疼痛与瘙痒,部分患者甚至会发生进展性的纤维化,反复出现皮肤感染。目前关于放射性皮肤纤维化的发生机制尚不完全清楚,也缺乏针对性的救治手段及有效治疗药物。因此,深入探索电离辐射所致放射性皮肤纤维化的机制,寻找更有效的防治手段显得尤为重要。笔者就放射性皮肤纤维化的影响因素、临床表现、发生机制及其治疗方法等进行综述,并对其发展进行展望,旨在为放射性皮肤纤维化的研究提供参考。     

The effect of oxidized low-density lipoprotein (ox-LDL) on radiation-induced endothelial-to-mesenchymal transition

Abstract

Purpose: Radiation-induced cardiovascular disease is a potentially severe side-effect of thoracic radiotherapy treatment. Clinically, this delayed side-effect presents as a form of accelerated atherosclerosis several years after irradiation. As general endothelial dysfunction is known to be an initiating event in radiation-induced vascular damage, we examined the effects of radiation on endothelial cells in radiation-induced atherosclerosis.

Materials and methods: The effects of radiation on human aortic endothelial cells (HAoEC) were assessed by immunoblotting and immunofluorescence assays. Radiation-induced phenotypic changes of endothelial cells (ECs) were examined using atherosclerotic tissues of irradiated apoprotein E null (ApoE^?/?) mice.

Results: Radiation induced the HAoEC to undergo phenotypic conversion to form fibroblast-like cells, called the endothelial-to-mesenchymal transition (EndMT), which leads to the upregulation of mesenchymal cell markers such as alpha-smooth muscle actin (α-SMA), fibroblast specific protein-1 (FSP-1), and vimentin, and downregulation of endothelial cell-specific markers such as CD31 and vascular endothelial (VE)-cadherin. Furthermore, compared with low-density lipoprotein (LDL), oxidized low-density lipoprotein (ox-LDL) significantly augmented radiation-induced EndMT in HAoEC. These fibrotic phenotypes of ECs were found in atherosclerotic tissues of irradiated ApoE^?/? mice with increased levels of ox-LDL.

Conclusions: Taken together, these observations suggest that ox-LDL accelerates radiation-induced EndMT and subsequently contributes to radiation-induced atherosclerosis, providing a novel target for the prevention of radiation-induced atherosclerosis.     

Therapy for prevention and treatment of skin ionizing radiation damage: a review

Abstract

Radiologic accidents or terrorist acts involving radioactive material, as well as radiation exposure in medical or industrial procedures are potential sources of risk for human health. All these risks share a common element, exposure to ionizing radiation. The extent of ionizing radiation injury will depend on a number of independent variables such as dose, type of radiation and tissue, etc. As a result of ionizing radiation exposure, biological effects can take place in acute or long-term manner. As in the case of other self-renewing tissues (e.g. hematopoietic system and intestinal epithelium), skin is also extremely sensitive to ionizing radiation. In this way, appropriate management of radiation skin effects might improve the therapeutic benefit of medical radiation therapy, as well as reduce the mortality associated with any radiological incident (e.g. accident or terrorist attack). For this reason, current and potential future treatment approaches for skin radiation injury are reviewed in this work. Unfortunately, there is no sufficient evidence for establishing a standard treatment to prevent or mitigate radiation-induced cutaneous injury. Thus, continued research is necessary to achieve effective therapies to address this important health problem.     

放射性皮肤损伤的治疗进展

人体暴露于电离辐射后会引发各个组织器官的损伤,其中,皮肤是人体最先暴露于射线的器官,其损伤的机制和治疗是研究的热点。放射性皮肤损伤（RISI）最常见于放疗后,还可见于核工业生产、放射性实验室和工业探伤等意外核事故。RISI形成后影响患者的健康状况和生活质量,严重者会威胁患者的生命健康。然而,到目前为止,对于RISI尚无...     

Apoptotic Response of Irradiated T-Lymphocytes

BACKGROUND: Evaluation of radiation-induced apoptosis in T-lymphocytes was developed for human medicine in order to predict the sensitivity of individual patients to radiation therapy and has regular use in cases of suspected hypersensitivity. A major goal of the present study was to evaluate the usefulness of the apoptosis assay in veterinary medicine for application in radiation sensitivity testing. The main goal was to examine potential changes in sensitivity of T-lymphocytes to radiation-induced apoptosis during the course of radiation treatment. This is a clear example of the advantageous use of spontaneous canine tumors to augment human cancer research. MATERIAL AND METHODS: Blood was collected in heparin tubes, diluted 1 : 10 in RPMI medium, irradiated with X-rays and incubated for 48 h. T-lymphocytes were labeled using FITC-conjugated antibodies, erythrocytes were lysed, and DNA stained with propidium iodide. For cell analysis, a Becton Dickinson FACScan flow cytometer was used. Radiation-induced apoptosis in T-lymphocytes was quantified. Blood samples from tumor-bearing dogs were taken before the first fraction and at the end of radiation therapy. RESULTS: Apoptosis in lymphocytes is dependent on donor age and donor weight. Tumor-bearing dogs when compared with healthy dogs showed no significant differences in levels of induced apoptosis. No significant changes were seen in the levels of radiation-induced apoptosis in blood taken before, during, or after radiation therapy. CONCLUSION: The leukocyte apoptosis assay can be successfully applied to canine patients, and a wide spectrum of sensitivities to radiation-induced apoptosis is observed. The sensitivity of a patient's peripheral blood T-lymphocytes to radiation-induced apoptosis does not change as a result of the trauma of radiotherapy during the course of tumor treatment.     

Systemic effects of ionizing radiation at the proteome and metabolome levels in the blood of cancer patients treated with radiotherapy: the influence of inflammation and radiation toxicity

Purpose: Blood is the most common replacement tissue used to study systemic responses of organisms to different types of pathological conditions and environmental insults. Local irradiation during cancer radiotherapy induces whole body responses that can be observed at the blood proteome and metabolome levels. Hence, comparative blood proteomics and metabolomics are emerging approaches used in the discovery of radiation biomarkers. These techniques enable the simultaneous measurement of hundreds of molecules and the identification of sets of components that can discriminate different physiological states of the human body. Radiation-induced changes are affected by the dose and volume of irradiated tissues; hence, the molecular composition of blood is a hypothetical source of biomarkers for dose assessment and the prediction and monitoring of systemic responses to radiation. This review aims to provide a comprehensive overview on the available evidence regarding molecular responses to ionizing radiation detected at the level of the human blood proteome and metabolome. It focuses on patients exposed to radiation during cancer radiotherapy and emphasizes effects related to radiation-induced toxicity and inflammation.

Conclusions: Systemic responses to radiation detected at the blood proteome and metabolome levels are primarily related to the intensity of radiation-induced toxicity, including inflammatory responses. Thus, several inflammation-associated molecules can be used to monitor or even predict radiation-induced toxicity. However, these abundant molecular features have a rather limited applicability as universal biomarkers for dose assessment, reflecting the individual predisposition of the immune system and tissue-specific mechanisms involved in radiation-induced damage.