Study On Changes Of Reproductive And Endocrine Function Of A Case Who Was Exposed To �5.7�¹⁹²Ir Source Accident In Nanjing

ObjectiveTo study on the changes of reproductive and endocrine function in a case of mild bone marrow form of acute radiation sickness from external exposure in Nanjing�5.7�¹⁹²Ir source accident,in order to provide experience for diagnosing and treating the related cases in the future.Methods1.Study subject:A patient,hereinafter referred to as�wang�,in Nanjing"5.7"¹⁹² Ir source radiation accident.2.Dose estimation:Three methods,including the yields of dicentrics plus rings,cytokinesis-block micronuclei assay and nucleoplasmic bridge plus FHC,were used to estimate the biological dose.The monte-carlo package was used to reconstruct the physical dose,in order to estimate the local doses of important organs and tissues for�wang�.3.Imaging examinations:B ultrasound examination was used to observe the thyroid of�wang�,MRI examination was used to observe the testicle and epididymis.4.Serum hormone levels:We monitored the thyroid hormones and sex hormones in the serum by electrochemiluminescence with the common clinical instruments,5.Seminal quality analysis:Seminal quality analysis for�wang�was carried out on a regular basis.6.Replacement therapy:Three months after exposure,we gave�wang�androgen replacement therapy,and monitored the hormones in the serum of�wang�.Results1.According to the results of biological dose estimation,the whole body dose of�wang�was about 1.51 Gy,combined with the clinical manifestation,�wang�was diagnosed as mild bone marrow form of acute radiation sickness.According to the results of physical dose estimation,local dose of thyroid illuminated was about 0.03 Gy,local dose of testicular was about 9.16 Gy.2.B ultrasonic examination of the thyroid showed no obvious abnormal morphology and blood flow,MRI scans of the testicle and epididymis showed bilateral hydrocele of tunica vaginalis.3.Four months after exposure,the serum T4 level was decreased and the TSH level was increased,while ten months after exposure,the serum T4 level was decreased to 4.37?g/dl.Eleven months after exposure,the serum T4 level returned to normal,and the serum TSH level was higher than normal all the time.The follow-up results suggested that the thyroid function of�wang�was not abnormal.4.Several great fluctuations were observed in the serum sex hormone levels,and the secretion of several sex hormones was abnormal,three months after exposure,the serum T level achieved the lowest 5.41 ng/dl,after androgen replacement therapy,the serum T level returned to normal range.5.The patient's sperm viability showed a progressive decrease,three months after exposure,the sperm viability decreased to 0%,sperm survival rate did not returned to normal in the follow-up results.ConclusionsExternal exposure from ¹⁹²Ir source can damage the function of gonad and thyroid,and can also affect the reproductive ability of exposed personnel.In physiological condition,the secretion of sex hormones is controlled by the hypothalamus-pituitary-testicular axis,and in pathophysiological condition,it is also influenced by nutritional states and controlling of infection.Androgen replacement therapy is of great importance to improve the survival quality of the patient.