This standard specifies the diagnostic criteria and treatment principles for acute radiation pneumonitis. This standard applies to the diagnosis and treatment of acute radiation pneumonitis caused by one or multiple high-dose (≥8Gy) irradiation of the lungs within a few days, including radiation accidents, whole-body irradiation in pretreatment of hematopoietic stem cell transplantation, nuclear accidents, and irradiation under nuclear weapon explosion conditions; it can also be used as a reference for the diagnosis and treatment of radiation pneumonitis caused by clinical tumor patients receiving radiotherapy. GBZ 110-2002 Diagnostic Criteria for Acute Radiation Pneumonitis GBZ110-2002 Standard Download Decompression Password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ110-2002
Diagnostic criteria for acute radiation pneumonitis2002—04-08 Issued
Ministry of Health of the People's Republic of China
Implementation on 2002—06-01
Chapters 3 and 4 of this standard are mandatory, and the rest are recommended. This standard is specially formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases. GBZ110-2002
This standard makes necessary provisions for the diagnostic criteria and treatment principles of acute radiation pneumonitis in order to correctly diagnose and treat acute radiation pneumonitis, and serves as a supporting standard for GBZ104-2002 "Diagnostic criteria for acute radiation sickness caused by external irradiation", GBZ106-2002 "Diagnostic criteria for radiation skin diseases", GBZ102-2002 "Diagnostic criteria for radiation-shock combined injuries", GBZ103-2002 "Diagnostic criteria for radiation-burn combined injuries", GBZ99-2002 "Diagnostic criteria for subacute radiation sickness", etc. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. The drafting unit of this standard is the Institute of Radiation Medicine, Academy of Military Medical Sciences. The main drafters of this standard are Peng Ruiyun, Mao Bingzhi, Wang Dewen, Song Liangwen, and Luo Qingliang. The Ministry of Health of the People's Republic of China is responsible for the interpretation of this standard. 1 Scope
Diagnostic criteria for acute radiation pneumonitis
This standard stipulates the diagnostic criteria and treatment principles for acute radiation pneumonitis. GBZ110-2002wwW.bzxz.Net
This standard applies to the diagnosis and treatment of acute radiation pneumonitis caused by one or multiple high-dose (8Gy) irradiation of the lungs within a few days, including radiation accidents, whole-body irradiation in pretreatment of hematopoietic stem cell transplantation, nuclear accidents and irradiation under nuclear weapon explosion conditions; the diagnosis and treatment of radiation pneumonitis caused by clinical tumor patients receiving radiotherapy can also be used as a reference. 2 Terms and Definitions
The following terms and definitions apply to this standard. 2.1 Acute radiation pneumonitis Acute radiation pneumonitis refers to an acute inflammatory disease with interstitial changes in lung tissue as the main lesion after the lungs are irradiated with 8Gy or more (including 8Gy) once or multiple times within a few days.
2.2 Nuclear accident Nuclear accident
A sudden unexpected event or sequence of events caused by a runaway nuclear chain reaction or the uncontrolled escape of radioactive materials. 2.3 Radiation accident Radiation accident A general term for events that lead to or may lead to abnormal radiation conditions when a nuclear device or other radiation source loses control. It is sometimes also used to refer to abnormal radiation events caused by operational errors. 3 Diagnostic principles
It is necessary to conduct a comprehensive analysis based on the history of irradiation, irradiation dose, clinical manifestations, laboratory tests, and auxiliary examinations such as X-rays to exclude lung diseases caused by other factors before a correct diagnosis can be made. 4 Diagnostic criteria
4.1 Diagnostic indicators
The irradiation dose to the lungs is 8Gy or more (including 8Gy). It usually occurs 1 to 6 months after irradiation.
There are clinical symptoms such as cough, chest tightness, chest pain, dyspnea and low fever. Signs: There may be no obvious abnormalities in mild cases, and in severe cases, the breath sounds decrease and dry and wet rales appear. X-ray examinations reveal reticular, irregularly edged, blurred shadows in the irradiated lungs. Laboratory tests may show no obvious abnormalities in mild cases, and in severe cases, WBC increases or decreases. Blood gas analysis shows a decrease in oxygen partial pressure (O2) and an increase in carbon dioxide (CO2) partial pressure. GBZ110-2002
4.1.7 Lung function tests show no abnormality in mild cases, but in severe cases, lung compliance is reduced, accompanied by a decrease in the ratio of pulmonary ventilation to blood perfusion and a decrease in diffusion function.
Reference indicators
A series of physiological, pathological and clinical manifestations of radiation damage to the hematopoietic, immune and digestive systems may be accompanied. 4.2.2
Increased plasma angiotensin I activity.
Increased plasma endothelin I activity.
In plasma and/or lung tissue, tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), intracellular adhesion molecule-1 (ICAM-1) and P and E selectins may increase. 5If necessary, puncture biopsy, bronchial lavage fluid and airway secretion pathological examination can help with diagnosis. 4.2.5
5 Clinical classification standards
5.1 Mild radiation pneumonitis
Mild diagnosis can be basically made if more than two of the following conditions are met. 5.1.1 The lesion is limited in scope or the degree is relatively mild. 5.1.2 The clinical symptoms are mild or not obvious.
5.1.3 No abnormal findings or focal decrease in breath sounds and dry or wet rales are found in the physical examination. 5.1.4 No obvious changes are found in laboratory tests and pulmonary function tests. 5.1.5 X-rays show only a small amount of focal cloud-like shadows in the lungs. 5.2 Severe radiation pneumonitis
Severe diagnosis can be basically made if more than two of the following conditions are met. 5.2.1 The lesion is diffuse or the degree is relatively severe. 5.2.2 There are obvious symptoms of respiratory dysfunction, such as cough, chest tightness, shortness of breath, chest pain and dyspnea. 5.2.3 The breath sounds in the lungs are reduced, and dry or wet rales can be heard. 5.2.4 There may be low fever, increased or decreased white blood cell count. 5.2.5 Pulmonary function tests show obvious respiratory dysfunction, manifested as decreased lung compliance and decreased lung ventilation/blood flow ratio. Blood gas analysis shows decreased oxygen partial pressure and increased carbon dioxide partial pressure. 5.2.6 X-ray signs: Obvious blurred shadows with unclear edges are seen in the lungs, which are in the form of masses, reticles or cords. 6 Differential diagnosis
Acute radiation pneumonia should be differentiated from the following diseases. The key point is to make a comprehensive judgment based on the cause, medical history, clinical manifestations, and multiple examinations.
GBZ110-2002
6.1 Non-radiation pneumonia: including Mycoplasma pneumoniae pneumonia, pneumococcal pneumonia, Staphylococcus pneumonia, Klebsiella pneumonia, and drug-induced interstitial pneumonia caused by certain anticancer drugs such as bleomycin. 6.2 Pulmonary tuberculosis
6.3 Lung tumors: including primary bronchial lung cancer and lung metastatic tumors7
Treatment principles
Once diagnosed with radiation pneumonitis, radiation should be removed in time. Symptomatic treatment such as oxygen inhalation, anti-infection and increased nutrition. Adhere to adrenal cortex hormones to alleviate clinical symptoms and control the progression of the disease7.4
Use cytokines such as interferon to alleviate symptoms and control the disease. Use antioxidants to control the disease.
Inhale an appropriate amount of nitric oxide as soon as possible.
Prevent and control complications as soon as possible.
Apply Chinese medicine for auxiliary treatment appropriately.
Assist in artificial respiration for severe cases.
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