This standard specifies the diagnostic criteria and treatment principles for chronic radiation sickness caused by external exposure. This standard is applicable to occupational radiation workers, and non-occupational radiation workers can also refer to this standard for diagnosis and treatment. GBZ 105-2002 Diagnostic Standard for Chronic Radiation Sickness Caused by External Exposure GBZ105-2002 Standard download decompression password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ105-2002
Diagnostic criteria for chronic radiation sickness from external exposure2002-04-08 Issued
Ministry of Health of the People's Republic of China
Implementation on 2002-06-01
Chapters 4 and 5 of this standard are mandatory, and the rest are recommended. GBZ105-2002
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. In case of any inconsistency between the original standard GB8281-2000 and this standard, this standard shall prevail. The purpose of formulating this standard is to enable personnel who are exposed to long-term continuous or intermittent external radiation exceeding the dose limit to receive timely and correct diagnosis and treatment when their health is damaged, so as to prevent the disease from further developing and promote recovery. Since the promulgation and implementation of GB8281-2000 "Diagnostic Standards and Treatment Principles for Chronic Radiation Sickness Due to External Exposure", certain experience has been accumulated in the diagnosis and treatment of this disease. In the process of implementation, there are also some problems. In combination with the actual situation in my country, it is necessary to revise it again to meet the needs of modernization construction. The appendixes A, B and C of this standard are all informative appendices. This standard is proposed by the Ministry of Health of the People's Republic of China. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. The drafting units of this standard are: Institute of Radiation Medicine, Chinese Academy of Medical Sciences, Sichuan Institute of Labor Health and Occupational Disease Prevention and Control.
The main drafters of this standard are: Chen Ziqi, Wang Jingying, Jia Delin, Xu Xiufeng, Jiang Enhai. This standard is interpreted by the Ministry of Health of the People's Republic of China. 1 Scope
Diagnostic Standards for Chronic Radiation Sickness Due to External Exposure
This standard specifies the diagnostic standards and treatment principles for chronic radiation sickness due to external exposure. GBZ105-2002
This standard applies to occupational radiation workers. Non-occupational radiation-exposed personnel can also refer to this standard for diagnosis and treatment.
2 Normative references
The clauses in the following documents become clauses of this standard through reference in this standard. For any dated referenced document, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, the parties who reach an agreement based on this standard are encouraged to study whether to use the latest versions of these documents. For any undated referenced document, its latest version applies to this standard. GBZ95
GBZ106
GB/T16149
3 Terms and definitions
Diagnostic standards for radiation cataracts
Diagnostic standards for radiation skin diseases
Specifications for dose estimation of chronic radiation sickness caused by external exposure The following terms and definitions apply to this standard. 3.1 Chronic radiation sickness from external exposure Chronic radiation sickness from external exposure is a systemic disease characterized by hematopoietic tissue damage and other systemic changes caused by continuous or intermittent external radiation exposure of radiation workers for a long period of time, which reaches a certain cumulative dose. 4 Diagnostic principles
There is no specific diagnostic indicator for chronic radiation sickness from external exposure. It must be diagnosed based on the exposure history, personal dose records, cumulative doses, clinical manifestations and laboratory tests, combined with health records, and a comprehensive analysis must be conducted to exclude other factors and diseases. 5 Grading diagnostic criteria
Those who meet the following can be diagnosed as Grade I.
5.1.1 There is a history of long-term continuous or intermittent exposure exceeding the dose limit. The legal personal dose record shows that the average annual dose is more than 0.15Gy, or the maximum annual dose is more than 0.25Gy (including 0.25Gy), and the cumulative dose reaches or exceeds 1.5Gy. GBZ105-2002
5.1.2 Before exposure to radiation, the patient was healthy. After several years of exposure, he developed obvious symptoms of asthenia-type neurasthenia. The symptoms wax and wane with the withdrawal and exposure to radiation. 5.1.3 There may be a tendency to bleed.
5.1.4 Before exposure to radiation, the hematopoietic function was normal. After several years of exposure, the blood picture was abnormal after repeated dynamic observation (the blood sampling site should be fixed for self-control). 5.1.4.1 The total number of white blood cells decreased progressively in self-control, and remained below 4.0×10°/L for a long time (6-12 months) after multiple examinations (more than 10 times). It may be accompanied by a long-term platelet count below 80×10/L, a decrease in the number of red blood cells (less than 3.5×102/L for men and less than 3.0×10/2/L for women) and a decrease in the amount of hemoglobin (less than 110g/L for men and less than 100g/L for women).
5.1.4.2 Bone marrow hyperplasia is active or low; or a series of cell production is poor or maturation disorder. 5.1.5 May be accompanied by one of the following system objective examination abnormalities: 5.1.5.1 Reduced immunity
5.1.5.1.1 Those with one of the following abnormalities: a) Reduced humoral immunity;
b) Reduced cellular immunity;
c) Reduced lymphocyte transformation function.
5.1.5.1.2 Susceptible to infection, reduced systemic resistance. 5.1.5.2 Reduced reproductive function
5.1.5.2.1 Male: Any of the following three itemsa) The sperm count in the second test is less than 20×10%L (20 million/ml) in three semen tests: or no one exceeds 40×10%/L (40 million/ml);
b) The percentage of live sperm in the second test is less than 60% in three semen tests; c) The number of sperm with normal morphology in the second test is less than 60% in three semen tests. 5.1.5.2.2 Female: Mainly check the ovarian function, understand whether the ovaries ovulate and the corpus luteum function. For example, check the basal body temperature, vaginal exfoliated cells, cervical mucus, etc. for comprehensive judgment. 5.1.5.3 Decreased adrenal cortex function
5.1.5.3.1 Two of the following abnormalities: a) Decreased plasma cortisol;
b) Decreased 24h urinary 17-hydroxysteroid (17-OHCS) and 17-ketosteroid (17-KS), 5.1.5.3.2 Skin and mucous membrane pigmentation may occur. 5.1.5.4 Decreased thyroid function
GBZ105-2002
Serum T3 and T4 are lower than normal after several tests; thyroid stimulating hormone (TSH) is higher than normal. 5.1.5.5 Metabolism disorder: mainly check protein and sugar metabolism function, 5.1.6 It can be alleviated or recovered after being away from radiation and active treatment. 5.2 Grade I
In addition to Grade I 5.1.1, those who have the following items can be diagnosed as Grade II. 5.2.1 Have more stubborn subjective symptoms and obvious bleeding tendency. 5.2.2 White blood cell count is continuously below 3.0×10°/L; white blood cell count is continuously between 3.0 and 4.0×10/L and platelet count and/or hemoglobin volume are continuously reduced. 5.2.3 Low bone marrow proliferation.
5.2.4 Have one or more abnormalities in 5.1.5 5.2.5 Slow recovery after being separated from radiation and active treatment. 6 Treatment principles
6.1 I degree: separated from radiation, symptomatic treatment with a combination of Chinese and Western medicine, strengthen nutrition, check once a year in the first two years, and then check once every two years. During this period, according to health status, you can participate in non-radioactive work. After recovery, continue to observe for another year. If clinically confirmed to be cured, it will no longer be diagnosed as external irradiation chronic radiation sickness of 1 degree. 6.2 I degree: separated from radiation, hospitalized for active treatment, full rest. Recuperation if necessary, regular follow-up, and comprehensive review once every 1-2 years. Depending on the recovery situation, you may consider participating in non-radioactive work within your ability. 6.3 Treatment and treatment methods shall be handled in accordance with relevant national regulations on occupational diseases. Appendix A
(Informative Appendix)
Radiation reaction and observation subjects
GBZ105-2002
A1 Radiation reaction refers to the short exposure to radiation (usually a few months to 2 years), small radiation dose or short-term overdose, and the occurrence of certain symptoms of asthenia-type neurasthenia; the increase or decrease of the self-control white blood cell count, or the large fluctuation range, and the classification may have an increase in eosinophils or basophils, and there is no other reason to be found. Short-term radiation withdrawal can recover.
A2 Observation subjects refer to those who have been in radiation work for a long time, have been exposed to a certain dose, have certain symptoms of asthenia-type neurasthenia, and have certain changes in laboratory tests, but have not yet reached the diagnostic criteria for external irradiation chronic radiation sickness grade I. Temporarily withdraw from radiation, closely observe, symptomatic treatment and regular follow-up. After one year of observation, diagnosis and treatment are carried out according to the condition.
A3 Radiation reaction and observation subjects are not radiation occupational diseases. Their treatment and handling shall refer to relevant national regulations.
B1 Reference indicators for diagnostic criteria
Appendix B
(Informative Appendix)
Reference indicators for diagnostic criteria and differential diagnosis
GBZ105-2002
B1.1 The chromosomal aberration rate of peripheral blood lymphocytes is significantly increased and/or the micronucleus rate of peripheral blood lymphocytes is significantly increased.
B1.2 Chronic radiation skin damage and/or radiation cataracts are present. B2 Differential diagnosis of chronic radiation sickness caused by external irradiation Changes in the hematopoietic system should be differentiated from chronic benzene poisoning, leukopenia, thrombocytopenia, iron deficiency anemia, aplastic anemia, malnutrition anemia, hypersplenism, etc.; as well as viral infections such as influenza and viral hepatitis; and hematological changes caused by certain drugs and chemicals. Clinical symptoms should be differentiated from diseases such as neurasthenia, inner ear vertigo, and menopausal syndrome. Appendix C
(Informative Appendix)
Instructions for the correct use of this standard
GBZ105-2002
C1 Patients with chronic radiation skin damage and/or radiation cataracts shall be diagnosed and treated in accordance with GBZ106 and/or GBZ95.
For chromosomal aberrations in peripheral blood lymphocytes, it is recommended that units with the necessary conditions perform stable chromosomal aberrations (mainly C2
observe changes in translocation rate). For the micronucleus rate in peripheral blood lymphocytes, it is recommended that units with the necessary conditions perform the culture micronucleus method, preferably the CB micronucleus method. bZxz.net
3 For chronic radiation sickness caused by external irradiation, the dose shall be estimated in accordance with GB/T16149. C3
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