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Title: THE EXPERTISE OF THE CAUSAL RELATIONSHIP BETWEEN THE DEVELOPMENT OF ARTERIAL HYPERTENSION WITH PARTICIPATION IN WORKS FOR LIQUIDATION OF THE CONSEQUENCES OF CHORNOBYL NPP ACCIDENT IN REMOTE POSTACCIDENTAL PERIOD.
Author: Sushko VO, Tatarenko OM, Kolosynska OO, Hapieienko DD.
Journal: Probl Radiac Med Radiobiol; 2020 Dec; 25():543-557. PubMed ID: 33361860.
Abstract:
UNLABELLED: Loss of health and work ability, as well as deaths from diseases of the circulatory system (DCS), first of all arterialhypertension (AH), due to radiation exposure (RE) in the conditions of Chernobyl catastrophe (ChC) in the performance of professional, military or official duties and / or living on radiation-contaminated areas, additional exposurenot through their own fault but due to a radiation accident, caused the development of a special form of medicalexpertise as part of the of medical social protection system for these suffered contingents. OBJECTIVE: to optimize decision-making criteria for the expert estimation of the casual relationship between development and progression of AH under the influence of RE in clean-up workers of the Chornobyl NPP accident (CWs)in the remote postaccidental period based on the study of odds ratio (OR) of the course of the disease. MATERIAL AND METHODS: A retrospective analysis of the structure of 16073 cases of victims of the Chornobyl NPP(ChNPP) accident, considered by the Central Interagency Expert Commission of Ministry of Health of Ukraine for diseases, reason of disability and death causal relationship to ChNPP accident (CIEC) during 2014-2016, allowed toform a group of 401 cases of CW with AH to determine the OR of the course of the disease. The main group consisted of 330 CWs for whom the development of AH has a causal relationship with the participation in the work for liquidation consequences of the Chornobyl NPP accident (WLAc), the comparison group - 71 CWs in respect of whoma negative expert decision was made. There were not significant differences between both groups of CWs in doseof external radiation exposure (DERE) in the main group - (0.155 ± 0.085) Sv, in CWs of the comparison group -(0.135 ± 0.086) Sv (р = 0.868). RESULTS: In the remote postaccidental period, HSC take the second place (39.62 %) in the structure of medicalexpertise of the causal relationship of the diseases development and progression with RE for all categories of victims of the Chernobyl accident. The share of cases of AH was 28.4% of the total number of cases considered CWs. Inthe structure of cases of relationship of diseases of CWs that led to death, the share of AH was 17.8 %. In CWs themain group the AH developed in (9.4 ± 6.2) years after participation in WLAc, which is on average 6 years earlierthan in the comparison group (р < 0.001). AH in the main group of CWs developed at the age of 5.8 years youngerthan in the comparison group (р = 0.0005). The need for inpatient treatment come 8.6 years earlier (14.6 ± 7.7years) than in CWs comparison group (р < 0.001). At DERE 0,05 Sv and over, increases the probability of developmentand progression of AH that has causal relationship with participation in the WLAc. For medical expertise of thecausal relationship of the AH development and progression with WLAc at DERE 0.20 Sv and over the significant evidence value have the next criteria: terms Somatoform Vegetative (autonomic) Dysfunction (SVD) development(within 3,5 years) and its transformation into AH (within 7 years), verification of the AH diagnosis (within 9,5 years),inpatient treatment for SVD or AH (within 15 years), vascular events (Acute Cerebrovascular Accident - Stroke(ACVA) - within 24 years after participation in the WLAc or 11 years after the AH diagnosed, myocardial infarction(MI) - within 22 years after participation in the WLAc or 10.5 years after the AH diagnosed), the establishment ofpermanent disability. CONCLUSION: Radiation factor has an evidence influence on the development and progression of AH in CWs. Criteria ofthe development and progression of AH in CWs can be used for evidence-based medical expertise for estimation of thecausal relationship of the disease with the WLAc in the remote post accidental period at DERE more than 0.20 Sv. Vtrata zdorov’ia ta pratsezdatnosti, a takozh vypadky smerti cherez khvoroby systemy krovoobigu (KhSK), v pershuchergu arterial'noï gipertenziï (AG), vnaslidok vplyvu radiatsiĭnogo oprominennia (RO) v umovakh Chornobyl's'koïkatastrofy (ChK) pry vykonanni profesiĭnykh, viĭs'kovykh abo sluzhbovykh obov’iazkiv ta/abo prozhyvanni naradioaktyvno zabrudnenykh terytoriiakh, dodatkove oprominennia ne z vlasnoï provyny vnaslidok radiatsiĭnoïavariï, vyklykaly rozroblennia spetsial'noï formy medychnoï ekspertyzy iak chastyny systemy medychnogo sotsial'nogo zakhystu dlia tsykh postrazhdalykh kontyngentiv.Meta: optymizuvaty kryteriï pryĭniattia rishen' shchodo ekspertnoï otsinky prychynnogo zv’iazku rozvytku i progresuvannia AG z vplyvom RO v uchasnykiv likvidatsiï avariï na Chornobyl's'kiĭ AES (ULNA) u viddalenomu pisliaavariĭnomu periodi na osnovi doslidzhennia vidnoshennia shansiv terminiv perebigu zakhvoriuvannia.Material i metody. Retrospektyvnyĭ analiz struktury 16 073 sprav postrazhdalykh vnaslidok avariï na Chornobyl's'kiĭ AES (ChAES), rozglianutykh Tsentral'noiu mizhvidomchoiu ekspertnoiu komisiieiu MOZ Ukraïny z vstanovlennia prychynnogo zv’iazku khvorob, invalidnosti i smerti z diieiu ionizuiuchogo vyprominiuvannia ta inshykh shkidlyvykhchynnykiv vnaslidok avariï na Chornobyl's'kiĭ AES (TsMEK) vprodovzh 2014–2016 rr., dozvolyv sformuvaty grupu z 401 ULNA, khvorykh na AG, dlia vyznachennia vidnoshennia shansiv terminiv perebigu zakhvoriuvannia. Osnovnu grupu sklaly 330 ULNA, dlia iakykh rozvytok AG pov’iazanyĭ z uchastiu v robotakh po likvidatsiï naslidkiv avariï na ChAES(LNA), grupu porivniannia – 71 ULNA, stosovno iakykh buly pryĭniati negatyvni ekspertni rishennia. V ULNA obokh grupdoza zovnishn'ogo oprominennia (DZO) suttievo ne vidriznialas': v osnovniĭ grupi – (0,155 ± 0,085) Zv, v ULNA grupy porivniannia – (0,135 ± 0,086) Zv (r = 0,868).Rezul'taty. U viddalenomu pisliaavariĭnomu periodi KhSK zaĭmaiut' druge mistse (39,62 %) v strukturi medychnoï ekspertyzy prychynnogo zv’iazku rozvytku i progresuvannia zakhvoriuvan' z vplyvom RO shchodo vsikh kategoriĭ postrazhdalykh vnaslidok avariï na ChAES. Chastka vypadkiv AG stanovyla 28,4 % vid zagal'noï kil'kosti rozglianutykh sprav ULNA. U strukturi rozgliadu vypadkiv zv’iazku zakhvoriuvan' v ULNA, shcho pryzvely do smerti, chastka AG stanovyla 17,8 %. V ULNA osnovnoï grupy AG rozvyvalasia cherez (9,4 ± 6,2) rokiv pislia uchasti v LNA, shcho na 6 rokiv ranishe, nizh v osib grupy porivniannia (r < 0,001). AG v osnovniĭ grupi ULNA na ChAES rozvyvalasia u vitsi, na 5,8 roku molodshomu, nizh u grupi porivniannia (r = 0,0005). Neobkhidnist' u statsionarnomu likuvanni vynykala na 8,6 roku ranishe (cherez (14,6 ± 7,7) rokiv), nizh vULNA grupy porivniannia (r < 0,001). Pry DZO bil'she 0,05 Zv zrostaie virogidnist' rozvytku ta progresuvannia AG, pov’iazanoï z uchastiu v robotakh z LNA na ChAES. Dlia medychnoï ekspertyzy prychynnogo zv’iazku rozvytku ta progresuvannia AGz robotamy z LNA na ChAES pry DZO bil'she 0,20 Zv vazhlyve dokazove znachennia maiut' nastupni kryteriï: terminy rozvytku somatoformnoï vegetatyvnoï dysfunktsiï (SVD) (vprodovzh 3,5 roku) i transformatsiï v AG (protiagom 7 rokiv), veryfikatsiï diagnozu AG (vprodovzh 9,5 roku), statsionarnogo likuvannia z pryvodu SVD abo AG (protiagom 15 rokiv), sudynnykh podiĭ (gostrogo porushennia mozkovogo krovoobigu (GPMK) – vprodovzh 24 rokiv pislia uchasti v robotakh z LNA abo11 rokiv pislia vstanovlennia diagnozu AG; infarktu miokarda (IM) – protiagom 22 rokiv pislia uchasti v robotakh z LNAabo cherez 10,5 roku pislia vyznachennia diagnozu AG), vstanovlennia stiĭkoï vtraty pratsezdatnosti (invalidnosti).Vysnovok: Radiatsiĭnyĭ faktor dokazovo vplyvaie na rozvytok i progresuvannia AG v ULNA. Kryteriï rozvytku taprogresuvannia AG v ULNA mozhut' buty vykorystani dlia dokazovoï medychnoï ekspertyzy otsinky prychynnogozv’iazku zakhvoriuvannia z robotamy z LNA na ChAES u viddalenomu pisliaavariĭnomu periodi pry DZO bil'she 0,20 Zv.

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