鼻咽癌患者放疗致后组颅神经损伤综合治疗的临床研究

Comprehensive treatment of radiation-induced lower cranial neuropathy in patients with nasopharyngeal carcinoma： a clinical analysis

目的探讨甲基强的松龙、鼠神经生长因子以及高压氧治疗鼻咽癌患者放射治疗后出现的放射性后组颅神经损伤的疗效。方法将鼻咽癌放射治疗后有放射性后组颅神经损伤的50例患者按照随机数字表法分为2组。治疗组25例给予甲基强的松龙60～80mg静脉滴注，持续10d后逐渐减量；给予鼠神经生长因子（金路捷）20μg肌肉注射，每天1次，连用28d；高压氧治疗10次；乙酰谷酰胺500mg静脉滴注，每天1次，连用28d。对照组25例给予维乐生2片，每天3次，连用45d；复方丹参片3片，每天3次，连用45d。结果治疗组总有效率96％，对照组总有效率12％．治疗组优于对照组，差异有统计学意义（P〈0．05）。治疗组中未行化疗以及损伤症状持续时间越短者疗效好，与行化疗和持续时间越长者比较，差异有统计学意义（P〈0．05）。结论甲基强的松龙、鼠神经生长因子以及高压氧治疗等联合应用能较有效地改善鼻咽癌放射性后组颅神经损伤的症状，其疗效与症状持续时间的长短以及有无配合化疗有关，对早期损伤者建议积极治疗。

Objective To evaluate the therapeutic effect of comprehensive treatments for radiation-induced lower cranial neuropathy in patients with nasopharyngeal carcinoma （NPC）. Meathods Fifty NPC patients with radiation-induced lower cranial neuropathy were randomly divided into comprehensive treatment group and control group. In the former group, the 25 patients received 10 sessions of hyperbaric oxygen treatment in addition to intravenous infusion of methyprednisolone （60-80 mg, once daffy for 10 consecutive days） and aceglutamide （500 mg, once daily for 28 days）, with also intramuscular injection of mouse nerve growth factor at the daily dose of 20 μg for 28 days. The 25 patients in the control group were given 2 compound vitamine B tablets and 3 compound Denshen tablets three times a day for 45 days. Results The excellent effect, improvement, non-response, and exacerbation rates in the comprehensive treatment group were 24%, 72%, 4%, and 0%, as compared to the rates of 0%, 12%, 80%, and 8% in the control group, respectively. The overall response rate in the comprehensive treatment group was 96%, significantly higher than that in the control group （12%, P〈0.05）. In the patients receiving comprehensive treatment, exclusion of chemotherapy and shorter duration of symptoms of nerve damage were associated with better therapeutic effect （P〈0.05）. Conclusion Methyprednisolone, mouse nerve growth factor and hyperbaric oxygen treatment can relieve the symptoms of radiation-induced lower cranial neuropathy in NPC patients, and the therapeutic effect of the treatments is associated with chemotherapy and sustaining time of the symptoms of nerve damage, suggesting the necessity of early treatment of neurological impairment in these patinets.