糖尿病与放射性肺炎发生的相关危险性分析

Effect of diabetes mellitus on the development of radiation pneumonitis in patients with non-small cell lung cancer

目的探讨伴有糖尿病的肺癌患者在接受放射治疗后放射性肺炎的发生情况。方法156例非小细胞肺癌（NSCLC）患者均接受三维适形放射治疗，其中伴有糖尿病者52例，无糖尿病的对照组104例，随访观察1年，比较两组患者放射性肺炎的发生情况，并分析血糖控制水平和糖尿病病史与放射性肺炎的发病相关性。结果糖尿病组和对照组患者放射性肺炎的发病率分别为40.4％和21.2％。（P〈0.05），伴有糖尿病的肺癌患者放射性肺炎的发病危险是对照组患者的2.05倍（95％CI为1.17-3.58）。糖尿病组和对照组患者放射性肺炎的严重程度无明显差异。血糖控制较好的NSCLC患者放射性肺炎的发病率（30.6％）低于血糖控制欠佳者（62.5％，P〈0.05）。糖尿病病史较长的NSCLC患者与糖尿病病史较短者比较，放射性肺炎的发病率差异无统计学意义（P〉0.05）。结论糖尿病为NSCI.C患者发生放射性肺炎的易感因素，其易感程度与血糖控制水平有关。

Objective The purpose of this study was to investigate whether the associated diabetes mellitus exerts a certain effect on the development of radiation pneumonitis in patients with non-small cell lung cancer. Methods 156 patients with non small cell lung cancer were treated with three-dimensional conformal radiation therapy in this study, including 52 associated with diabetes and 104 non-diabetic patients as a control group. All the patients were followed up for one year and the development of radiation pneumonitis was observed. Radiation pneumonitis was diagnosed according to the criteria of radiation therapy oncology group. The morbidities of radiation pneumonitis in the two groups were compared. The relationships between the morbidity of radiation pneumonitis and blood sugar level as well as diabetic history were analyzed by chi-square test. Results Twenty-one （40.4%） of 52 patients with diabetes had radiation pneumonitis （grade 2 or greater）, while in the control group only 22 of 104 patients （21.2%） suffered from radiation pneumonitis. There was a statistically significant difference between the two groups in the morbidity of the radiation pneumonitis （P 〈0.05）, with a relative risk value of 2.05 （95% CI, 1.17, 3.58）. The rate of the radiation pneumonitis in the patients with a lower blood sugar level （ 〈 7 retool/L） was significantly lower than that in those with a higher blood sugar level （30.6% vs. 62.5% , P 〈 0.05 ）. However, the rate of radiation pneumonitis in the patients with a longer diabetic history was not significantly different from that in those with a shorter diabetic history （ P 〉 0.05 ）. Conclusion Non-small cell lung cancer patients with diabetes mellitus are more vulnerable than those without to radiation pneumonitis. Therefore, diabetes mellitus is a newly discovered risk factor to radiation pneumonitis, and the blood sugar level is positively correlated with the morbidity of radiation pneumonitis.