老年人放射性肺炎临床分析

The clinical Analysis of the Radiation Pneumonitis in the elderly patients

目的研究老年放射性肺炎(radiation pneumonitis,RP)的发生、发展、治疗及预后特点,为临床制定科学的放射治疗计划提供参考,争取早发现、早诊断、早治疗。方法回顾性分析解放军总医院老年病房38例接受放射治疗的老年肺癌患者的临床资料,并分析其RP发生的特点。结果 38例患者100%出现肺部影像学改变,发生RP23例,占60.5%。RTOG分级:1级8例,占34.8%;2级13例,占56.5%;3级1例,占4.3%;4级1例,占4.3%;20例(87.0%)影像学改变发生在放疗后6个月之内,21例占91.3%出现在放疗部位,2例占8.7%同时发生在包括放疗部位在内的≥2个部位。治疗以糖皮质激素为一线药物,治疗后大部分可在1个月左右吸收。结论老年人RP发病率高,但症状轻。肺部影像学改变可发生在放疗部位之外的肺区。糖皮质激素仍为治疗RP的一线药物。

Objective To study the characteristic of radiation pneumonitis（RP）in the elderly patients from its occurrence,progress and treatment conditions in favor to early detection,early diagnosis and early treatment.Methods 38 cases of patients diagnosed as lung cancer who received three-dimensional conformal radiation therapy were selected,and their clinical features associated with RP were collected and analyzed.Results One hundred percent（38/38）of patients experienced pulmonary fibrosis,RP occurred in 23 of 38 patients.The patients who occurred RP experienced RTOG,34.8%（8/23）of patients covers 1 grade,56.5%（13/23）2 grade,4.3%（1/23）3 grade,4.3%（1/23）4 grade.87.0%（20/23）of patients with clinical symptoms or imaging changes occurred within 6 months,91.3%（21/23） X-ray changes appearred in the radiotherapy site,8.7%（2/23）change occurred in two or more areas,besides radiotherapy area at the same time.Glucocorticoids were used to treat RP,most of which can be absorbed in about one month.Conclusions The incidence of radiation pneumonitis among aged people was high,but the symptoms were less severe.Lung imaging changes can occur in other Lung area apart from the radiation zone.Glucocorticoids is the first-line drugs to cure the radiation pneumonitis.