鼻咽癌放疗后迟发性放射性脑损伤患者颈动脉斑块形成的危险因素分析

Risk factors of carotid artery plaque formation in radiation-induced late brain injury patients received irradiation for nasopharyngeal carcinoma

目的探讨鼻咽癌放疗后迟发性放射性脑损伤（RILBI）患者伴随的颈动脉斑块形成的发生率及危险因素。方法选择中山大学附属第一医院神经科自2008年1月至2011年9月收治的82例鼻咽癌放疗后RILBI患者，以其中无卒中病史、缺血性心脏病史、高血压病史、糖尿病史或吸烟史者50例作为RILBI组，以同期体检中心健康查体的40例体检者作为正常对照组，采集病史并测定患者的血糖、血脂水平，应用彩色多普勒超声仪测量颈动脉内膜-中层厚度（CIMT），根据CIMT值将RILBI患者分为无斑块形成组和斑块形成组，非条件Logistic回归分析斑块形成的危险因素。结果排除动脉斑块形成主要危险因素的50例RILBI患者中斑块检出率为32．0％。正常对照组斑块检出率为12．5％。比较差异具有统计学意义（P〈0．05）。82例RILBI患者中斑块形成组和无斑块形成组患者年龄、距离放疗后的时间及卒中史的发生率不同，差异有统计学意义（P〈0．05）。非条件Logistic回归分析显示年龄是RILBI患者颈动脉斑块形成的独立危险因素（OR=1．103，95％CI：1．046～1．163，P=-0．000）。结论鼻咽癌放疗后RILBI患者容易出现颈动脉斑块形成，年龄是其重要危险因素，需定期随访及早发现伴随的放射性颈动脉损伤。

Objective To investigate the rates and risk factors of carotid artery plaques formation in radiation-induced late brain injury （RILBI） patients who have received irradiation for nasopharyngeal carcinoma. Methods Eighty-two patients with RILBI, admitted to our hospital ~om January 2008 to September 2011, and 40 healthy controls were recruited in this study; in these 82 patients, we chose 50 patients who did not have such risk factors of main carotid artery plaque formation as stroke, ischemic heart disease, hypertension, diabetes mellitus and smoking as our RILBI group. Their medical histories were obtained, and the levels of fasting blood glucose, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol were examined. Carotid intima-media thicknesses （CIMT） in these 82 patients were measured by Doppler ultrasound; according to the CIMT, RILBI patients were divided into plaque formation sub-group and non-plaque formation sub-group; unconditional logistic regression was employed to analyze the risk factors of carotid artery plaque formation. Results Relevance ratio of plaque formation in RILBI group （32.0%） was significantly higher than that of controls （12.5%, P〈0.05）. Significant differences of age, post-radiation interval without plaque, history of stroke were noted between the RILBI patients of plaque formation sub-group and non-plaque formation sub-group （P〈0.05）. Logistic regression demonstrated that age wasan independent risk factor for plaque formation in RILBI patients （OR=l.103, 95%CI： 1.046-1.163, P=0. 000）. Conclusion The incidence rate of plaque formation in RILBI patients received irradiation for nasopharyngeal carcinoma is high, and age is an important risk factor. Focused screening of carotid artery injury in RILBI patients may be medically beneficial.