单光子发射型计算机断层肺灌注扫描联合肺功能检查筛选发生放射性肺炎高危人群的价值

Single-photon emission computed tomography lung perfusion combining with respiratory function tests for screening high-risk population of radiation pneumonitis

目的探讨放疗前单光子发射型计算机断层扫描(SPECT)肺血流灌注显像联合肺功能检查(RFTs)筛选发生放射性肺炎(RP)高危人群的价值。方法前瞻性入组57例接受根治性三维适形或调强放疗的Ⅲ期非小细胞肺癌患者,治疗结束后随访观察,采用NCICTC3.0标准对RP进行分级。所有患者放疗前行SPECT肺灌注扫描和RFTs以评价基础肺功能。分析肺功能损伤与发生RP风险的相关性。结果 RP组肺通气功能参数有下降趋势,但没有达到具有统计学意义的程度(P值范围0.111～0.854),然而当患者放疗前用力肺活量(FVC)≤2.4L或第1秒用力呼气容积(FEV1.0)≤1.8L或平均用力呼气流量(FEF25%～75%)≤2.0L/s时发生RP的概率显著增加,具有统计学意义(P=0.017,0.026,0.042)。FVC是RP发生的独立影响因素(B=3.045,P=0.027),但是FVC与FEV1.0、FEF25%～75%之间均具有共线性(r=0.843,0.600,P均<0.001)。结论放疗前行肺功能检查评价患者基础肺功能,对筛选发生RP高危人群具有重要的临床价值。

Objective To investigate the value for screening high-risk population of radiation pneumonitis （RP）with single-photon emission computed tomography（SPECT） lung peffusion combining respiratory function tests （RFTs） before radiation therapy （RT）. Methods A total of 57 cases with stageIII non-small cell lung cancer （NSCLC） patients treated with radical three dimensional conformal or intensity-modulated radiotherapy were recruited and followed-up prospectively. The grade of RP was evaluated according to the NCI Common Terminology Criteria for Adverse Events （ version 3.0 ）. All patients performed with SPECT lung peffusion and RFFs before RT to evaluate the base-line lung function. The correlation among the base-line lung function and RP occmrrence was analyzed. Results Although parameters for RFTs trend to decline in RP group, there was no statistical significance observed （ P value 0. 111-0. 854 ）, however, if patient with FVC ≤ 2.4 L or FEV1.0 ≤1.8 L or FEF25%-75%≤2. 0 L/s before RT, the probability of RP occurrence was increased significantly （ P = O. 017,0. 026,0. 042, respectively ）. FVC was an independent risk factor（ B = 3.045, P = O. 027 ） associated with RP, but colinearity with FEV1.0, and FEF25%-75%（ Pearson r = 0. 843, O. 600, respectively, P 〈 0. 001 ）. Conclusions Base-line lung function tests before RT is important for screening high-risk population of radiation pneumonitis.