鼻咽癌放疗后放射性颈髓损伤的临床研究

Radiation-induced cervical cord injury in patients with nasopharyngeal carcinoma

目的探讨鼻咽癌放疗后放射性颈髓损伤（RICCI）的临床特点、治疗方式及影响其发病的相关危险因素。方法回顾性收集中山大学孙逸仙纪念医院神经科自2000年1月至2013年10月收治的30例鼻咽癌放疗后RICCI患者（颈髓损伤组）和31例同期随访的无RICCI鼻咽癌患者（对照组）的临床资料，分析鼻咽癌放疗后RICCI的临床症状及体征、影像学资料，采用单因素分析及非条件Logistic回归分析探讨影响鼻咽癌放疗后RICCI发生的相关危险因素。观察新型神经病理性疼痛抑制剂普瑞巴林对患者低头触电样感症状的缓解作用。结果颈髓损伤组中，19例于首程放疗后出现低头触电样感，4例于再程放疗后出现；颈部MRI检查发现上颈段脊髓萎缩4例，增粗肿胀17例；且患者颈髓MRI检查发现异常的概率在颈部淋巴结放射剂量≥64Cy时明显高于〈64Gy者，差异有统计学意义（P〈0．05）。单因素分析发现，颈髓损伤组与对照组颈部淋巴结放射剂量、放疗方法、再程放疗均不同，差异均有统计学意义（P〈0．05）；进一步非条件Logistic回归分析显示颈部淋巴结放射剂量是鼻咽癌放疗后RICCI发生的独立危险因素（OR=1．877，95％CI：1．282～2．748，P=-0．001）。接受普瑞巴林治疗的患者的低头触电样感症状缓解率（73.3％1与未接受者（25．0％）比较差异有统计学意义（P=0．039）。结论颈部淋巴结放射剂量是影响鼻咽癌放疗后RICCI发生的独立危险因素，低头触电样感是其常见的临床表现，而普瑞巴林可有效地缓解该症状。

Objective To investigate the characteristics and measurements of radiation-induced cervical cord injury （RICCI） in patients with nasopharyngeal carcinoma after radiotherapy, and explore its risk factors. Methods A retrospective study was performed on the clinical data of 30 RICCI patients with nasopharyngeal carcinoma after radiotherapy and 31 patients without RICCI （control group）, admitted to our hospital from January 2000 to October 2013. Clinical symptoms and signs, imaging data of RICCI patients with nasopharyngeal carcinoma after radiotherapy were analyzed, and univariate analysis and Logistic regression analysis were used to explore the risk factors of RICCI in patients with nasopharyngeal carcinoma after radiotherapy. The effect of new type neuropathic pain inhibitor pregabalin on Lhermitte＇s sign （LS） was observed. Results LS was a common manifestation of RICCI; LS occurred after the initial radiotherapy in 19 patients, and 4 developed after re-irradiation for recurrences. Radiological imaging showed cervical spinal cord atrophy in 4 patients and enlargement in 17. The incidence of MRI checked exception was higher when irradiation dose of cervical node was over 64 Gy （P〈0.05）. Significant differences of irradiation doses of cervical lymph node, methods of radiotherapy and re-irradiation were noted between the RICCI group and non-RICCI group （P〈0.05）; further Logistic regression demonstrated that irradiation dose of cervical lymph node was an independent risk factor for RICCI （OR=1.877, 95%CI： 1.282-2.748, P=-0.001）. Remission rate of LS in patients accepted pregabalin （73.3%） was significantly higher than those without pregabalin （25.0%, P=0.039）. Conclusions RICCI may occur in nasopharyngeal carcinoma patients following radiotherapy; irradiation dose of cervical lymph node is an independent risk factor for RICCI. LS is a common manifestation of RICCI, and pregabalin could effectively relief LS.