子午沙鼠骨组织细粒棘球蚴病放射治疗后转归观察

A preliminary study on the outcomes of radiation therapy of bone hydatid disease in Meriones meridianus

目的观察子午沙鼠骨组织细粒棘球蚴病放射治疗后转归情况。方法建立子午沙鼠骨细粒棘球蚴病动物模型240只，按体质量采用随机数字表法分为3组：对照组、40Gy／5次组、50Gy／5次组，每组80只，雌雄各半。对照组沙鼠未进行干预处理，40Gy／5次和50Gy／5次组采用6WV—X线定位照射治疗，5次连续放射，间隔2天后再重复放射5次。放疗结束后3、6个月时，观察子午沙鼠死亡和病变部位破溃、感染情况；每组选取存活沙鼠15只处死，观察计算囊液内头节死亡数并检测蛋白质、钙离子浓度，测量病变部位最大直径和细粒棘球蚴囊湿重；显微镜下观察病变部位骨骼破坏、重建情况。结果放疗结束后3、6个月时，随着放射剂量升高，沙鼠死亡数量明显减少（χ2=10．4、17．4，P均〈0．05）；沙鼠病变部位破溃、感染情况明显降低（χ2=6．0、10．1，JP均〈0．05）；囊液内头节死亡例数明显升高[3个月：（22．4±3．1）、（95．0±5．2）、（136．0±5．4）个；6个月：（23．2±2．2）、（98．2±4．6）、（169．3±7．0）个；F=2252．5、3220．3，P均〈0．05]；囊液蛋白质含量、钙离子浓度明显改变[3个月：（1．059±0．056）、（0．733±0．051）、（0．571±0．043）g／L和（2．802-I-0．157）、（3．056±0．060）、（3．546±0．135）mmol／L；6个月：（1．088士0．043）、（0．753±0．034）、（0．340±0．032）g／L和（2．804±0．019）、（3．068±0．052）、（3.886±0．046）mmol／L；F：366．0、138．9和1550．5、2727．3，P均〈0．05]；病变部位最大直径明显减小[3个月：（2．38±0．14）、（1．69±0．05）、（1．40±0．09）cm；6个月：（2．65±0．05）、（1．69±0．03）、（1．03±0．06）cm；F=372．5、3846．1，P均〈0．05]；细粒棘球蚴囊湿重明显减小[3个月：（3．47±0．11）、（2．54±0．12）、（1．46±0．07）g；6个月：（3．75±0．31）、（2．55±0．08）、（1．02±0．20）g；F=1475．6、608．0，P均〈0．05]。随着时间延长，对照组及40Gy／5次组沙鼠死亡数量明显升高（χ2=4．3、4．6，P均〈0．05），而50Gy／5次组未见明显改变（χ2=1．1，P〉0．05）；对照组及40Gy／5次组沙鼠病变部位破溃、感染情况明显增加（χ2=5．5、4．3，P均〈0．05），而50Cy／5次组未见明显改变（χ2=0.3，P〉0．05）；50Gy／5次组囊液内头节死亡例数明显升高，囊液蛋白质含量、钙离子浓度明显改变（F=212．6、271．8、84．7，P均〈0．05）；对照组病变部位最大直径明显增加（F=47．1，P〈0．05），50Gy／5次组明显减小（F=188．3，P〈0．05）；对照组细粒棘球蚴囊湿重明显增加（F=10．7，P〈0．05），50Gy／5次组明显减小（F=68．5，P〈0．05）。光镜下，随着放射剂量升高，病变部位骨基质及陷窝内细胞损伤情况逐渐加重；随着时间延长，对照组内骨陷窝内细胞少量死亡，而40Gy／5次组及50Gy／5次组骨基质及骨陷窝内细胞都有变性坏死和部分修复。结论经合适剂量（50Gy／5次）的放射线治疗，子午沙鼠细粒棘球蚴病的远期效果较好。

Objective According to radiation therapy （6WV-X line） on experimental gerbils which were successfully infected by echinococcus granulosus, the outcomes of bone hydatid disease after radiation therapy were studied. Methods Totally 240 gerbil models that were infected bone hydatid disease, were randomly divided into three groups （each group was further divided into three-month and six-month groups, 40 gerbils per group）, one group as a control group, the 40 Gy/5 times and 50 Gy/5 times groups were given 6WV-X line radiation therapy. After 5 consecutive radiation therapies, stopped for two days and then repeated for five times. At the end of three and six months after radiotherapy, the rate of death and the ulceration or infection of the lesions was compared. Fifteen gerbils from each group were randomly selected to observe the deaths of scolex, protein and calcium concentration changes, the maximum diameter changes of the lesions, the changes of hydatid cyst wet weight and the rate of suppressing capsule, the bone destruction, and rebuilding situation of lesions under a microscope. Results At the end of three and six months after radiation therapy, with increasing dosage, the deaths decreased significantly （χ2 = 10.4, 17.4, all P 〈 0.05）; the ulceration or infection of the lesions decreased significantly （χ2 = 6.0, 10.1, all P 〈 0.05）; the mortality rate of scolex increased [3 month： （22.4 ± 3.1）, （95.0 ± 5.2）, （136.0±5.4）; 6 month： （23.2 ± 2.2）, （98.2± 4.6）, （169.3 ±7.0）; F = 2 252.5, 3 220.3, all P 〈 0.05]; the concentration of protein and the calcium ion were changed significantly [3 month： （1.059 ±0.056）, （0.733 ± 0.051）, （0,571 ± 0.043）g/L and （2.802 ± 0.157）, （3.056± 0.060）, （3.546 ± 0.135 ）mmol/L; 6 month： （1.088 ±0.043）, （0.753 ± 0.034）, （0.340 ±0.032）g/L and （2.804 ± 0.019）, （3.068± 0.052）, （3.886 ± 0.046）mmol/L; F = 366.0, 138.9 and 1 550.5, 2 727.3, all P 〈 0.05]; the maximum diameters of the lesions reduced significantly [3 month： （2.38 ± 0.14）, （1.69 ± 0.05）, （1.40 ±0.09）cm; 6 month： （2.65± 0.05）, （1.69 ± 0.03）, （1.03 ± 0.06）era; F = 372.5, 3 846.1, all P 〈 0.05]; the hydatid cyst wet weight decreased significantly [3 month： （3.47± 0.11）, （2.54 ±0.12）, （1.46 ± 0.07）g; 6 month： （3.75± 0.31）, （2.55 ±0.08）, （1.02 ± 0.20）g; F = 1 475.6, 608.0, all P 〈 0.05]. In the same group with time went on, in the control and 40 Gy/5 times group, the deaths gradually increased （χ2 = 4.3, 4.6, all P 〈 0.05）, but in the 50 Gy/5 times group, the deaths was not significantly increased （χ2 = 1.1, P 〉 0.05）; in the control and 40 Gy/5 times group, the ulceration or infection of the lesions gradually increased （χ2 = 5.5, 4.3, all P 〈 0.05）, but in the 50 Gy/5 times group, the ulceration or infection of the lesions did not change significantly （χ2 = 0.3, P 〉 0.05）; in the 50 Gy/5 times group, the mortality rate of scolex was significantly increased （F = 212.6, P 〈 0.05）; in 50 Gy/5 times group, the protein （calcium） concentration decreased （increased） significantly （F = 271.8, 84.7, all P 〈 0.05）; the maximum diameters of the lesions increased gradually in the control group （F = 47.1, P 〈 0.05）, in 50 Gy/5 times group, the maximum diameters of the lesions decreased gradually （F = 188.3, P 〈 0.05）; in the control group, hydatid cyst wet weight increased significantly （F = 10.7, P 〈 0.05）, in the 50 Gy/5 times group, hydatid cyst wet weight was significantly reduced （F = 68.5, P 〈 0.05）; with increasing dosage, the damage of the bone matrix and the cells in lacunae of the lesions gradually increased, in the same group with time went on, in the control group, a few amount of bone cells in lacuna died, and in 40 Gy/5 times and 50 Gy/5 times groups, the bone matrix and bone cells were partially repaired. Conclusion The long-term effects of appropriate dosage （50 Gy/5 times） radiation on experiments hydatid diseased gerbils are affirmed, but it is still need a clinical validation.