放射性肺炎相关因素分析

Related Factors of Radiation Pneumonia

目的分析放射性肺炎(RP)的相关因素。方法选取2014年1月—2016年1月在咸阳市中心医院放射治疗科行三维适形放射治疗(3DCRT)的癌症患者65例,均经病理学检查确诊。回顾性分析患者的临床资料,包括性别、年龄、吸烟史、肿瘤类型、有无接受同步化疗、基础肺功能指标〔包括第1秒用力呼气容积(FEV_1)和第1秒用力呼气容积与用力肺活量比值(FEV_1/FVC)〕;借阅患者既往放疗记录,根据剂量体积直方图(DVH)得到受到某种照射剂量肺组织占全肺体积的百分比(Vdose)、平均肺剂量(MLD)和总剂量;检测RP患者放疗前后血清转化生长因子β(TGF-β)水平。结果 65例患者中发生RP 16例,RP发生率为24.6%。不同性别、肿瘤类型、FEV_1、FEV_1/FVC及有无接受同步化疗患者RP发生率比较,差异无统计学意义(P>0.05);不同年龄、有无吸烟史患者RP发生率比较,差异有统计学意义(P<0.05)。有无RP患者V10、V20、V30、V40和总剂量比较,差异无统计学意义(P>0.05);RP患者MLD高于未发生RP患者(P<0.05)。放疗后RP患者血清TGF-β水平高于放疗前(P<0.05)。结论 RP的发生率较高,且年龄、吸烟、MLD与RP的发生有一定关系。

Objective To analyze the related factors of radiation pneumonia. Methods A total of 65 cancer patients undergoing three-dimensional conformal radiotherapy( 3DCRT) were selected in Xianyang Central Hospital from January 2014 to January 2016,all of them were confirmed by pathological examination. Clinical data of all the patients was retrospectively analyzed,including gender,age,smoking history,cancer types,received concurrent chemotherapy or not,baseline index of pulmonary function( including FEV1 and FEV1/ FVC);by looking up the radiotherapy records,the proportion of lung tissue exposed to radioactive rays( Vdose),mean lung radiological dose( MLD) and total radiological dose were calculated by dose volume histogram( DVH);serum TGF-β level of patients complicated with radiation pneumonia were detected before and after radiotherapy. Results Of the 65 patients,16 cases occurred radiation pneumonia( accounting for 24. 6%). No statistically significant differences of incidence of radiation pneumonia was found in patients with different gender,cancer types,FEV1,FEV1/ FVC,received concurrent chemotherapy or not( P > 0. 05);while there were statistically significant differences of incidence of radiation pneumonia in patients with different age, with smoking history or not( P < 0. 05). No statistically significant differences of 10% Vdose,20% Vdose,30% Vdose,40% Vdose or total radiological dose was found in patients complicated with radiation pneumonia or not( P > 0. 05), while MLD of patients complicated with radiation pneumonia was statistically significantly higher than that of patients did not complicate with radiation pneumonia( P < 0. 05). After radiotherapy,serum TGF-β level of patients complicated with radiation pneumonia was statistically significantly higher than that before radiotherapy( P < 0. 05). Conclusion The incidence of radiation pneumonia is relatively high in cancer patients undergoing 3DCRT,age,smoking and MLD are correlated with radiation pneumonia to some extent.