脑转移瘤放射治疗后对海马功能的影响及防治

Effect of radiotherapy on hippocampus function and prevention and treatment strategies in metastatic brain tumors

目的 探讨脑转移瘤放射治疗后对海马相关功能的影响及防治策略。方法 选取2016年8月至2021年5月间延安大学咸阳医院收治的67例采用放射治疗的脑转移瘤患者,采用随机数字表法分为观察组34例和对照组33例。对照组患者采用全脑放疗,观察组患者采用针对海马区保护的放疗策略,比较两组患者简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分及认知功能障碍发生率。结果 放疗前,两组患者MMSE评分比较,差异无统计学意义(P>0.05)。放疗1个月到放疗6个月,两组患者MMSE评分均下降,而放疗3个月和6个月,观察组患者高于对照组,差异均有统计学意义(均P<0.05)。放疗前,两组患者MoCA评分比较,差异无统计学意义(P>0.05)。放疗1个月到放疗6个月,两组患者MoCA评分均下降,而放疗3个月和6个月,观察者高于对照组,差异均有统计学意义(均P<0.05)。MMSE量表测定:放疗前,观察组患者认知功能障碍2例(5.9%),对照组为1例(3.0%);放疗后6个月,观察组4例(11.8%),对照组11例(33.3%),观察组均低于对照组,差异均有统计学意义(均P<0.05)。MoCA量表测定:放疗前,两组患者认知功能障碍情况同上;放疗6个月后,观察组患者认知功能障碍5例(14.7%),对照组12例(36.4%),差异均有统计学意义(均P<0.05)。结论 脑转移瘤放射治疗后采用海马区保护放疗技术,能有效减轻患者的认知功能障碍。

Objective To investigate the effects of radiotherapy for metastatic brain tumors on hippocampal functions and prevention and treatment strategies. Methods Sixty-seven patients with metastatic brain tumors who received radiotherapy at Xianyang Hospital, Yan’an University were selected from August 2016 to May. They were divided into an observation group(34 patients) and a control group(33 patients) using the random number table method. The observation group received hippocampal sparing radiotherapy and the control group received whole brain radiotherapy. Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment(MoCA) score and the incidence of cognitive impairment were compared between the two groups. Results Before radiotherapy, there was no statistical difference in MMSE and MoCA scores between the two groups(P>0.05). From 1 month to 6 months after radiotherapy, MMSE and MoCA scores decreased in both groups and from 3 and 6 months after radiotherapy, they were higher in the observation group than in the control group(all P<0.05). According to MMSE test, cognitive impairment occurred in 2 patients(5.9%) in the observation group and 1 patient(3.0%) in the control group before the initiation of radiotherapy. At 6 months after radiotherapy, cognitive impairment occurred in 4 patients(11.8%) in the observation group which was lower than 11 patients(33.3%) of the control group(P<0.05). According to MoCA test, cognitive impairment occurred in 5 patients(14.7%) in the observation group and 12 patients(36.4%) in the control group at 6 months after radiotherapy(P<0.05). Conclusion Hippocampal sparing radiotherapy for metastatic brain tumors can significantly allieve the cognitive dysfunction.