鼻咽癌放射治疗患者放射性脑损伤的危险因素分析及风险预测模型构建

Risk Factors and Risk Prediction Model Construction of Radiation-Induced Brain Injury in Nasopharyngeal Carcinoma Patients Undergoing Radiotherapy

目的探讨影响鼻咽癌放射治疗患者发生放射性脑损伤的危险因素,并构建风险预测模型。方法回顾性选取郑州大学第五附属医院2021年1月至2022年1月放射治疗后发生放射性脑损伤的40例鼻咽癌患者作为发生组,另选取同期接受放射治疗后未发生放射性脑损伤的61例鼻咽癌患者作为未发生组。收集两组患者的一般资料及临床指标,采用logistic回归性分析检验影响鼻咽癌放射治疗患者并发放射性脑损伤的危险因素,同时依据回归分析结果构建风险预测模型,绘制受试者工作特征(ROC)曲线检验风险预测模型对鼻咽癌放射治疗患者放射性脑损伤发生的预测价值。结果两组患者双侧颞叶最高照射剂量、血清胶质纤维酸性蛋白(GFAP)、血清环氧化酶-2(COX-2)及血浆纤维蛋白原(Fib)差异有统计学意义(P<0.05)。logistic回归性分析显示,高水平双侧颞叶最高照射剂量、血清GFAP、血清COX-2及血浆Fib是影响鼻咽癌放射治疗患者放射性脑损伤发生的危险因素(P<0.05)。构建风险预测模型,ROC内部验证显示曲线下面积(AUC)为0.911,AUC的95%CI为0.851~0.972,特异度0.967,敏感度0.775,约登指数0.742,(P<0.001)。结论双侧颞叶最高照射剂量、血清GFAP、血清COX-2及血浆Fib是影响鼻咽癌放射治疗患者放射性脑损伤发生的危险因素。

Objective To explore the risk factors of radiation-induced brain injury in nasopharyngeal carcinoma patients undergoing radiation therapy,and to construct a risk prediction model.Methods Retrospective selection of 40 nasopharyngeal carcinoma patients who experienced radiation brain injury after radiotherapy at the Fifth Affiliated Hospital of Zhengzhou University from January 2021 to January 2022 as the incidence group,and 61 nasopharyngeal carcinoma patients who did not experience radiation brain injury after radiotherapy during the same period as the non incidence group.General data and clinical indicators of the two groups were collected.Logistic regression analysis was used to test the risk factors affecting radiation-induced brain injury in patients with nasopharyngeal carcinoma radiotherapy.At the same time,a risk prediction model was constructed based on the results of regression analysis.The receiver operating characteristic(ROC)curve was drawn to test the predictive value of the risk prediction model for radiation-induced brain injury in patients with nasopharyngeal carcinoma radiotherapy.Results There was statistical difference between the two groups of patients in terms of the highest bilateral temporal lobe irradiation dose,serum glial fibrillary acidic protein(GFAP),serum cyclooxygenase-2(COX-2),and plasma fibrinogen(Fib)levels(P<0.05).Logistic regression analysis showed that high levels of bilateral temporal lobe maximum radiation dose,serum GFAP,serum COX-2,and plasma Fib levels were risk factors for radiation-induced brain injury in nasopharyngeal carcinoma radiotherapy patients(P<0.05).The risk prediction model was constructed.The ROC internal validation showed that the area under the curve(AUC)was 0.911,the 95%CI of AUC was 0.851-0.972,the specificity was 0.967,the sensitivity was 0.775,and the Youden’s statistic index was 0.742,P<0.001.Conclusion The highest bilateral temporal lobe irradiation dose,serum GFAP,serum COX-2,and plasma Fib are risk factors that affect the occurrence of radiation-induced brain injury in nasopharyngeal carcinoma patients undergoing radiotherapy.