放疗前SII、PNI和LDH对放射性肺炎的预测价值

clinical research of SII, PNI and LDH before radiotherapy predicts the radiation pneumonia

目的探究放疗前外周血系统免疫炎症指数(SII)、预后营养指数(PNI)、乳酸脱氢酶(LDH)对胸部肿瘤患者发生放射性肺炎(RP)的预测价值及发生≥2级RP的影响因素。方法回顾性分析2021年7月—2022年12月于徐州市第一人民医院行调强适形放疗的115例胸部肿瘤患者的相关资料。根据RP的发生情况,将患者分为RP组(27例)与非RP组(88例)。采用logistic回归分析胸部肿瘤患者放疗后发生RP的影响因素,并采用受试者工作特征(ROC)曲线评价放疗前SII对RP发生的预测作用。结果≥2级RP发生率为23.48%(27/115,2级15例,3级9例,4级3例)。单因素分析显示,2组患者在吸烟史、同步放化疗、免疫治疗、V_(20)及放疗前SII水平上差异具有统计学意义(P<0.05)。多因素回归分析表明,吸烟史、免疫治疗、V_(20)及放疗前SII水平为胸部肿瘤患者放疗后发生RP的独立危险因素(OR>1,P<0.05)。ROC曲线表明,放疗前SII水平预测RP发生的阈值为1107.46,敏感度为0.704,特异度为0.659。结论胸部肿瘤患者吸烟史、免疫治疗、V_(20)及放疗前SII水平均为发生RP的独立危险因素,且放疗前SII水平对RP发生具有一定的预测价值。

Objective To explore the predictive value of systemic immune-inflammation index(SII),prognostic nutritional index(PNI),and lactate dehydrogenase(LDH)measured in peripheral blood before radiotherapy on the incidence of radiation pneumonia(RP)in patients with thoracic tumors,and to identify factors influencing the occurrence of RP grade≥2 RP.Methods A retrospective analysis was conducted on 115 patients with thoracic tumors who received intensity-modulated radiotherapy at Xuzhou First People′s Hospital from July 2021 to December 2022.According to the occurrence of RP,patients were divided into an RP group(27 cases)and non-RP group(88 cases).Logistic regression analysis was used to examine the factors related to the occurrence of RP after radiotherapy,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of SII for RP occurrence before radiotherapy.Results The incidence of RP of grade≥2 was 23.48%(27/115,grade 2 was 15 patients,grade 3 was 9 patients and grade 4 was 3 patients).The univariate analysis showed that there were statistically significant differences in smoking history,concurrent chemoradiotherapy,immunotherapy history,levels of V_(20) and SII before radiotherapy between RP group and non-RP group(P<0.05).Multivariate regression analysis indicated that smoking history,immunotherapy history,levels of V_(20) and SII before radiotherapy were independent risk factors for RP in patients with thoracic tumor after radiotherapy(OR>1 and P<0.05).The ROC curve revealed that the threshold,sensitivity,and specificity of RP predicted by SII before radiotherapy were 1107.46,0.704 and 0.659,respectively.Conclusions Smoking history,immunotherapy history,levels of V_(20) and SII before radiotherapy are all independent risk factors of RP in patients with thoracic tumor,and the level of SII before radiotherapy has a certain value in predicting the occurrence of RP.