中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2012年
3期
227-230
,共4页
丁秀平%李红军%李宝生%王冬青
丁秀平%李紅軍%李寶生%王鼕青
정수평%리홍군%리보생%왕동청
胸部肿瘤%三维放射疗法%心肌酶%剂量体积直方图
胸部腫瘤%三維放射療法%心肌酶%劑量體積直方圖
흉부종류%삼유방사요법%심기매%제량체적직방도
Thoracic neoplasma%Three-dimensional radiotherapy%Myocardial enzyme%Dose-volume histogram
目的 探讨胸部肿瘤患者三维放疗前后血清心肌酶谱改变与心脏体积剂量的相关性.方法 102例胸部肿瘤患者(肺癌68例、食管癌34例)放疗前后检测血清天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、CK同工酶(CK-MB)、乳酸脱氢酶(LDH)及α-羟丁酸脱氢酶(α-HBDH)水平.放疗前后各种酶水平比较行配对t检验,组间比较行成组t检验.采用剂量体积直方图(DVH)参数[心脏接受≥x Gy照射体积占总体积百分比(Vx)]评价心脏体积剂量,各种酶与DVH参数相关性行Pearson法分析.结果 放疗后血清AST、CK-MB、LDH、α-HBDH水平较放疗前明显增高(19.42:27.89、14.72:19.57、178.80:217.57、140.32:176.25,t=-3.39～ -6.92,P均=0.000).调强放疗前后AST变化与V20、V25、V30相关(r=0.302～0.431,P=0.039～0.003),CK变化与V30相关(r=0.345,P=0.013),CK-MB、LDH、α-HBDH变化与V25、V30均相关(r--0.465～0.376,P=0.001～0.005)；三维适形放疗前后CK-MB、LDH变化与V30相关(r=0.330、0.274,P=0.014、0.033),α-HBDH变化与V25、V30、V35相关(r=0.270～0.331,P=0.046～0.014).当放疗剂量＞50 Gy时AST、LDH、α-HBDH变化与V25、V30相关(r=0.256～0.359,P=0.019～0.006),CK-MB变化与V30相关(r=0.233,P =0.037)；≤50 Gy时仅V5 V45与CK变化相关(r=0.581、0.536,P=0.023、0.043).结论 心脏体积剂量与三维放疗前后心肌酶水平变化有一定相关性,提示心脏DVH参数有助于评价放疗诱导的心肌损伤.
目的 探討胸部腫瘤患者三維放療前後血清心肌酶譜改變與心髒體積劑量的相關性.方法 102例胸部腫瘤患者(肺癌68例、食管癌34例)放療前後檢測血清天鼕氨痠氨基轉移酶(AST)、肌痠激酶(CK)、CK同工酶(CK-MB)、乳痠脫氫酶(LDH)及α-羥丁痠脫氫酶(α-HBDH)水平.放療前後各種酶水平比較行配對t檢驗,組間比較行成組t檢驗.採用劑量體積直方圖(DVH)參數[心髒接受≥x Gy照射體積佔總體積百分比(Vx)]評價心髒體積劑量,各種酶與DVH參數相關性行Pearson法分析.結果 放療後血清AST、CK-MB、LDH、α-HBDH水平較放療前明顯增高(19.42:27.89、14.72:19.57、178.80:217.57、140.32:176.25,t=-3.39～ -6.92,P均=0.000).調彊放療前後AST變化與V20、V25、V30相關(r=0.302～0.431,P=0.039～0.003),CK變化與V30相關(r=0.345,P=0.013),CK-MB、LDH、α-HBDH變化與V25、V30均相關(r--0.465～0.376,P=0.001～0.005)；三維適形放療前後CK-MB、LDH變化與V30相關(r=0.330、0.274,P=0.014、0.033),α-HBDH變化與V25、V30、V35相關(r=0.270～0.331,P=0.046～0.014).噹放療劑量＞50 Gy時AST、LDH、α-HBDH變化與V25、V30相關(r=0.256～0.359,P=0.019～0.006),CK-MB變化與V30相關(r=0.233,P =0.037)；≤50 Gy時僅V5 V45與CK變化相關(r=0.581、0.536,P=0.023、0.043).結論 心髒體積劑量與三維放療前後心肌酶水平變化有一定相關性,提示心髒DVH參數有助于評價放療誘導的心肌損傷.
목적 탐토흉부종류환자삼유방료전후혈청심기매보개변여심장체적제량적상관성.방법 102례흉부종류환자(폐암68례、식관암34례)방료전후검측혈청천동안산안기전이매(AST)、기산격매(CK)、CK동공매(CK-MB)、유산탈경매(LDH)급α-간정산탈경매(α-HBDH)수평.방료전후각충매수평비교행배대t검험,조간비교행성조t검험.채용제량체적직방도(DVH)삼수[심장접수≥x Gy조사체적점총체적백분비(Vx)]평개심장체적제량,각충매여DVH삼수상관성행Pearson법분석.결과 방료후혈청AST、CK-MB、LDH、α-HBDH수평교방료전명현증고(19.42:27.89、14.72:19.57、178.80:217.57、140.32:176.25,t=-3.39～ -6.92,P균=0.000).조강방료전후AST변화여V20、V25、V30상관(r=0.302～0.431,P=0.039～0.003),CK변화여V30상관(r=0.345,P=0.013),CK-MB、LDH、α-HBDH변화여V25、V30균상관(r--0.465～0.376,P=0.001～0.005)；삼유괄형방료전후CK-MB、LDH변화여V30상관(r=0.330、0.274,P=0.014、0.033),α-HBDH변화여V25、V30、V35상관(r=0.270～0.331,P=0.046～0.014).당방료제량＞50 Gy시AST、LDH、α-HBDH변화여V25、V30상관(r=0.256～0.359,P=0.019～0.006),CK-MB변화여V30상관(r=0.233,P =0.037)；≤50 Gy시부V5 V45여CK변화상관(r=0.581、0.536,P=0.023、0.043).결론 심장체적제량여삼유방료전후심기매수평변화유일정상관성,제시심장DVH삼수유조우평개방료유도적심기손상.
Objective To analyze the correlation between the changes of myocardial enzyme level in serum before and after radiotherapy and dose - volume histogram ( DVH ) parameters of the heart.Methods A total of 102 patients with 68 cases of lung cancer and 34 cases of esophageal cancer were recruited.All patients received three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT),with the radiation beams passing through the heart.Aspertate aminotransferase (AST),creatine kinase (CK),creatine kinase isozyme ( CK-MB ),lactate dehydrogenase ( LDH ),α-hydroxybutyrate dehydrogenase (α-HBDH) were determined in the serum before and after radiotherapy.All the enzyme levels before and after radiotherapy were compared through paired t-test.Independent sample t-test was conducted between sub-groups.And the dose-volume histogram (DVH) parameters of the heart were calculated ( the volume percentage of heart receiving dose equal to or exceeding x Gy ( Vx ).The correlation between myocardial enzyme level and DVH parameters was analyzed through Pearson method.Results Serum AST,CK-MB,LDH,α-HBDH levels increased significantly after radiotherapy ( 19.42∶ 27.89,14.72∶19.57,178.80 ∶ 217.57,140.32 ∶ 176.25,t =-3.39 - -6.92,all P=0.000).In Group IMRT,significant correlations between the increase of myocardial enzyme concentration and DVH parameters of the heart are found,AST with V20,V25,V30 of heart ( r=0.302 - 0.431,P =0.039 - 0.003 ),CK with V30of heart (r=0.345,P=0.013),and CK-MB,LDH,α-HBDH with V25,V30(r=0.465 -0.376,P=0.001-0.005).In Group CRT,there are significant correlations between changes of CK-MB,LDH level and V30 of heart (r =0.330,0.274,P=0.014,0.033),α-HBDH and V25,V30,and V35 of heart (r=0.270-0.331,P=0.046-0.014).When the irradiation dose was more than 50 Gy,significant correlations were found between the concentration changes of AST,LDH,α-HBDH and V25,V30 of heart (r=0.256-0.359,P =0.019-0.006),CK-MB and V30(r=0.233,P=0.037).When the irradiation dose was 50 Gy or less,only the concentration change of serum CK has significant correlation with V5 and V45 of heart (r=0.581,0.536,P=0.023,0.043).Conclusions There exists certain correlations between changes of myocardial enzymes level before and after radiation and DVH parameters of the heart,which indicates that the DVH parameters of heart are helpful to evaluate the radiation-induced myocardial damage.
