现代中西医结合杂志
現代中西醫結閤雜誌
현대중서의결합잡지
MODERN JOURNAL OF INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE
2014年
33期
3670-3674
,共5页
局部晚期非小细胞肺癌%三维适形放射治疗%放射性肺损伤%细胞因子%DVH 参数
跼部晚期非小細胞肺癌%三維適形放射治療%放射性肺損傷%細胞因子%DVH 參數
국부만기비소세포폐암%삼유괄형방사치료%방사성폐손상%세포인자%DVH 삼수
locally advanced non -small cell lung cancer%three -dimensional conformal radiation therapy%radiation in-duced lung injury%cytokines%dose volume parameter
目的：研究局部晚期非小细胞肺癌患者血浆 TNF －α、IL －6水平及 DVH 参数在发生与未发生放射性肺损伤（RILI）组间的差异，评价其在预测发生 RILI 中的意义。方法回顾性分析68例局部晚期非小细胞肺癌行三维适形放射治疗患者发生 RILI 的情况。分别于放射治疗前及照射45～50 Gy 时，用酶联免疫吸附法（ELISA）检测血浆 TNF －α及 IL －6的含量；于剂量－体积直方图中获取 V5， V10， V20，V30及 MLD 参数。依据 RTOG 急性放射性肺损伤分级标准进行评价分级，观察终点为2级及2级以上的 RILI。结果68例患者中发生 RI－LI 18例，发生率为26％，其中2级12例，3级6例。放射治疗前及照射45～50 Gy 时血浆TNF －α及 IL －6含量的差异有统计学意义（P ＜0．05）。单因素分析表明，放疗前肺功能、放疗前血浆 TNF －α基础水平、V5、V10、V20、V30及 MLD 是发生 RILI 的相关因素（P 均＜0．05）。多因素分析表明，V20≥25％、放射治疗前较高的血浆 IL －6水平是发生 RILI 的独立危险因素（OR 值分别为4．023，1．856，P 均＜0．05）。结论放射治疗前血浆 IL －6水平较高、V20≥25％是 RILI 发生的高危因素，该研究结果有一定的临床意义。
目的：研究跼部晚期非小細胞肺癌患者血漿 TNF －α、IL －6水平及 DVH 參數在髮生與未髮生放射性肺損傷（RILI）組間的差異，評價其在預測髮生 RILI 中的意義。方法迴顧性分析68例跼部晚期非小細胞肺癌行三維適形放射治療患者髮生 RILI 的情況。分彆于放射治療前及照射45～50 Gy 時，用酶聯免疫吸附法（ELISA）檢測血漿 TNF －α及 IL －6的含量；于劑量－體積直方圖中穫取 V5， V10， V20，V30及 MLD 參數。依據 RTOG 急性放射性肺損傷分級標準進行評價分級，觀察終點為2級及2級以上的 RILI。結果68例患者中髮生 RI－LI 18例，髮生率為26％，其中2級12例，3級6例。放射治療前及照射45～50 Gy 時血漿TNF －α及 IL －6含量的差異有統計學意義（P ＜0．05）。單因素分析錶明，放療前肺功能、放療前血漿 TNF －α基礎水平、V5、V10、V20、V30及 MLD 是髮生 RILI 的相關因素（P 均＜0．05）。多因素分析錶明，V20≥25％、放射治療前較高的血漿 IL －6水平是髮生 RILI 的獨立危險因素（OR 值分彆為4．023，1．856，P 均＜0．05）。結論放射治療前血漿 IL －6水平較高、V20≥25％是 RILI 髮生的高危因素，該研究結果有一定的臨床意義。
목적：연구국부만기비소세포폐암환자혈장 TNF －α、IL －6수평급 DVH 삼수재발생여미발생방사성폐손상（RILI）조간적차이，평개기재예측발생 RILI 중적의의。방법회고성분석68례국부만기비소세포폐암행삼유괄형방사치료환자발생 RILI 적정황。분별우방사치료전급조사45～50 Gy 시，용매련면역흡부법（ELISA）검측혈장 TNF －α급 IL －6적함량；우제량－체적직방도중획취 V5， V10， V20，V30급 MLD 삼수。의거 RTOG 급성방사성폐손상분급표준진행평개분급，관찰종점위2급급2급이상적 RILI。결과68례환자중발생 RI－LI 18례，발생솔위26％，기중2급12례，3급6례。방사치료전급조사45～50 Gy 시혈장TNF －α급 IL －6함량적차이유통계학의의（P ＜0．05）。단인소분석표명，방료전폐공능、방료전혈장 TNF －α기출수평、V5、V10、V20、V30급 MLD 시발생 RILI 적상관인소（P 균＜0．05）。다인소분석표명，V20≥25％、방사치료전교고적혈장 IL －6수평시발생 RILI 적독립위험인소（OR 치분별위4．023，1．856，P 균＜0．05）。결론방사치료전혈장 IL －6수평교고、V20≥25％시 RILI 발생적고위인소，해연구결과유일정적림상의의。
Objective It is to observe the difference of plasma factor -α(TNF -α), interleukin -6 (IL -6) levels and DVH parameters between locally advanced non -small cell lung cancer (LA -NSCLC) patients with radiation -induced lung injury (RILI) or not, and evaluate its significance in predicting the occurrence of RILI.Methods 68 cases of LA -NSCLC patients, which were treated by Three -dimensional conformal radiotherapy (3D -CRT), were retrospectively collected and analyzed.The levels of plasma TNF -αand IL -6 were detected by enzyme -linked immunosorbent assay (ELISA), when before radiotherapy (pre -RT) and radiotherapy does reached 45 -50 Gy (during -RT).DVH parameters were come from Dose -volume histograms (DVH), include V5, V10, V20, V30 and MLD.In accordance with the RTOG morbidity scoring classification, RILI was classified.The primary endpoint was RILI with grade 2 or more 2.Results 18 cases occurred RILI in 68 patients, the incidence of RILI was 26%, of which 12 were grade 2 and 6 were grade 3.There were statistically significant in the levels of plasma TNF -αand IL -6 between the pre -RT and during -RT group (P <0.05).Univariate analysis dem-onstrated that the RILI incidence was associated with the pre -RT of plasma TNF -αlevels, V5, V10, V20, V30 and MLD (all P <0.05).Multivariate analysis demonstrated that V20≥25% and the pre -RT of plasma IL -6 higher levels were the independent risk factor for the occurrence RILI (OR =4.023, 1.856, P <0.05).Conclusion V20≥25% and the pre -RT higher levels of plasma IL -6 were the risk factors of RILI, the results of the study have certain clinical significance.
