CAJ | 학술논문

目的通过比较不同剂量水平椎体适形调强放疗(IMRT)对成年比格犬椎体骨细胞的损伤作用,初步探讨一次全椎体IMRT的安全剂量范围.方法选取纯种比格犬30只按随机数字表法平均分为5组,以全椎体IMRT的治疗方式分别对5组比格犬胸9～10椎体给予0、40、50、60和70 Gy剂量的照射,于照后3个月处死,取相同部位的胸9～10节段椎体骨进行HE染色、电镜观察后,免疫组织化学法定量检测椎体中血管内皮细胞生长因子(VEGF)蛋白的表达,TUNEL法定量检测椎体骨中凋亡骨细胞.结果 HE染色结果提示随着IMRT剂量的增大,比格犬椎体骨空骨陷窝率增加明显(F=2.57,P ＜0.05),骨小梁断裂程度增加,但面积未见明显下降(P＞0.05)；电镜结果提示40 Gy IMRT组部分骨细胞出现凋亡,而50 Gy及以上剂量IMRT组绝大多数骨细胞凋亡.TUNEL表达结果提示40 Gy IMRT组骨细胞凋亡率低于50 Gy及以上剂量组骨细胞凋亡率(F=3.52,P＜0.05),50 Gy及以上剂量组骨细胞凋亡率差异无统计学意义(P＞0.05).50 Gy以上组的VEGF蛋白表达高于40 Gy组(F=3,64,P＜0.05),但50、60、70 Gy组之间差异无统计学意义(P＞0.05).结论 50 Gy可作为临床选择治疗总剂量界限的参考标准.
목적 통과비교불동제량수평추체괄형조강방료(IMRT)대성년비격견추체골세포적손상작용,초보탐토일차전추체IMRT적안전제량범위.방법 선취순충비격견30지안수궤수자표법평균분위5조,이전추체IMRT적치료방식분별대5조비격견흉9～10추체급여0、40、50、60화70 Gy제량적조사,우조후3개월처사,취상동부위적흉9～10절단추체골진행HE염색、전경관찰후,면역조직화학법정량검측추체중혈관내피세포생장인자(VEGF)단백적표체,TUNEL법정량검측추체골중조망골세포.결과 HE염색결과제시수착IMRT제량적증대,비격견추체골공골함와솔증가명현(F=2.57,P ＜0.05),골소량단렬정도증가,단면적미견명현하강(P＞0.05)；전경결과제시40 Gy IMRT조부분골세포출현조망,이50 Gy급이상제량IMRT조절대다수골세포조망.TUNEL표체결과제시40 Gy IMRT조골세포조망솔저우50 Gy급이상제량조골세포조망솔(F=3.52,P＜0.05),50 Gy급이상제량조골세포조망솔차이무통계학의의(P＞0.05).50 Gy이상조적VEGF단백표체고우40 Gy조(F=3,64,P＜0.05),단50、60、70 Gy조지간차이무통계학의의(P＞0.05).결론 50 Gy가작위림상선택치료총제량계한적삼고표준.
Objective To explore a safe dose range of spinal IMRT by comparing the cell damage in Beagles at different dose levels.Methods Thirty Beagles were randomly divided into 5 groups.The Beagle clinical model of tumor was established in the ninth and tenth thoracic spine.The Beagles were subjected to IMRT with the total doses of 0,40,50,60,70 Gy,respectively.The samples of spine were taken out from the same locum of the ninth and tenth thoracic spine at 3 month after radiation.All the samples were observed by the hematoxylin-eosin staining,and the VEGF expression in spine was evaluated by immunohistochemistry.Terminal deoxynucleatidyl transferase mediated dUTP nick and labeling (TUNEL) technique was used to examine the apoptotic cells in the spine.Results The osteocytes in the spine showed reversible injury in 40 Gy group,and cell apoptosis in 50,60,70 Gy groups.Compared with 40 Gy group,the rates of lacuna were increased in 50,60,70 Gy groups(F =2.57,P ＜0.05),as well as the cell apoptotic rates(F =3.52,P ＜ 0.05) and the expression of VEGF (F =3.64,P ＜ 0.05),but there were no significant differences among 50,60,70 Gy groups (P ＞ 0.05).Conclusions The late radiotherapy response of the spine was obviously observed at 3 month after radiation,especially at 50 Gy.