CAJ | 학술논문

目的：探讨放疗致肺癌患者发生放射性肺炎（RP）的影响因素。方法选择2012年1月—2014年1月于青岛市胶州中心医院放疗科接受胸部适行放疗的肺癌患者104例，分为发生 RP 组和未发生 RP 组。对比分析两组患者放疗前后肿瘤坏死因子（TNF）-α、白介素（IL）-6、IL -10的表达水平；采用多因素 Logistic 回归分析发生RP 的影响因素。结果104例患者共29例发生 RP，RP 发生率为27.9％。患者放疗后 TNF -α、IL -6水平较放疗前升高，差异有统计学意义（P ＞0.05），IL -10水平较治疗前降低，差异有统计学意义（P ＜0.05）。发生 RP 组患者放疗前TNF -α水平高于未发生 RP 组，差异有统计学意义（P ＜0.05）；两组放疗前 IL -6和 IL -10水平比较，差异无统计学意义（P ＞0.05）。发生 RP 组患者放疗后 IL -6水平低于未发生 RP 组，差异有统计学意义（P ＜0.05）；两组放疗后TNF -α、IL -10水平比较，差异无统计学意义（P ＞0.05）。放疗前肺功能正常患者与放疗前肺功能异常患者的RP 发生率比较，差异有统计学意义（P ＜0.05）。多因素 Logistic 回归分析结果显示，放疗总剂量与放疗前TNF -α水平是 RP 的危险因素（OR ＝3.779、1.912，P ＝0.002、0.046）。结论肺癌放疗患者的放疗总剂量≥60 Gy 与放疗前 TNF-α水平是发生 RP 的危险因素，患者接受放疗时应测量患者放疗前 TNF -α水平和控制放疗总剂量，以降低 RP 发生率。
목적：탐토방료치폐암환자발생방사성폐염（RP）적영향인소。방법선택2012년1월—2014년1월우청도시효주중심의원방료과접수흉부괄행방료적폐암환자104례，분위발생 RP 조화미발생 RP 조。대비분석량조환자방료전후종류배사인자（TNF）-α、백개소（IL）-6、IL -10적표체수평；채용다인소 Logistic 회귀분석발생RP 적영향인소。결과104례환자공29례발생 RP，RP 발생솔위27.9％。환자방료후 TNF -α、IL -6수평교방료전승고，차이유통계학의의（P ＞0.05），IL -10수평교치료전강저，차이유통계학의의（P ＜0.05）。발생 RP 조환자방료전TNF -α수평고우미발생 RP 조，차이유통계학의의（P ＜0.05）；량조방료전 IL -6화 IL -10수평비교，차이무통계학의의（P ＞0.05）。발생 RP 조환자방료후 IL -6수평저우미발생 RP 조，차이유통계학의의（P ＜0.05）；량조방료후TNF -α、IL -10수평비교，차이무통계학의의（P ＞0.05）。방료전폐공능정상환자여방료전폐공능이상환자적RP 발생솔비교，차이유통계학의의（P ＜0.05）。다인소 Logistic 회귀분석결과현시，방료총제량여방료전TNF -α수평시 RP 적위험인소（OR ＝3.779、1.912，P ＝0.002、0.046）。결론폐암방료환자적방료총제량≥60 Gy 여방료전 TNF-α수평시발생 RP 적위험인소，환자접수방료시응측량환자방료전 TNF -α수평화공제방료총제량，이강저 RP 발생솔。
Objective To investigate influencing factors for radiation pneumonitis(RP)induced by radiation therapy for lung cancer. Methods We enrolled 104 patients with lung cancer who received chest conformal radiotherapy in the Department of Radiotherapy of Jiaozhou Central Hospital of Qingdao from January 2012 to January 2014 and divided them into RP group and non- PR group. The expression levels of tumor necrosis factor alpha( TNF - α),interleukin - 6( IL - 6)and interleukin - 10 (IL - 10)of the two groups were compared and analyzed before and after radiotherapy. Multivariate logistic regression analyses were conducted on influencing factors for RP. Results Among all subjects,RP was noted in 29 subjects with an incidence of 27. 9% . The levels of TNF - α and IL - 6 of the subjects increased(P < 0. 05)and the level of IL - 10 decreased(P < 0. 05) after radiotherapy. Before radiation therapy,the RP group was higher(P < 0. 05)than the non - RP group in the level of TNF - α, and the two groups were not significantly different(P > 0. 05)in the levels of IL - 6 and IL - 10. After radiation therapy,the RP group was lower than non - RP group in the level of IL - 6(P < 0. 05),and the two groups were not significantly different(P >0. 05)in the levels of TNF - αand IL - 10. The subjects with normal pulmonary function and those with abnormal pulmonary function before radiation therapy were significantly different(P < 0. 05)in the incidence of RP. Multivariate Logistic regression analyses showed the total dose of radiation therapy and the level of TNF - α before radiation therapy were risk factors( OR =3. 779,1. 912;P = 0. 002,0. 046)for radiation pneumonitis. Conclusion The total dose of radiation therapy ≥60 Gy and the level of TNF - α before radiation therapy are risk factors for RP. The level of TNF - α should be monitored and the total dose of radiation therapy should be controlled before radiation therapy in order to decrease the incidence of RP.