摘要
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。
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 -α and 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.
出处
《现代中西医结合杂志》
CAS
2014年第33期3670-3674,共5页
Modern Journal of Integrated Traditional Chinese and Western Medicine
关键词
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
locally advanced non -small cell lung cancer
three -dimensional conformal radiation therapy
radiation induced lung injury
cytokines
dose volume parameter
