胸部放疗中肺功能变化与放射性肺炎的相关性研究

目的 讨论胸部放疗中肺功能变化与放射性肺炎的相关性.方法 回顾性分析105例接受放疗的胸部肿瘤患者的临床资料,根据其是否有放射性肺炎分为观察组35例和对照组70例.分析两组患者的临床资料、剂量体积直方图参数和放疗前后肺功能变化,探讨其与放射性肺炎的相关性.结果 观察组患者的放射性肺炎分级:1级有24例(68.57％),2级患者7例(20.00％),3级患者4例(11.43％),无4级和5级放射性肺炎患者;两组患者在性别、平均年龄、肿瘤来源、肿瘤部位、放疗参数和肺功能参数上均有差异,差异均有统计学意义(P﹤0.05);经Logistic多因素逐步回归分析显示,肺癌、深处肿瘤、放疗参数(PTV、Vdose和MLD)和肺功能参数(FEV1、FEV1/FVC和DLCO)是放射性肺炎发生的独立危险因素(P﹤0.05).结论 放射性肺炎是由多因素综合所致,尤其需要重视肺功能基础差的肺癌深部肿瘤患者,对此类患者必须严格控制放疗剂量和时间等,提供个体化治疗方案.

Correlation between the change of pulmonary function and radiation pneumonitis during chest radiotherapy

Objective To study the correlation between the change of pulmonary function and radiation pneumonitis during chest radiotherapy. Method 105 patients with thoracic tumors treated by thoracic radiotherapy were retrospective-ly analyzed, and were divided as study group (n=35) or control group (n=70) according to whether they were with radia-tion pneumonitis. The clinical data, dose-volume histogram parameters and the changes of pulmonary function before and after radiotherapy in the two groups were compared to explore the correlation with radiation pneumonitis. Result In study group, 24 patients were with grade 1 radiation pneumonitis (68.57％), 7 were with grade 2 (20.00％), 4 were grade 3 (11.43％), but there was no grade 4 and 5 cases;there were significant differences in the distribution of sex, average age, source of tumor, tumor location, radiotherapy parameters and pulmonary function parameters between the two groups, and the difference was statistically significant (P<0.05); multivariate Logistic stepwise regression analysis showed that, lung cancer, deep tumor and radiotherapy parameters (PTV, Vdose and MLD) and pulmonary function parameters (FEV1, FEV1/FVC and DLCO) were independent risk factors of radiation pneumonitis (P<0.05). Conclusion Radiation pneu-monitis is caused by multiple complex of factors, and patients with deep lung cancer along with poor basic lung function should be focused, for whom the dosage and time should be strictly controlled to provide an individualized scheme.