摘要
目的探讨非小细胞肺癌(NSCLC)患者在不同放疗剂量下放射性肺损伤(RILD)的发生率及炎症改变。方法采用前瞻性研究方法,选择笔者所在医院2017年1月—2017年6月放疗科接受三维适形放疗的NSCLC患者90例,随机分为低剂量组(10~30 Gy)、中剂量组(31~60 Gy)和大剂量组(>60 Gy)。比较每组患者放射性肺损伤的发生率和放射相关参数;采用酶联免疫吸附试验检测放疗前、放疗后1 W和4 W的血清干扰素诱导蛋白-10(IP-10)、金属蛋白酶组织抑制蛋白(TIMP-1)、白介素6(IL-6)和转化生长因子β(TGF-β)的表达。结果低、中和高剂量组患者RILD发生率分别是17.4%(4/23)、56.7%(14/30)和76.0%(19/25)。三组患者的MLD分别是(21.8±5.2)、(40.0±5.6)和(63.0±2.1)Gy。随着放疗剂量的增加,患者的全肺V5≥45%、全肺V10≥45%、全肺V20≥29%、全肺V30≥19%、患肺V5≥71%、患肺V10≥56%、患肺V20≥46%和患肺V30≥42%比例依次升高。与低剂量组比较,中剂量组和高剂量组的全肺MLD≥17.5 Gy及患肺MLD≥23.5 Gy比例明显增加,但中剂量组和高剂量组比较差异无统计学意义。放疗剂量增加导致血清炎症因子IP-10、IL-6和TGF-β升高而TIMP-1降低。结论放疗剂量的增加可提高NSCLC患者RILD的发生率,可能与V5、V10、V20和V30比例增加有关,同时血清炎症因子IP-10、IL-6和TGF-β升高而TIMP-1降低。
Objective To explore the inflammation and incidence of radiation-induced lung damage（RILD） in non-small cell lung cancer（NSCLC） patients with different dose of three-demensional conformal radiotherapy. Methods A total of ninety NSCLC patients received three-demensional conformal radiotherapy in the department of Radiotherapy at our hospital from Januanry 2017 to June 2017 were enrolled via a prospective study. According to the dose of radiotherapy,these patients were randomly divided into low-dose group（10-30 Gy）,moderate-dose group（31-60 Gy） and high-dose group（〉60 Gy）. The general materials,incidence of RILD and radiation related parameters were recored and compared. The level of interferon inducible protein-10（IP-10）,tissue inhibitor of metalloproteinase（TIMP-1）,interleukin-6（IL-6） and transforming growth factor-β（TGF-β） in serum at baseline,1 W and 4 W after radiation were assessed by enzyme linked immunosorbent assay. Results There were seven patients quited the study in low-dose group because of inadequate dosage and unsatisfactory effect of radiation,five cases excluded because of not acceptable high-doase radiation. The incidence of RILD in low-dose group,moderate-dose group and high-dose group were 17.4%（4/23）,56.7%（14/30） and 76.0%（19/25）respectively,and the MLD in these groups were（21.8±5.2）,（40.0±5.6） and（63.0±2.1）Gy respectively. The V5≥45%,V10≥45%,V20≥29% and V30≥19% of total lung and V5≥71%,V10≥56%,V20≥46% and V30≥42%of ipsilateral lung were successively increased in low-dose group,moderate-dose group and high-dose group.Compared with low-dose group,the MLD of total lung ≥17.5 Gy and MLD of ipsilateral lung ≥23.5 Gy in moderate-dose and high-dose group were increased,but these changes in moderate-dose and high-dose group were similar. The increased dose of radiation would trigger the up-regulation of IP-10,IL-6 and TGF-β level but the reduction of TIMP-1 level. Conclusion The increased dose of radiation would be
作者
罗佩
李东涛
LUO Pei,LI Dong-tao.(Department of Cardiothoracic Surgery,The First People＇s Hospital of Qinzhou,Qinzhou 535000,China)
出处
《实用医药杂志》
2018年第5期392-396,399,共6页
Practical Journal of Medicine & Pharmacy
关键词
非小细胞肺癌
放疗
放射性肺损伤
炎症
Non-small-cell lung cancer
Radiation
Radiation-induced lung damage
Inflammation
