【摘要】 目的检测食管癌患者放疗前、中、后血浆中CRP的变化,探讨CRP对放射性肺炎的预测价值。方法 66例经病理证实的食管鳞癌患者,采用Elekta-precise计划系统制定三维适形放疗计划,处方剂量为50～70 Gy,并采集相关物理学数据,通过三维适形计划中的剂量体积直方图来获得肺的V₅、V₁₀、V₂₀ 及正常组织并发症概率（NTCP）等数据。根据胸部CT、患者的呼吸道症状和体征来对肺损伤状况进行评价。据RTOG定义的Lent-Soma量表来对肺损伤的严重程度进行分级。用全自动生化分析仪检测放疗前、放疗中（40 Gy）、放疗结束时、放疗结束后1个月及结束后3个月时血浆中CRP水平。统计学数据采用单因素分析、多因素分析、t检验。结果 66例患者中31.82%（21/66）的患者发生放射性肺损伤,其中1级24.24%（16/66）,≥2级7.58%（5/66）。发生急性放射性肺损伤患者血浆中CRP水平在放疗中及放疗后较未发生放射性肺损伤的患者升高（P<0.05）。对患者一般资料单因素分析提示:放射剂量≥60 Gy、紫杉类药物应用者更易发生放射性肺损伤。结论在严格限制肺受照剂量和药物应用的情况下,CRP可作为放射性肺损伤的预测因子。更多还原

【Abstract】 Objective To explore the predictive value of C-reactive protein（CRP） in predicting radiation-induced pneumonitis（RP） through detecting the plasma CRP in patients with esophageal carcinoma before RT, during（at 40 Gy） and after radiotherapy. Methods 66 patients with esophageal squamous carcinoma were treated with three-dimensional conformal radiotherapy（RT） using Elekta Precise treatment planning system with a prescribed dose of 50～70 Gy. Dose-volume histograms were collected from three-dimensional conformal RT to determine the volume percentage of the lung received V₅,V₁₀,V₂₀,and normal tissue complication probability. RP was assessed based on computed tomography imaging, respiratory symptoms, and signs. The severity of radiation-induced lung toxicity was determined using the Lent-Soma scale defined by the Radiation Therapy Oncology Group（RTOG）. Plasma samples obtained before RT, during RT（at 40 Gy）, and at 1 day, 1 month and 3 months after RT for CRP levels by automatic biochemical analyzer. The data were analyzed with Univariate analysis, multivariate analysis, and t-test. Results 21 patients（31.82%） developed RP, in which 16（24.24%） had RP of grade I and 5（7.58%） had grade II or higher. Plasma CRP levels were elevated in the patients that had RP when compared with the other patients who did not have RP during（at 40 Gy） and after radiotherapy（P<0.05）. The results show that the patients with radiation dose ≥60 Gy and taxoside drug application were more likely to have RP. Conclusion If the radiation dose of lung and drugs are strictly limited, plasma CRP can be used as a marker of RP.更多还原