【摘要】 目的分析与放射性肺炎可能相关的放疗剂量体积参数与血液学指标,以期获得具有预测价值的临床参数用以指导预防性干预。方法回顾性分析在我院接受胸部放射治疗且年龄>60岁的老年肿瘤患者的临床病史、物理计划和随访资料。根据常见不良反应事件评价标准(CTCAE 4.0),记录放疗后6个月内出现≥2级放射性肺炎的情况,统计学分析多种因素与放射性肺炎的相关性。结果共纳入回顾性分析患者80例,放疗结束6个月内发生≥2级放射性肺炎22例(27.5%)。单因素分析显示≥2级的放射性肺炎的发生与V10、V20、V30、MLD、D-二聚体有统计学相关性(P=0.011、0.000、0.008、0.001)。多因素回归分析显示,V20、血浆D-二聚体水平的变化是放射性肺炎严重性的独立危险因素P=0.009、0.002)。结论通过限制V20有助于控制老年胸部放疗患者的急性期放射性肺炎的严重性,而血浆D-二聚体对于放射性肺炎严重程度具有一定的预测价值,因此通过密切检测D-二聚体浓度并予以干预,有助于降低放射性肺炎的严重性。更多还原

【Abstract】 Objective To analyze the possible correlations of hematological indexes and dose-vlume parameters with radiation pneumonitis(RP). Methods A retrospective analysis was made to the clincal data, radiotherapy plan and follow-up data of the elderly with tumor, aged over 60 and undergoing radiotherapy in our hospital; according to the Common Terminology Criteria for Adverse Events(CTCAE 4.0), the incidence of moderate and severe(grade≥2) RP within 6 months after raiotherapy was recorded and factors correlated with RP were statistically analyzed. Results In total, 80 elderly were enrolled in the retrospective analysis; the incidence of moderate and severe(grade≥2) RP within 6 months after raiotherapy was 27.5%( n=22);univariate analysis indicated that RP(grade≥2) was statistically correlated with V10, V20, V30, MLD and D-dimer( P=0.011, 0.000, 0.008, 0.001) while multivariate regression analysis revealed that V20 and plasma D-dimer changes were the independent factors related to the severity of RP(P =0.009,0.002, respectively). Conclusions The limitation of V20 is of certain help to control the severity of acute RP in the elderly undergoing thoracic radiation and plasma D-dimer is of certain value in predicating the severity of RP; dynamic monitoring of D-dimer and administration of medical intervention can help reduce the severity of RP.更多还原