老年鼻咽癌患者放射治疗颞叶损伤的MR波谱研究  

^1 H-MR spectroscopy study on radiation-induced injury of the temporal lobes in the elderly patients with nasopharyngeal carcinoma

作　　者：陈旺生[1] 李建军[1] 邢增宝[1] 洪澜[2] 王奋[3] 李长清[1] 

机构地区：[1]海南省人民医院放射科,海口570311 [2]海南省人民医院妇科,海口570311 [3]海南省人民医院放疗科,海口570311

出　　处：《中华放射学杂志》2011年第11期1023-1027,共5页Chinese Journal of Radiology

基　　金：海南省自然科学基金资助项目（30717）

摘　　要：目的应用氢质子MR波谱成像（^1H—MRS）研究老年鼻咽癌患者放射治疗颞叶损伤的代谢特点。方法对同期接受放射治疗（简称放疗）的21例年龄／〉60岁的老年和33例年龄≤45岁的青年鼻咽癌患者在治疗前、接受放射线剂量为20、40和60Gy时分别进行常规MR和^1H—MRS检查，观察不同放射剂量时双侧颞叶主要代谢物比值N-乙酰天冬氨酸（NAA）／肌酸（Cr）、胆碱（Cho）／Cr的变化趋势，两组间3种比值的比较采用独立样本t检验。结果放疗前，老年组NAA／Cr、Cho／Cr值分别为1．94±0．15、1．86±0．20，青年组分别为2．12±0．25、1．82±0．24，两组间差异无统计学意义（t值分别为1．417、1．070，P值均〉0．05）。放疗剂量达20、40、60Gv时，老年组和青年组NAA／Cr值分别为1．81±0．14、1．53±0．16、1．06±0．08和2．03±0．16、1．92±0．21、1．77±0．18，差异具有统计学意义（t值分别为8．386、9．113、13．729，P值分别〈0．05、〈0．05、〈0．01）；Cho／Cr值分别为1．82±0．16、1．61±0．29、1．37±0．13和1．77±0．19、1．48±0．17、1．06±0．14，在剂量达40、60Gy时差异具有统计学意义（t值分别为5．230、9．322，P值均〈0．05）；NAA／Cho值分别为1．17±0．15、1．10±0．08、0．83±0．05和1．52±0．13、1．36±0．15、1．10±0．17，差异具有统计学意义（t值分别为5．862、2．560、9．754，P值分别〈0．05、〈0．05、〈0．01）。老年组NAA／Cr值在20、40和60Gy时较放疗前降低的百分比分别为6．70％、14．43％、24．23％，大于青年组（4．25％、5．19％、7．08％）；Cho／Cr降低百分比分别为2．15％、11．29％、12．90％，小于青年组（3．30％、15．93％、17．58％）；NAA／Cho降低的百分比分别为8．59％、5．47％、21．09％，大于青年组（2．56％、10．26％、16．67％）。结论相同放疗模式和接受同等剂量放射Objective To study the metabolic characteristics of neuronal injury in the temporal lobes during the radiotherapy in the elderly patients with nasopharyngeal carcinoma by ^1H-MR spectroscopy. Methods Conventional MRI and 1H-MRS were performed in 21 elderly （age ≥ 60 years ） and 33 young （age ≤45 years ） patients who were historically confirmed with nasopharyngeal carcinoma and received radiotherapy for the first time. MR data were collected before and during the therapy at the radiation dosages of 20,40 and 60 Gy, respectively. Student t test was used to compare the NAA/Cr, Cho/Cr and NAA/Cbo ratios of ^1H-MRS in the temporal lobes between the two groups. Results The ratios of NAA/Cr,Cho/Cr before radiotherapy were 1.94 ± 0. 15,1.86 ± 0. 20 in the elderly group, and 2. 12 ± 0. 25,1.82 ± 0. 24 in the young group respectively, but the difference was not statistically significant （ t = 1. 417, 1. 070, P 〉 0. 05）. At the radiation with dosages of 20,40,and 60 Gy, the ratios of NAA/Cr were 1.81 ±0. 14,1.53 ± 0. 16,1.06 ±0. 08 in the elderly group respectively, and were 2. 03 ±0. 16,1.92 ±0. 21,1.77 ±0. 18 in the young group respectively. There were statistical differences between two groups （t = 8. 386,9. 113,13. 729, respectively, P 〈0. 05, 〈 0. 05, 〈 0. 01 ）. The ratios of Cho/Cr were 1.82 ± 0. 16,1.61 ± 0. 29,1.37 ± 0. 13 in the elderly group respectively, and were 1.77 ±0. 19,1.48 ±0. 17,1.06 ±0. 14 in the young group respectively. There were statistical differences between the two groups at dosages of 40 and 60 Gy （ t = 5. 230,9. 322 respectively, P 〈 0. 05） . The ratios of NAA/Cho were 1.17 ± 0. 15,1.10 ± 0. 08,0. 83 ± 0. 05 in the elderly group respectively, and were 1.52 ± 0. 13,1.36 ± 0. 15,1.10 ± 0. 17 in the young group respectively. There were statistical differences between two groups （ t = 5. 862,2. 560,9. 754 respectively, P 〈 0. 05, 〈 0. 05, 〈 0. 01 ）. At the dosages of 20 ,40 and 60 Gy, the decreases of NAA/Cr in the elderly group （6.

关 键 词：老年人 鼻咽肿瘤 颞叶 辐射损伤 磁共振波谱学 

分 类 号：R739.63[医药卫生—肿瘤]