血栓调节蛋白水平和剂量体积参数与急性放射性肺炎的相关性  

Clinical research on correlationship between thrombomodulin level,dose-volume parameters with acute radiation pneumonitis

作　　者：赵艳海[1] 张纯[1] 邓雪英[1] 成奇峰[1] 陈昱明[1] 吴伟艺[1] 孙彦秋[1] 黄军荣[1] 刘惠珠[1] 

机构地区：[1]广东省东莞市人民医院放射治疗科,523000

出　　处：《重庆医学》2013年第25期2972-2974,共3页Chongqing medicine

基　　金：东莞市科技局立项(2010105150013)

摘　　要：目的研究血清血栓调节蛋白(TM)水平和放射剂量体积参素与急性放射性肺炎(ARP)发生的相关性。方法对54例肺癌患者给予常规三维适形放射治疗(3DCRT)和化疗;20例同步放化疗,34例序贯化放疗。放疗前和放疗30Gy时用酶联免疫吸附法(ELISA)检测血清TM水平。依照美国国立肿瘤研究所CTCAE V3.0标准进行ARP评级,2级以上定为ARP。分析TM水平和放射剂量体积因素与ARP发生率的关系。结果 20例(37%)发生了ARP,2级12例,3级8例。ARP发生率在MLD(Gy)<10与≥10组、V5<50%与≥50%组、V10<40%与≥40%组、V20<25%与≥25%组、V30<13%与≥13%组、在照射30Gy后TM降低组与增高组分别是8%vs.62%、7%vs.69%、21%vs.75%、28%vs.56%、15%vs.57%、50%vs.13%,差异均有统计学意义(χ2=16.83、22.29、14.05、3.97、10.08、6.46,P<0.05);在ARP和无ARP组,MLD、V5、V10、V20和V30大小分别是:(12±2)vs.(9±2)、(58±10)vs.(43±10)、(42±8)vs.(30±8)、(23±3)vs.(19±6)、(15±4)vs.(11±4),差异均有统计学意义(t=-4.96、-5.27、-5.70、-3.37、-3.61,P<0.05)。结论多个剂量体积参数与ARP的发生率相关,放疗后血清TM水平降低的患者容易发生ARP。Objective To study the relationship between the level of serum thrombomodulin（TM） ,radiation dose-volume factors with acute radiation pneumonitis（ARP）. Methods 54 patients with lung cancer were given the routine 3--dimensional conformal radiation therapy（3DCRT） and chemotherpy,20 cases received the concurrent radiochemotberapy and 34 cases were performed the the sequential chemotherapy. The serum TM level was measured with enzyme-linked immunosorbent assay（ELISA） before radiotherapy（B-RT） and at 30 Gy（M-RT） in radiotherapy. The ARP grade was evaluated according to the criteria of the Common Terminology Criteria for Adverse Events（CTCAE v3.0） by the National Caner Institute（NCI）, grade 2 or more was taken as ARP. The relationship between the serum TM level,dose-volume factors with ARP was analyzed. Results 20 cases （37%） had ARP. 12 cases got grade 2 ARP and 8 cases had grade 3. The occurrence rates of ARP in the minimal lethal dose （MLD） Gy 〈10 and 〉10 groups,V5〈50% and ≥50% groups, V10〈40% and ≥40% groups,V20〈25% and ≥25% groups,V30〈13% and ≥13% groups, TM decrease group and TM increase group after 30 Gy radiation were 8% vs. 62%, 7% vs. 69%, 21% vs. 75%, 28% vs. 56%, 15 % vs. 57% and 50% vs. 13 % respectively, the differences had statistical significance （χ^2= 16. 83,22. 29,14. 05,3. 97, 10.08,6.46,P〈0.05） ; in the ARP group and non-ARP group,MLD,V5 ,V10 ,V20 and V30 were （12±2） vs. （9±2）, （58± 10） vs.（43±10）,（42±8） vs. （30±8）,（23±3） vs. （19±6）,（15±4） vs. （11±4） respectively,the differences had statistical signifi cance （t=4. 96,-5. 27, -5.70, -3.37, -3.61,P〈0.05）. Conclusion Multiple dose-volume parameters are associated with the occurrence rate of ARP. The patients with decreased serum TM level after radiotherapy are liable to develop ARP.

关 键 词：肺炎 血栓调节蛋白 放射剂量 

分 类 号：R818[医药卫生—放射医学]