合并糖尿病或高血压的食管癌患者发生放射性食管炎和肺炎的危险因素分析  

Risk factors for radiation esophagitis and pneumonitis in esophageal cancer patients with diabetes or hypertension

作　　者：刘惠兰[1] 汪建林 戴圣斌 于波[3] 沙莎[3] 舒忠琴[3] 顾小伟[3] 王坚 Liu Huilan;Wang Jianlin;Dai Shengbin;Yu Bo;Sha Sha;Shu Zhongqin;Gu Xiaowei;Wang Jian(Department of Tumor,Taizhou People＇s Hospital,Taizhou 225300,Chin;Department of Radiotherapy,Changzhou Second People＇s Hospital,Affiliated Hospital of Nanfing Medical University,Changzhou 213001,China;Department of Radiotherapy,Jiangyin People＇s Hospital,Jiangyin 214400,Chin)

机构地区：[1]泰州市人民医院肿瘤科,225300 [2]南京医科大学附属常州第二人民医院放疗科,常州213003 [3]江阴市人民医院放疗中心,无锡214400

出　　处：《中华放射医学与防护杂志》2018年第8期584-589,共6页Chinese Journal of Radiological Medicine and Protection

基　　金：国家自然科学基金（11705095）

摘　　要：目的 探讨伴有糖尿病或高血压的食管癌患者接受放射治疗后急性放射性食管炎和肺炎发生情况。方法 回顾性分析373例食管癌患者接受三维适形或调强放射治疗资料，其中，伴有糖尿病者42例，无糖尿病者331例，伴高血压者99例，无高血压者274例。随访观察1年，分析有无糖尿病或高血压的患者放射性食管炎和肺炎的发生情况。结果 有无糖尿病患者1、2、3、4级放射性食管炎发生率分别为40.5%、38.1%、14.3%、4.8%和66.2%、27.8%、2.7%、1.8%。有无糖尿病患者1、2、3级放射性肺炎发生率分别为31.0%、16.7%、9.5%和30.8%、15.7%、1.2%。伴糖尿病的食管癌患者≥ 3级急性放射性食管炎和肺炎发生率均高于无糖尿病患者（χ^2=13.573、12.279，P〈0.05）。有无高血压患者1、2、3、4级放射性食管炎发生率分别为49.5%、38.4%、8.1%、3.0%和68.2%、25.5%、2.6%、1.8%。有无高血压患者1、2、3级放射性肺炎发生率分别为30.3%、18.2%、5.1%和31.0%、15.0%、1.1%。伴高血压的患者≥ 3级急性放射性食管炎和肺炎发生率均高于无高血压患者（χ^2=5.695、5.422，P〈0.05）。糖尿病是≥ 3级急性放射性食管炎和肺炎发生的独立因素。结论 糖尿病或高血压为根治性放疗食管癌患者发生严重（≥ 3级）急性放射性食管炎和肺炎的易感因素。Objective To investigate the risk factors for acute radiation esophagitis andpneumonitis after radiation therapy in esophageal cancer （EC） patients with diabetes or hypertension.Methods A total of 373 EC patients receiving three dimensional conformal radiation therapy （3D-CRT） or intensity modulated radiation therapy （IMRT） were included in this study. Among these patients, 42 showed concurrent with diabetes and 99 with hypertension. Radiation esophagitis or pneumonitis in patients with or without diabetes, and with or without hypertension were monitored in the 1-year follow up, respectively.Results The prevalence of grade 1, 2, 3 and 4 radiation esophagitis in diabetes and non-diabetes patients was 40.5%, 38.1%, 14.3%, 4.8% and 66.2%, 27.8%, 2.7%, 1.8%, respectively, while that of the grade 1, 2 and 3 radiation pneumonitis in diabetes and non-diabetes patients was 31.0%, 16.7%, 9.5% and 30.8%, 15.7%,1.2%, respectively. The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with diabetes and was significantly higher than those with non-diabetes （χ^2=13.573, 12.279, P〈0.05）. The prevalence of grade 1, 2, 3 and 4 radiation esophagitis in hypertension and non-hypertension patients was 49.5%, 38.4%, 8.1%, 3.0% and 68.2%, 25.5%, 2.6%, 1.8%, respectively, while that of the grade 1, 2 and 3 radiation pneumonitis in hypertension and non-hypertension patients were 30.3%, 18.2%, 5.1% and 31.0%, 15.0%, 1.1%, respectively. The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with hypertension was significantly higher than those with non-hypertension （χ^2=5.695、5.422, P〈0.05）. Diabetes is an independent risk factor for grade 3 or above acute radiation esophagitis and pneumonitis.Conclusions Diabetes or hypertension might be risk factors for severe radiation esophagitis and pneumonitis in EC patients receiving radiation therapy.

关 键 词：糖尿病 高血压 食管癌 放射性食管炎 放射性肺炎 

分 类 号：R735.1[医药卫生—肿瘤] R587.1[医药卫生—临床医学] R730.55