正交试验优选子午沙鼠继发性骨包虫病的三维适形调强放疗方案  

Orthogonal design for optimizing intensity-modulated radiation therapy for secondary bone echinococcosis in Meriones meridianuses

作　　者：杨秀恩 地力木拉提·艾克热木 徐万龙[3] YANG Xiuen;Dilimulati AIKEREMU;XU Wanlong(Department of Orthopedics,Qilu Hospital of Shandong University Nanshan Branch,Yantai 265706,China;Department of Orthopedics,Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830001,China;Department of Orthopedics,Qilu Hospital of Shandong University,Jinan 250002,China)

机构地区：[1]山东大学齐鲁医院南山分院骨科,山东烟台265706 [2]新疆维吾尔自治区人民医院骨科,乌鲁木齐830001 [3]山东大学齐鲁医院骨科,济南250002

出　　处：《中华实用诊断与治疗杂志》2020年第6期545-547,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81360276);新疆维吾尔自治区科技支疆项目(2013911129);新疆维吾尔自治区青年科技创新人才培养工程项目-青年博士科技人才培养项目(2013731013);新疆维吾尔自治区自然科学基金(2012211B34);中国博士后科学基金(2014M552566XB)。

摘　　要：目的探讨三维适形调强放疗(intensity-modulated radiation therapy,IMRT)计划中对骨包虫杀灭效力高、优化且经济的继发性骨包虫病的放疗方案。方法右侧股骨继发性骨包虫病成年雄性子午沙鼠60只,采用L12(3×23)正交试验表对不同水平的放疗射野、分割剂量、剂量率、射线角度4个因素进行分配,在5周内对鼠股骨继发性包虫病灶行总剂量为20 Gy的IMRT。于放疗24 h后取子午沙鼠股骨包虫包囊,采用Western blot法检测骨包虫包囊组织凋亡因子Fas蛋白相对表达量。结果放疗后,60只鼠均未发现组织放疗损伤;正交实验结果显示,相同放疗总剂量情况下,各因素对鼠股骨继发性骨包虫杀灭作用影响程度依次为单次放疗剂量(R=2.17)、剂量率(R=0.72)、射野数(R=0.48)、射线角度(R=0.11);子午沙鼠股骨骨包虫包囊组织Fas蛋白相对表达量在不同放射野数、不同单次放疗剂量、不同剂量率上差异有统计学意义(P<0.05),在不同射线角度上差异无统计学意义(P>0.05);当单次放疗剂量为5 Gy、剂量率为1.5 Gy/min、射野数为9野、射线角度为等角度时,骨包虫包囊组织Fas蛋白相对表达量最高,对骨包虫的杀灭效果最好。结论IMRT生物安全性好,单次放疗剂量为5 Gy、剂量率为1.5 Gy/min、射野数为9野、射线角度为等角度是最优的骨包虫放疗方案。Objective To explore the optimal,effective and economical bone hydatid radiotherapy in intensity-modulated radiation therapy(IMRT)for secondary bone echinococcosis.Methods Sixty adult male Meriones meridianuses with secondary bone echinococcosis of the right femur were allocated four factors including radiation field,segmentation dose,dose rate and ray angle at different levels by L12(3×23)orthogonal test table.IMRT with a total dose of 20 Gy was given to the lesions in 5 weeks.The femur hydatid cyst was collected 24 h after radiotherapy,and the relative expression of Fas protein in hydatid cyst was detected by Western blot.Results After radiotherapy,no irradiation injury was found.The results of orthogonal experiments showed that under the same total radiotherapy dose,the single radiotherapy dose(R=2.17),dose rate(R=0.72),field number(R=0.48)and ray angle(R=0.11)achieved effect in turn on killing secondary bone hydatid.The relative expression of Fas protein was significantly different in radiation field number,single dose and dose rate(P<0.05),except radiation angle(P>0.05).When the single radiotherapy dose was 5 Gy,the dose rate was 1.5 Gy/min,the number of fields was 9 and the ray angle was equal,the relative expression of Fas was the highest,and the killing effect of bone echinococcosis was the best.Conclusion IMRT has a good biological safety.The bone hydatid radiotherapy in IMRT program achieves an optimal result at a dose of 5 Gy,dose rate of 1.5 Gy/min,radiation field of 9 and equal ray angle.

关 键 词：继发性骨包虫病 三维适形调强放疗 FAS 正交实验 子午沙鼠 

分 类 号：R532.32[医药卫生—内科学]