妇科肿瘤放疗后急性放射性直肠损伤相关因素研究  

Study on the related factors of acute radiation rectal injury after radiotherapy for gynecological tumors

作　　者：孙蕊蕊 代元飞 魏洁[1] SUN Ruirui;DAI Yuanfei;WEI Jie(Department of Oncology,The First People's Hospital of Chuzhou,Chuzhou 239000,China)

机构地区：[1]滁州市第一人民医院肿瘤科,安徽滁州239000

出　　处：《社区医学杂志》2023年第9期456-460,465,共6页Journal Of Community Medicine

基　　金：滁州市医疗卫生重点专科建设项目(滁卫科秘[2021]105号);2021年安徽医科大学青年科学基金项目(2021xkj085);2021年滁州市科学技术局重点项目(2021ZD002)。

摘　　要：目的观察妇科恶性肿瘤患者行调强放射治疗(IMRT)后并发急性放射性直肠损伤(RARI)的情况,探讨RARI发生的相关危险因素。方法收集2020-02-01-2022-02-28滁州市第一人民医院行放疗的70例妇科恶性肿瘤患者的临床资料。根据RTOG/EORTC评分对RARI患者的严重程度进行分级,分成<2级RARI(n=38)和≥2级RARI(n=32)2组。使用χ^(2)检验、t检验、logistic回归分析、非参数检验进行单因素分析,具有统计学意义的因素进行多因素分析,探讨发生≥2级RARI的独立危险因素。结果70例患者在观察期间内,表现出≥2级急性放射性直肠损伤32例(45.71%)。单因素分析显示,临床因素中年龄差异有统计学意义,χ^(2)=13.243,P=0.001;剂量体积因素中最大剂量(D_(max))、平均剂量(D_(mean))、V_(40)、V_(45)其中P值分别为<0.001、0.009、0.010和0.016;炎症指标中血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)的OR值分别为1.012和1.518,P值分别为0.009和0.040。多因素分析显示,年龄(OR=1.079,95%CI为1.013~1.150,P=0.019)、D_(max)(OR=1.005,95%CI为1.000~1.010,P=0.031)和PLR(OR=1.013,95%CI为1.002~1.024,P=0.024)是预测≥2级RARI的独立危险因素。ROC曲线分析显示,年龄的AUC为0.707,临界值60.50,95%CI为0.583~0.831;D_(max)的AUC为0.771,临界值52.17,95%CI为0.661~0.882;PLR的AUC为0.685,临界值142.66,95%CI为0.557~0.813。结论妇科恶性肿瘤患者行IMRT时可用年龄、D_(max)和PLR这些因素预测≥2级RARI。年龄>60岁、D_(max)>52 Gy和PLR>143发生≥2级RARI的危险因素更高。Objective To observe the incidence of acute radiation rectal injury(RARI) in patients with gynecological malignant tumor after intensity modulate radiotherapy(IMRT),and to investigate the risk factors of RARI.Methods The clinical data of 70 patients with gynecological malignant tumor who underwent radiotherapy in Chuzhou First People's Hospital from 2020-02-01 to 2022-02-28 were collected.The severity of RARI patients was graded according to RTOG/EORTC score, and they were divided into two groups: Grade 2 RARI(n=38) and ≥ grade 2 RARI(n=32).χ^(2) test, t test, logistic regression analysis, and nonparametric test were used for univariate analysis, and multivariate analysis was performed for statistically significant factors to explore independent risk factors for ≥2 grade RARI.Results During the observation period, 32(45.71%) of 70 patients showed grade 2 or greater acute radiation rectal injury.Univariate analysis showed that there was significant difference in age among clinical factors, χ^(2)=13.243,P=0.001;The P values of maximum dose(D_(max)),average dose(D_(mean)),V_(40) and V_(45) were 0.001,0.009,0.010 and 0.016,respectively;The OR values of platelet/lymphocyte ratio(PLR) and lymphocyte/monocyte ratio(LMR) were 1.012 and 1.518,and the P values were 0.009 and 0.040.Polyfactor analysis showed that age(OR=1.079,95%CI:1.013-1.150,P=0.019),D_(max)(OR=1.005,95%CI:1.000-1.010,P=0.031) and PLR(OR=1.013,95%CI:1.002-1.024,P=0.024) were independent risk factors for predicting grade ≥2 RARI.ROC curve analysis showed that the AUC of age was 0.707,the critical value was 60.50,and 95%CI was 0.583-0.831;The AUC of D_(max) was 0.771,the threshold was 52.17,and 95%CI was 0.661-0.882;The AUC of PLR was 0.685,the critical value was 142.66,and 95%CI was 0.557-0.813.Conclusion Age,Dmax,and PLR can be used to predict grade≥2RARI for gynecological malignancies.Age>60years,D_(max)>52Gy and PLR >143had higher risk factors for grade 2RARI.

关 键 词：宫颈恶性肿瘤 子宫内膜恶性肿瘤 放射治疗 炎症指标 急性放射性直肠损伤 

分 类 号：R737.3[医药卫生—肿瘤]