超声结合检验指标评价不同放疗方式对肺癌患者淋巴细胞亚群的影响  

Ultrasonography combined with laboratory testing in evaluating the effect of radiotherapy modalities on lymphocyte subpopulations in lung cancer patients

作　　者：刘宏强[1] 王聪 李锦秋[2] 王义成[1] 张志林[2] LIU Hongqiang;WANG Cong;LI Jinqiu(Department of Ultrasound Medicine,the First Affiliated Hospital of Hebei North University,Hebei,Zhangjiakou 075000,China;不详)

机构地区：[1]河北北方学院附属第一医院超声医学科,河北省张家口市075000 [2]河北北方学院附属第一医院放射治疗科,河北省张家口市075000

出　　处：《河北医药》2024年第14期2117-2121,共5页Hebei Medical Journal

基　　金：河北省重点科技研究计划(编号:20220595)。

摘　　要：目的探索不同调强放疗方式H-alfentanil区差异对原发性肺癌患者围放疗期外周血淋巴细胞亚群的影响。方法选取2021年8月至2023年1月于河北北方学院附属第一医院放疗科行放疗的原发性肺癌患者58例,根据放疗方式不同分为IMRT组(n=28)、VMAT组(n=30);记录2组患者放疗计划参数;选定放疗前1周内(T0)、放疗剂量至40Gy时(T1)、放疗结束后4周(T2)3个时间点进行外周血淋巴细胞和亚群化验及超声检查锁骨上淋巴结及颈部淋巴结。结果治疗前VMAT组双肺V5、V10、V15、V20、V25、V30高于IMRT组,MLD低于IMRT组,差异均有统计学意义(P<0.05),治疗前PTV、2组淋巴细胞亚群各指标比较差异均无统计学意义(P>0.05);治疗后2组的淋巴细胞总数、CD3^(+)T总数、CD3^(+)CD4^(+)T亚群、CD4^(+)/CD8^(+)均降低(P<0.01);CD3^(+)CD8^(+)T亚群、CD16^(+)CD56^(+)NK亚群均升高(P<0.01);其中VMAT组CD3^(+)CD4^(+)T亚群指标、CD4^(+)/CD8^(+)指标低于IMRT组(P<0.05);Logistic分析,2组患者淋巴细胞总数的下降与双肺V5、V10、V15、V35、V40、V45、V50、V60呈正相关(P<0.05);超声检查锁骨上淋巴结及颈部淋巴结大小、形态及淋巴门的位置比较,差异无统计学意义(P>0.05)。结论原发性肺癌行IMRT、VMAT放疗均引起外周血淋巴细胞减少及淋巴细胞亚群再分布,VMAT放疗双肺H-alfentanil区较IMRT范围更大,外周血淋巴细胞减低越明显,超声的形态学检查在评价不同放疗方式对肺癌患者淋巴细胞亚群的影响的作用有限。Objective To explore the effect of different low-dose region of intensity-modulated radiation therapies(IMRT) on peripheral blood lymphocyte subpopulations in patients with primary lung cancer.Methods A total of 58 primary lung cancer patients who received radiotherapy(RT) in the Radiotherapy Department of the First Affiliated Hospital of Hebei North University from August 2020 to January 2021 were enrolled.They were assigned into IMRT group and volumetric-modulated arc radiotherapy(VMAT) group depending on the type of RT.RT planning parameters of two groups were recorded.The peripheral blood lymphocytes and their subpopulations,as well as ultrasound of supraclavicular and cervical lymph nodes examination were performed within 1 week before RT(T0),at the time point of RT dose reaching 40 Gy(T1) and 4 weeks after RT(T2).Results There were significant differences in Zone V5,V10,V15,V20,V25 and V30 in bilateral lungs before RT between IMRT group and VMAT group,which were significantly higher in VMAT group(P<0.05).A significantly higher mean lung dose(MLD) was detected in IMRT group than that of VMAT group(P<0.05).Before RT,no significant differences were detected in planning target volume(PTV) and lymphocyte subpopulations between groups(P>0.05).After RT,significantly lower total count of lymphocytes,CD3^(+)T count,CD3^(+)CD4^(+)T subpopulation and CD4^(+)/CD8^(+) were detected,but significantly higher CD3^(+)CD8^(+)T subpopulation and CD16^(+)CD56^(+)NK subpopulation were found in both groups(P<0.01).Significantly lower CD3^(+)CD4^(+)T subpopulation and CD4^(+)/CD8^(+) were seen in VMAT group compared to IMRT group(P<0.05).Logistic regression analysis revealed that the decline of total count of lymphocytes in primary lung cancer patients was significantly correlated with Zone V5 and V10 in bilateral lungs(P<0.01),as well as Zone V15,V35,V40,V45,V50 and V60(P<0.05).Ultrasound examination did not reveal significant differences in the size and morphology of supraclavicular and cervical lymph nodes,as well as the posit

关 键 词：超声 检验 放疗 淋巴细胞亚群 

分 类 号：R734.2[医药卫生—肿瘤]