鼻咽癌放疗后患者的放射性脑病与智能精神状态研究

摘要

Objective: To investigate clinical manifestations and image features (MRI) of radiation encephalopathy (RE) in nasopharyngeal cancer (NPC) patients of Guangdong Province after radiotherapy and study on the intelligent mental state of the patients as well as influencing factors in RE.Methods: The clinical data of 121 patients of RE were retrospectively reviewed.The intelligent mental state was evaluated using the simple intelligent mental state inspection scale/ MMSE scale in 63 RE and 66 NPC patients received radiotherapy but without RE who served as the controls.Results: There was significant difference in morbidity in six months between the re-radiotherapy group and the first course radiotherapy group (P＜0.05).The initial symptom was varied but mainly showed bulbar palsy (65 cases, 53.71％).The score in the MMSE scale of patients of the controls was (25.38卤1.98),the score in the MMSE scale of patients of the RE group was (23.03卤 2.69), so patients of the RE group had higher score in the MMSE scale (P＜0.05) compared with the controls.The score in the MMSE scale of patients of the first course radiotherapy group was (23.55卤2.26),the score in the MMSE scale of patients of the re-radiotherapy group was (21.29卤3.41),Patients of the re-radiotherapy group had lower score in the MMSE scale (P＜0.05) compared with the first course radiotherapy group.The results showed that there were negatively effects between bulbar palsy and intelligent mental state.Conclusion: The latency of RE is shorter after re-radiotherapy.Radiation encephalopathy negatively affecting some domain of intelligent mental state of the patients.The negative effect of bulbar palsy should be taken into account.%目的:分析广东地区鼻咽癌放疗后放射性脑病(radiation encephalopathy,RE)的临床和影像学特点,并对放射性脑病患者智能精神状态及其影响因素进行研究.方法:分析121例RE患者的临床资料,采用简易智能精神状态检查量表(MMSE)对63例RE患者(病例组)和66例疗程匹配的鼻咽癌放疗后无放射性脑病患者(对照组)进行评定,系统分析放射性脑病患者智能精神状态的变化、影响因素及与神经系统症状的相关性.结果:二程放疗后6个月内RE的发生率较一程放疗者差异有统计学意义(P<0.05);首发症状以球麻痹症状(65例,53.71%)最常见.对照组MMSE评分为(25.38±1.98)分,病例组MMSE评分为(23.03±2.69)分,对照组智能精神状态的评分高于病例组(P<0.05);一程放疗组MMsE评分为(23.55±2.26)分,二程放疗MMSE评分为(21.29±3.41)分,两组评分比较,差异有统计学意义(P<0.05).球麻痹症状与智能精神状态的评分呈负相关.结论:二程放疗后RE发病率在2年内明显增加.RE对患者智能精神状态存在一定的负性影响,其中球麻痹等症状对智能精神状态的负面作用将会被考虑进来.