血栓调节蛋白水平和剂量体积参数与急性放射性肺炎的相关性

摘要

目的：研究血清血栓调节蛋白（TM ）水平和放射剂量体积参素与急性放射性肺炎（ARP）发生的相关性。方法：对54例肺癌患者给予常规三维适形放射治疗（3DCRT ）和化疗；20例同步放化疗，34例序贯化放疗。放疗前和放疗30 Gy时用酶联免疫吸附法（ELISA）检测血清TM水平。依照美国国立肿瘤研究所CTCAE V3．0标准进行ARP评级，2级以上定为ARP。分析TM 水平和放射剂量体积因素与ARP发生率的关系。结果20例（37％）发生了ARP ，2级12例，3级8例。ARP发生率在M LD （Gy ）＜10与≥10组、V5＜50％与≥50％组、V10＜40％与≥40％组、V20＜25％与≥25％组、V30＜13％与≥13％组、在照射30 Gy后TM降低组与增高组分别是8％ vs ．62％、7％ vs ．69％、21％ vs ．75％、28％ vs ．56％、15％ vs ．57％、50％ vs ．13％，差异均有统计学意义（χ2＝16．83、22．29、14．05、3．97、10．08、6．46，P＜0．05）；在ARP和无ARP组，MLD、V5、V10、V20和V30大小分别是：（12±2） vs ．（9±2）、（58±10） vs ．（43±10）、（42±8） vs ．（30±8）、（23±3） vs ．（19±6）、（15±4） vs ．（11±4），差异均有统计学意义（t＝-4．96、-5．27、-5．70、-3．37、-3．61，P＜0．05）。结论：多个剂量体积参数与ARP的发生率相关，放疗后血清TM水平降低的患者容易发生ARP。%Objective To study the relationship between the level of serum thrombomodulin (TM ) ,radiation dose-volume factors with acute radiation pneumonitis (ARP) .Methods 54 patients with lung cancer were given the routine 3 -dimensional conformal radiation therapy(3DCRT) and chemotherpy ,20 cases received the concurrent radiochemotherapy and 34 cases were performed the the sequential chemotherapy .The serum TM level was measured with enzyme-linked immunosorbent assay(ELISA) before radio-therapy(B-RT) and at 30 Gy(M-RT) in radiotherapy .The ARP grade was evaluated according to the criteria of the Common Ter-minology Criteria for Adverse Events(CTCAE v3 .0) by the National Caner Institute(NCI) ,grade 2 or more was taken as ARP . The relationship between the serum TM level ,dose-volume factors with ARP was analyzed .Results 20 cases (37% ) had ARP .12 cases got grade 2 ARP and 8 cases had grade 3 .The occurrence rates of ARP in the minimal lethal dose (MLD) Gy <10 and >10 groups ,V5 < 50% and ≥ 50% groups ,V10 < 40% and ≥ 40% groups ,V20 < 25% and ≥ 25% groups ,V30 < 13% and ≥ 13%groups ,TM decrease group and TM increase group after 30 Gy radiation were 8% vs .62% ,7% vs .69% ,21% vs .75% ,28% vs . 56% ,15% vs .57% and 50% vs .13% respectively ,the differences had statistical significance (χ2 = 16 .83 ,22 .29 ,14 .05 ,3 .97 , 10 .08 ,6 .46 ,P<0 .05);in the ARP group and non-ARP group ,MLD ,V5 ,V10 ,V20 and V30 were (12 ± 2) vs .(9 ± 2) ,(58 ± 10) vs .(43 ± 10) ,(42 ± 8) vs .(30 ± 8) ,(23 ± 3) vs .(19 ± 6) ,(15 ± 4) vs .(11 ± 4) respectively ,the differences had statistical signifi-cance (t= -4 .96 ,-5 .27 ,-5 .70 ,-3 .37 ,-3 .61 ,P<0 .05) .Conclusion Multiple dose-volume parameters are associated with the occurrence rate of ARP .The patients with decreased serum TM level after radiotherapy are liable to develop ARP .