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C反应蛋白联合中性粒细胞数预测容积旋转调强放疗后急性放射性肺炎的临床研究
作者:吴侃  杨邵瑜  徐晓  李鑫  张敏娜  王冰  陈雪琴  夏冰  马胜林 
单位:杭州市肿瘤医院肿瘤放疗科  浙江 杭州 310002 浙江大学医学院附属杭州市第一人民医院肿瘤内科  浙江 杭州 310006 
关键词:肺肿瘤/放射疗法 放射疗法/方法 放射疗法 调强适形 锥束计算机体层摄影术 辐射性肺炎/病因学 C反应蛋白质/血液 中性白细胞/血液 回顾性研究 
DOI:R734.2;R730.55
出版年,卷(期):页码:2018,33(5):450-454
摘要:

目的 分析肺癌患者基于容积旋转调强放疗(volumetric modulated arc therapy,VMAT)技术的胸部放疗后急性放射性肺炎(acute radiation pneumonitis,ARP)的发生率,并评价血常规炎性反应相关指标及C反应蛋白(C-reactive protein,CRP)对ARP发生的预测价值。方法 回顾性分析77例接受VMAT胸部放疗的经细胞学或病理组织学证实的肺癌患者的病历资料,根据CTCAE 3.0标准进行ARP分级。采集患者放疗前1周内及放疗结束后1周内血常规数据及CRP指标,分析各指标与ARP发生的相关性。结果 77例患者ARP的发生率为39.0%(30/77),其中有症状ARP的发生率为28.6%(22/77)。Logistics多因素回归分析显示,放疗后中性粒细胞数较高(P=0.004)及放疗前、后CRP变化评分较高(P=0.006)是ARP发生的独立危险因素。ROC曲线分析显示,放疗后N和CRP变化评分联合预测ARP发生的曲线下面积为0.802,敏感度为0.857,特异度为0.690。结论 放疗后N联合CRP变化评分对于预测和诊断ARP可能有一定的价值。

Objective To evaluate the application of C-reactive protein (CRP) and blood routine tests in predicting acute radiation pneumonitis (ARP) in lung cancer patients treated with volumetric modulated arc therapy (VMAT). Methods The clinical data of 77 cytologically or pathologically confirmed lung cancer patients treated with VMAT was retrospectively reviewed. ARP was graded according to Common Terminology Criteria for Adverse Events (CTCEA) v.3. The results of blood routine tests and CRP were collected in a week before and after radiotherapy. The relationship between these biomarkers and the incidence of ARP was further analyzed. Results The incidence of ARP was 39.0% (30/77) in this series of patients,and the incidence of symptomatic ARP was 28.6% (22/77). Multivariate Logistics analysis suggested that higher neutrophil counts after radiation (P=0.004) and higher CRP alteration score before and after radiotherapy (P=0.006) are independent risk factors of ARP. ROC curve analysis indicated that when combining neutrophil counts after radiation with CRP alteration score,the area under curve was 0.802,the sensitivity was 0.857 and the was 0.690 for the prediction of ARP occurrence. Conclusion Neutrophil counts after radiation combined with CRP alteration may have value in the prediction of ARP in lung cancer patients undergoing VMAT.

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