胸部肿瘤患者放疗中肺功能指标的变化及放射性肺炎的影响因素分析

目的:研究胸部肿瘤患者放疗中肺功能指标的变化并分析放射性肺炎的影响因素。方法:将2018年3月至2019年3月于我院接受放疗的胸部肿瘤患者100例记为观察对象,按照是否发生放射性肺炎分为肺炎组28例与无肺炎组72例。分别比较两组的临床资料、放疗前后肺功能及放疗参数,并采用多因素Logistic回归分析放射性肺炎的影响因素。结果:放疗后两组第1秒用力呼气容积(FEV_1)、FEV_1/用力肺活量(FVC)、一氧化碳弥散量(DLCO)均高于放疗前,且肺炎组放疗前、后FEV_1、FEV_1/FVC、DLCO均低于无肺炎组(均P0.05)。两组年龄、肿瘤类型、化疗史、美国东部肿瘤合作组(ECOG)评分、放疗靶区比较差异有统计学意义(均P0.05)。肺炎组计划靶区(PTV)、受到一定剂量以上照射的肺体积占全肺总体积的百分数(V_(dose))、平均肺计量(MLD)、正常组织并发症概率(NTCP)、总射野数高于无肺炎组(均P0.05)。经多因素Logistic回归分析可得:胸部肿瘤放疗患者放射性肺炎的独立危险因素有肺癌、化疗史、ECOG评分为2分、放疗靶区以肺野为主、PTV、MLD、V_(dose)、NTCP、总射野数、FEV_1、FEV_1/FVC(均P0.05)。结论:放疗可有效改善胸部肿瘤患者的肺功能,其中肺癌、化疗史、ECOG评分为2分、放疗靶区以肺野为主以及PTV、MLD、V_(dose)、NTCP、总射野数、FEV_1、FEV_1/FVC是放射性肺炎的影响因素。

Changes of Lung Function Index and Risk Factors of Radiation Pneumonia in Patients with Chest Tumor During Radiotherapy

ABSTRACT Objective: To study the changes of pulmonary function indexes in radiotherapy for thoracic tumor patients and analyze the risk factors of radiation pneumonia. Methods: From March 2018 to March 2019, 100 cases of chest tumor patients who received radiotherapy in our hospital were recorded as the objects of observation. All patients were divided into pneumonia group with 28 cases and pneumonia group with 72 cases according to whether radiation pneumonia occurred. The clinical data, pulmonary function and radiotherapy parameters before and after radiotherapy were compared between the two groups, and the influencing factors of radiation pneumonia were analyzed by multivariate Logistic regression. Results: After radiotherapy, the forced expiratory volume (FEV₁), FEV₁/fatigue capacity (FVC) and carbon monoxide dispersion (DLCO) in the two groups were all higher than those before radiotherapy, and FEV₁, FEV₁/FVC and DLCO before and after radiotherapy in the pneumonia group were all lower than those in the non-pneumonia group (all P<0.05). There were significant differences in age, type of tumors, history of chemotherapy, eastern cooperative group (ECOG) score and target area of radiotherapy between the two groups (all P<0.05). The planning target volume (PTV), V _dose , mean lung dose (MLD), normal tissue complication probability (NTCP) and total field of radiation in pneumonia group were higher than those in non-pneumonia group (all P<0.05). Multivariate Logistic regression analysis showed that lung cancer, history of chemotherapy, history of radiotherapy, ECOG score was 2, and lung field as the main target area of radiotherapy, PTV, MLD, V _dose , NTCP, total field number, FEV₁ and FEV₁/FVC were the independent risk factors for radiation pneumonia in thoracic tumor radiotherapy patients (all P<0.05). Conclusion: Radiotherapy can effectively improve the lung function of patients with thoracic tumors. Lung cancer, history of chemotherapy, ECOG score is 2 scores, lung field as the main target area of radiotherapy and PTV, MLD, V _dose , NTCP, total field number, FEV₁, FEV₁/FVC are the influencing factors of radiation pneumonia.