鼻咽癌放疗后放射性脑病及生活质量研究

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生存质量的变化及其影响因素进行研究。方法分析89例RE患者的临床资料，采用世界卫生组织生存质量量表简表（WHOQOL-BREF）、LENT／SOMA放射性损伤评估量表对33例RE患者（病例组）和34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生存质量的变化、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；首发症状以球麻痹症状（33例，37．07％）最常见；病例组在社会关系、总的健康和总的生活评分方面低于对照组（P〈0．05）；二程放疗者较一程放疗者在总的健康评分、总的生活评分、生理因素和心理因素评分低（P〈0．05）。球麻痹症状与生活质量心理因素、总的生活和健康评分呈负相关（P〈0．05），头痛、神经功能障碍也分别与生活质量等的评分呈负相关。结论再程放疗后放射性脑损伤出现的潜伏期明显缩短。除环境因素外，放射性脑病对生命质量的其他方面存在一定的负性影响。球麻痹症状的存在对生存质量产生了较大的负性影响。

Clinical analysis and study on the life quality of patients with radiation encephalopathy after radiotherapy of nasopharyngeal cancer in Guangdong Province

Objective To investigate clinical manifestations and image features(MRI) of radiation encephalopathy (RE) in nasopharyngeal cancer(NPC) patients of Guangdong Province after radiotherapy and to evaluate the life quality of the patients as well as influencing factors in RE. Methods The clinical data of 89 patients of RE were retrospectively reviewed. The life quality was evaluated using the LENT/SOMA scoring system in 33 RE and 34 NPC patients received radiotherapy but without RE, who served as the controls. Results There is 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. The most common symptoms consisted of bulbar palsy,limb paralysis,sensory abnormality and headache. The magnetic resonance (MR) image showed long T1 and long T2. Patients of the RE group had lower QOL score in the social domain, health and life level (P<0.05) compared with the controls. The results of bivariate correlation statistics shows that there are high correlations between some domain of QOL and headache/ nervous system defect/bulbar palsy(P<0.05), indicating the influence of QOL after the onset of illness. Conclusions The latency of RE is shorter after re-radiotherapy. Radiation encephalopathy negatively affecting some domain of life quality of the patient. The negative effect of bulbar palsy should be taken into account.;