鼻咽癌放射治疗后长期生存病人的记忆力减退与脑损伤相关性的研究

目的研究放射治疗后鼻咽癌患者记忆力下降与脑损伤之间关系，探索记忆力检测作为放射性脑损伤早期发现方法的可行性。方法测定了２４例放射治疗后长期生存的鼻咽癌患者的记忆力指数，同时进行脑的影像学观察来研究记忆力下降与脑形态损伤之间的相关性，并设３０例正常人作为对照。结果全组病人记忆商较正常人明显减退，其中指向记忆、联想学习和图像自由回忆３个分项的得分下降最明显。记忆力的减退程度与脑损伤影像学表现的严重程度成正比：２４例病人中记忆商＞８０分的１５例病人ＣＴ或ＭＲＩ检查均未发现脑萎缩和脑软化；６５～８０分的５例病人中２例脑萎缩；＜６５分的４例均发生了脑软化。另外，记忆力减退随放射治疗后生存时间的延长而加重，相关系数为－０．７２（Ｐ＜０．００１）。结论放射治疗后长期生存的鼻咽癌患者记忆力下降与放射性脑损伤程度成正比，初步提示放射治疗后进行记忆力动态评测有助于早期发现鼻咽癌病人的放射性脑损伤。

Relationship of memory loss and brain injury in the longterm survivors of nasopharyngeal carcinoma after radiotherapy.

Objective To design a new useful tool for early detection of serious brain injury in longterm survivors of nasopharyngeal carcinoma after radiotherapy. Methods Memory test was used in 24 longterm survivors after irradiation for nasopharyngeal carcinoma, while CT scan (or MRI) of brain was used to detect morphological brain injury. Thirty normal people were matched as control. The relationship between memory loss and brain injury was analyzed. Results The memory loss was significant in the patients, especially the performance of directional memory, association tests, as well as picture memory. No brain atrophy or necrosis was found in cases whose memory quotient (MQ) was higher than 80; brain atrophy was observed in 2 of 5 patients whose MQ was 8065; and brain necrosis was found in all 4 patients whose MQ was lower than 65. The severity of memory loss was in direct proportion to the survival time after radiotherapy with a relative coefficient of -0.72 ( PWTBZ<0.001). Conclusions Memory test is a valuable tool to early detect and diagnose serious brain injury such as brain atrophy and necrosis in longterm survivors of nasopharyngeal carcinoma after radiotherapy.