血浆白细胞介素6、血管紧张素转换酶水平及放射剂量体积直方图参数对放射性肺炎预测的临床价值

 目的　研究血浆中白细胞介素6（IL-6）、血管紧张素转换酶（ACE）水平及剂量体积直方图（DVH）参数与放射性肺炎发生的相关性，并评价其在预测放射性肺炎中的临床价值。方法　常规给予60例不能手术切除或者不愿意手术切除的局部晚期非小细胞肺癌患者三维适形放疗。分别在放疗前、放疗中（放疗第1周至第6周）、放疗后（放疗第8、12周）采用酶联免疫吸附法（ELISA）检测血浆中IL-6及ACE的含量。 依照美国放射肿瘤学协作组（RTOG）放射性肺损伤标准进行放射性肺炎诊断及分级，以出现放射性肺炎组为观察组，未出现放射性肺炎组为对照组，统计两组血浆中IL-6、 ACE、DVH参数V20、V30、平均肺剂量（MLD）及正常组织并发症概率（NTCP）。结果　60例患者中16例发生放射性肺炎，其中5例发生于放疗中，10例发生于放疗结束后1个月内，1例发生于放疗结束后2个月内；包括Ⅱ级11例，Ⅲ级5例。放疗前、中、后血浆IL-6水平变化在观察组与对照组间差异均有统计学意义，ACE在放疗中第3周至第6周两组间差异有统计学意义（均P＜0.05）。V20、V30、MLD及NTCP在观察组与对照组分别为（46.2±4.5）%比（30.5±7.5）%、（37.5±5.6）%比（20.5±5.6）%、（20.4±2.3）Gy比（15.5±3.5）Gy、（25.2±8.2）%比（9.9±4.5）%，两组间差异有统计学意义（均P＜0.05）。结论　血浆中IL-6、ACE水平、V20、V30、MLD及NTCP指标均与放射性肺炎的发生有关。

Clinical value of the plasma IL-6, the ACE level and DVH parameters on the prediction of radiation pneumonitis

Objective　To investigate the relationship between the plasma IL-6, ACE level and DVH parameters radiation pneumonitis, and to evaluate its clinical value on the prediction of radiation pneumonitis. Methods　60 patients with locally advanced non-small cell lung cancer patients with unresectable or unwilling to surgical resection routinely received three-dimensional conformal radiation therapy. Before radiotherapy, radiotherapy beginning 1 week, 2 weeks, 3 weeks,　4　weeks, 5 weeks, 6 weeks, 8 weeks and 12 weeks, enzyme-linked immunosorbent assay (ELISA) was used to detect IL-6 and ACE content. The evaluation of radiation pneumonitis was accordance with the RTOG acute radiation pneumonitis grading standards. The patients with radiation pneumonitis were included in observation group, otherwise as control group. IL-6, ACE and DVH parameters in two groups were analyzed. The DVH parameters includes V20, V30, MLD and NTP. Results　Among all the 60 patients, 16 cases were diagnosed as radiation pneumonitis, among whom 5 cases occurred in radiotherapy, 10 cases occurred within one month after radiotherapy, 1 case occurred in two months after radiotherapy, including the 11 cases of grade Ⅱ and the other 5 cases of grade Ⅲ. In the observation group and the control group, expression level of the IL-6 had statistical significance before and after radiotherapy, ACE had significant difference in 2rd, 3rd, 4th, 5th, 6th week after radiotherapy (all P < 0.05). V20, V30 and MLD differences were statistically significant between the observation group and control group (46.2±4.5) % vs (30.5±7.5) %, (37.5±5.6) % vs (20.5±5.6) %, (20.4±2.3) Gy vs (15.5±3.5) Gy, (25.2±8.2) % vs (9.9±4.5) %, all P < 0.05]. Conclusion　Plasma IL-6, ACE levels, V20, V30, the MLD, and NTP are related to the occurrence of radiation pneumonitis.