肺癌三维适形放疗并化疗致放射性肺炎患者血清炎性因子研究

目的 观察肺癌三维适形放疗(3D-CRT)并化疗导致放射性肺炎(RP)血清炎性因子白细胞介素-6(IL-6)和白细胞介素-10(IL-10)、肿瘤坏死因子α(TNF-α)、高敏C-反应蛋白(hs-CRP)的影响.方法 选择医院自2010年1-10月经病理组织学证实的ⅢA期、ⅢB期的58例肺癌患者,三维适形放疗剂量为4000～6600 cGy,随机将患者分为3D-CRT放疗并常规化疗28例作为对照组,30例在放疗并化疗基础上给予盐酸氨溴索雾化吸入作为治疗组；放疗及前后测定患者IL-6和IL-10水平、TNF-α、hs-CRP、外周白细胞(WBC)数量,连续7d后评价血清因子的变化程度.结果 对照组患者中RP的发生率为35.7％,治疗组RP的发生率为23.3％,两组间比较差异有统计学意义(P＜0.05)；与对照组比较,治疗组血清中IL-6、IL-10、TNF-α的含量及WBC数量均升高(P＜0.05),治疗组患者的hs-CRP与WBC呈正相关性(r=0.998,P＜0.05).结论 对由3D-CRT引起的IL-6、IL-10、TNF-α的含量及WBC数量的升高,给予盐酸氨溴索气雾剂后水平改善显著,表明炎症反应参与肺癌三维适形放疗并化疗的发展变化过程,监测血清炎性因子水平的变化,可以为肺癌三维适形放疗并化疗提供参考依据.

Serum inflammatory factors in radiation pneumonitis patients induced by three-dimensional conformal radiotherapy and chemotherapy of lung cancer

OBJECTIVE To investigate serum inflammatory factors interleukin-6(IL-6) and interleukin-10(IL-10),tumor necrosis factor α(TNF-α) and high-sensitivity C-reactive protein(hs-CRP) in radiation pneumonitis(Radiation pneumonitis,RP) caused by three-dimensional conformal radiotherapy of lung cancer(three-dimensional conformal radiation therapy,3D-CRT) and chemotherapy.METHODS A total of 58 patients with lung cancer proven stage IIIA and IIIB by histopathological examination from Jan.2010 to Oct.2010 in our hospital were selected.The dose of three-dimensional conformal radiotherapy was 4000cGy~6600cGy.Patients were randomly assigned into two groups.28 cases received 3D-CRT radiotherapy and conventional chemotherapy were set as control group.30 patients who were given ambroxol hydrochloride inhalation on the basis of the radiotherapy and chemotherapy were set as the treatment group.The levels of serum interleukin-6(IL-6) and interleukin-10(IL-10),tumor necrosis factor α(TNF-α),high-sensitivity C-reactive protein(hs-CRP) and peripheral white blood cell count(WBC) before and after radiotherapy were determined.The change of serum factors after seven consecutive days was evaluated.RESULTS The incidence of RP was 35.7% in the control group,and the incidence of RP was 23.3% in the treatment group.There was statistically significant difference between the two groups(P<0.05).Compared with the control group,the serum IL-6,IL-10,TNF-αlevels and WBC count in treatment group were increased(P<0.05).Hs-CRP showed a positive correlation with WBC in treatment group.(r=0.998,P<0.05).CONCLUSION The increased levels of IL-6,IL-10,TNF-αand WBC count induced by 3D-CRT can be significantly ameliorated after using ambroxol aerosol,indicating that the inflammatory response is involved in the change and development process of lung cancer three-dimensional conformal radiotherapy and chemotherapy.Monitoring of the level of serum inflammatory factors can providereference for three-dimensional radiotherapy and chemotherapy for lung cancer.