乌司他汀对胸部肿瘤患者放射性肺炎和放射性肺纤维化的影响(1)
[摘要]目的 探究乌司他汀对胸部肿瘤患者放射性肺炎、放射性肺纤维化的影响。方法 选取我院2014年5月～2015年10月收治的80例行根治性放疗治疗的胸部肿瘤患者作为研究对象。所有患者经诊断均为Ⅲ期肿瘤，无法行手术治疗。随机将其分为对照组40例，采用三维适行放射疗法；实验组40例，在三维适行放疗基础上加用乌司他汀进行治疗，同时给予对照组安慰剂治疗。比较两组患者治疗前后肺功能指标中第1秒用力呼气量(FEV1)、用力肺活量(FVC)、一氧化碳弥散量(DLCO)变化、血清中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)指标变化及放射性肺炎发生率。结果 治疗后24周对照组患者肺功能改善效果较实验组差，对照组患者血清中IL-6、TNF-α、TGF-β1水平均高于实验组，差异有统计学意义(P<0.05)；治疗后对照组患者放射性肺炎发生率(55.0%)高于实验组(25.0%)，差异有统计学意义(P<0.05)。结论 采用乌司他汀治疗可有效改善胸部肿瘤患者肺功能，降低放射性肺炎、放射性肺纤维化的发生率。
[关键词]乌司他汀；胸部肿瘤；放射性肺炎；放射性肺纤维化
[中图分类号] R818.74 [文献标识码] A [文章编号] 1674-4721(2016)07(a)-0159-03
[Abstract]Objective To study the effect of ulinastatin on radiation pneumonitis and radiation pulmonary fibrosis in patients with thoracic neoplasms.Methods Altogether 80 cases of thoracic neoplasms patients treated with radical radiotherapy in the hospital from May 2014 to October 2015 were selected.All the patients randomly divided into control group and experiment group with 40 cases in each group.All the patients were diagnosed as Stage Ⅲ tumors，which could not be treated by surgery.In control group，three-dimensional conformal radiation therapy and placebo were adopted；while combination of application of three-dimensional conformal radiotherapy and ulinastatin were deployed for experiment group.The pre- and post-treatment lung function indexes were compared between the two groups，including the changes in forced expiratory volume in one second (FEV1)，forced vital capacity(FVC)，diffusion capacity for carbon monoxide(DLCO)，serum interleukin 6(IL-6)，tumor necrosis factor α(TNF-α) and transforming growth factor β1(TGF-β1) and the incidence rate of radiation pneumonitis.Results The improvement effect of pulmonary functions 24 weeks after treatment in control group was lower than that in experiment group，and serum IL-6， TNF-α and TGF-β1 level were higher than those of experiment group，with significant difference(P<0.05)；the post-treatment occurrence rate of radiation pneumonitis of control group was 55.0%，higher than 25.0% in experiment group with significant difference (P<0.05).Conclusion Using ulinastatin treatment can effectively improve the lung function for chest tumor patients and reduce the incidence of radiation pneumonitis and radiation pulmonary fibrosis.
[Key words]Ulinastatin；Thoracic neoplasms；Radiation pneumonia；Radiation-induced pulmonary fibrosis
胸部肿瘤是一种常见肿瘤疾病，病发率与致死率高。而70%～80%被确诊为胸部肿瘤的患者需行放射治疗，但放射治疗后患者易出现咳嗽、发热等并发症，不利于病情控制，导致患者肺功能下降，易引发呼吸困难症状。放射性肺损伤是患者放疗后一种最常见的不良症状，其发生具有不可逆性，且后期易发展形成放射性肺纤维化，难以治疗，严重者可出现死亡[1-2]。急性期的放射性肺炎、慢性期的肺纤维化是放射性损伤的主要表现，目前临床尚无疗效明确的治疗方法。相关研究[3]显示，乌司他汀作为一种高效的广谱水解酶抑制剂，可在机体受到外界刺激损伤时保护机体内源性物质，对多种蛋白、脂类水解酶及糖类水解酶的活性具有抑制作用；可有效缓解组织细胞损伤，阻止炎性介质释放，改善血管微循环与组织灌溉，对放射性肺损伤可起到治疗作用，使放疗后非小细胞肺癌患者的呼吸功能得到改善；但目前关于其治疗放射性肺炎、放射性肺纤维化的研究报道较少。本研究采用乌司他汀治疗胸部肿瘤患者，分析其对患者放射性肺炎、放射性肺纤维化影响。 (施华球 谢瑞莲 吴隆秋)
[关键词]乌司他汀；胸部肿瘤；放射性肺炎；放射性肺纤维化
[中图分类号] R818.74 [文献标识码] A [文章编号] 1674-4721(2016)07(a)-0159-03
[Abstract]Objective To study the effect of ulinastatin on radiation pneumonitis and radiation pulmonary fibrosis in patients with thoracic neoplasms.Methods Altogether 80 cases of thoracic neoplasms patients treated with radical radiotherapy in the hospital from May 2014 to October 2015 were selected.All the patients randomly divided into control group and experiment group with 40 cases in each group.All the patients were diagnosed as Stage Ⅲ tumors，which could not be treated by surgery.In control group，three-dimensional conformal radiation therapy and placebo were adopted；while combination of application of three-dimensional conformal radiotherapy and ulinastatin were deployed for experiment group.The pre- and post-treatment lung function indexes were compared between the two groups，including the changes in forced expiratory volume in one second (FEV1)，forced vital capacity(FVC)，diffusion capacity for carbon monoxide(DLCO)，serum interleukin 6(IL-6)，tumor necrosis factor α(TNF-α) and transforming growth factor β1(TGF-β1) and the incidence rate of radiation pneumonitis.Results The improvement effect of pulmonary functions 24 weeks after treatment in control group was lower than that in experiment group，and serum IL-6， TNF-α and TGF-β1 level were higher than those of experiment group，with significant difference(P<0.05)；the post-treatment occurrence rate of radiation pneumonitis of control group was 55.0%，higher than 25.0% in experiment group with significant difference (P<0.05).Conclusion Using ulinastatin treatment can effectively improve the lung function for chest tumor patients and reduce the incidence of radiation pneumonitis and radiation pulmonary fibrosis.
[Key words]Ulinastatin；Thoracic neoplasms；Radiation pneumonia；Radiation-induced pulmonary fibrosis
胸部肿瘤是一种常见肿瘤疾病，病发率与致死率高。而70%～80%被确诊为胸部肿瘤的患者需行放射治疗，但放射治疗后患者易出现咳嗽、发热等并发症，不利于病情控制，导致患者肺功能下降，易引发呼吸困难症状。放射性肺损伤是患者放疗后一种最常见的不良症状，其发生具有不可逆性，且后期易发展形成放射性肺纤维化，难以治疗，严重者可出现死亡[1-2]。急性期的放射性肺炎、慢性期的肺纤维化是放射性损伤的主要表现，目前临床尚无疗效明确的治疗方法。相关研究[3]显示，乌司他汀作为一种高效的广谱水解酶抑制剂，可在机体受到外界刺激损伤时保护机体内源性物质，对多种蛋白、脂类水解酶及糖类水解酶的活性具有抑制作用；可有效缓解组织细胞损伤，阻止炎性介质释放，改善血管微循环与组织灌溉，对放射性肺损伤可起到治疗作用，使放疗后非小细胞肺癌患者的呼吸功能得到改善；但目前关于其治疗放射性肺炎、放射性肺纤维化的研究报道较少。本研究采用乌司他汀治疗胸部肿瘤患者，分析其对患者放射性肺炎、放射性肺纤维化影响。 (施华球 谢瑞莲 吴隆秋)