| 叶剑虹,容小明,吕瑞妍,陈庆瑜.鼻咽癌放疗后放射性颞叶坏死患者的脑血管动脉硬化的临床研究[J].中华放射医学与防护杂志,2018,38(4):273-277 |
| 鼻咽癌放疗后放射性颞叶坏死患者的脑血管动脉硬化的临床研究 |
| Study of radiation-induced cerebral vascular and carotid atherosclerosis in nasopharyngeal carcinoma patients with radiation-induced temporal lobe necrosis |
| 投稿时间：2017-06-09 |
| DOI：10.3760/cma.j.issn.0254-5098.2018.04.006 |
| 中文关键词: 鼻咽癌 放射治疗 放射性颞叶坏死 放射性颈动脉硬化 放射性脑动脉硬化 |
| 英文关键词:Nasopharyngeal carcinoma Radiotherapy Radiation-induced temporal lobe necrosis Radiation-induced carotid atherosclerosis Radiation-induced cerebrovascular atherosclerosis |
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| 中文摘要: |
| 目的 探讨鼻咽癌患者放射性颈动脉损伤和脑血管损伤的临床特点及其与放射性颞叶坏死的关系。方法 回顾性分析本院58例鼻咽癌放射性颞叶坏死（temporal lobe necrosis，TLN）的临床资料，采用多普勒超声检查双侧颈动脉内膜中层厚度（intima-media thickness，IMT）和斑块形成情况，应用经颅彩色多普勒（TCD）检测双侧大脑中动脉（MCAs）、颈内动脉（ICAs）和基底动脉（BA）的血流速度，与33例放疗后无TLN的患者和29例健康者的相关结果进行比较，并分析IMT、斑块出现率与各因素的相关性。结果 放射治疗后患者颈内动脉IMT、斑块发生率及MCAs、ICAs的血流速度差异均有统计学意义（t=18.624、8.221，P < 0.05；χ2=17.886，P < 0.05；t=14.367、10.112，P < 0.05），IMT与放疗后时限呈正相关（r=0.368，P=0.049），IMT、斑块发生率与放疗剂量、疗程和病理分期可能有一定相关性（χ2=-17.635、12.006、-3.125，P < 0.05）。与无放射性TLN的患者相比，TLN患者平均IMT明显增厚（t=10.208，P < 0.05）。TLN患者的斑块比无TLN者更常见（χ2=13.118，P < 0.05），ICAs和MCAs的血流速度较快（t=5.011、5.035，P < 0.05）。在单侧TLN患者中，患侧与健侧的MCAs血流速度明显不同（t=18.362，P < 0.05）。结论 与健康者比较，鼻咽癌放疗后患者的IMT增厚、斑块形成和血流动力学异常较常见，特别是合并TLN者。 |
| 英文摘要: |
| Objective To investigate radiation-induced carotid and cerebral vascular injury and its relationship with radiation-induced temporal lobe necrosis in nasopharyngeal carcinoma (NPC) patients. Methods Fifty-eight NPC patients with radiation-induced temporal lobe necrosis (TLN) were recruited in the study. Duplex ultrasonography was used to scan bilateral carotid arterials to evaluate the intima-media thickness (IMT) and occurrence of plaque formation. Flow velocities of bilateral middle cerebral arteries (MCAs), internal carotid arteries (ICAs) and basal artery (BA) were estimated through Transcranial Color Doppler (TCD). The result were compared with data from 33 patients who were free from radiation-induced temporal lobe necrosis after radiotherapy and 29 healthy individuals, to study the relationship between IMT, occurrence of plaque and ventricular diastolic dysfunction. Results Significant differences in IMT, occurrence of plaques of ICAs and flow velocities of both MCAs and ICAs were found between patients after and healthy individuals (t=18.624, 8.221, P < 0.05; χ2=17.886, P < 0.05; t=14.367, 10.112, P < 0.05). IMT had positive correlation with post radiation interval (r=0.368, P=0.049). IMT or incidence of plaques may be related to dose of radiotherapy, course of treatment and T stage(χ2=-17.635, 12.006, -3.125, P < 0.05). Compared with result from patients without radiation-induced TLN, the mean IMT was significantly thicker in patients with TLN (t=10.208, P < 0.05). Plaques were more common in patients with TLN than patients without TLN (χ2=13.118,P < 0.05). In addition, flow velocities of MCAs and ICAs in patients with TLN were much faster (t=5.011, 5.035, P < 0.05). Among patients with unilateral TLN, flow velocity of MCAs was significantly different between ipsilateral and contralateral sides to the lesion (t=18.362, P < 0.05). Conclusions Thickening of IMT, occurrence of plaque formation and hemodynamic abnormality are more common in patients after radiotherapy, especially in those with TLN, compared with healthy individuals. |
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