| 熊浩,曾海仓,蔡兆熙,毕卓菲,郑亿庆.磁共振成像影像分析放射治疗对鼻咽癌患者乳突炎发生发展的影响[J].中华放射医学与防护杂志,2022,42(4):256-261 |
| 磁共振成像影像分析放射治疗对鼻咽癌患者乳突炎发生发展的影响 |
| MRI-based assessment of effects of radiotherapy on the onset and progression of mastoiditis in patients with nasopharyngeal carcinoma |
| 投稿时间：2021-09-07 |
| DOI：10.3760/cma.j.cn112271-20210907-00362 |
| 中文关键词: 鼻咽癌|放射治疗|乳突炎|磁共振|腭帆张肌 |
| 英文关键词:Nasopharyngeal carcinoma|Radiotherapy|Mastoiditis|Magnetic resonance imaging|Tensor veli palatini muscles |
| 基金项目:广州市科技计划项目（202102010332） |
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| 中文摘要: |
| 目的 根据磁共振成像（MRI）影像分析放射治疗对鼻咽癌患者乳突炎发生发展的影响及其危险因素。方法 收集中山大学孙逸仙纪念医院204例（408耳）鼻咽癌患者在放疗前、放疗后3、12、24个月时的MRI影像资料，根据MRI影像特征分析放疗后乳突炎发生发展及转归的规律。应用多因素logistic回归分析探索放疗后乳突炎发生的危险因素。动态观察腭帆张肌横截面积，分析放疗后腭帆张肌横截面积变化与乳突炎发生的关系。结果 放疗前、放疗后3、12和24个月时，乳突炎的发生率分别为20.6%（84/408耳）、41.1%（168/408耳）、22.3%（91/408耳）和19.6%（80/408耳）。放疗前正常耳在放疗后3、12和24个月时乳突炎的发生率分别为35.8%（116/324耳）、18.2%（59/324耳）和16.4%（53/324耳）。在放疗后3个月时新发乳突炎的63例患者（83耳）在放疗后12和24个月时的自然缓解率分别为63.9%（53/83耳）和75.9%（63/83耳），而放疗前即存在乳突炎的54例患者（60耳）在放疗后3、12和24个月时的自然缓解率分别为43.3%（26/60耳）、65.0%（39/60耳）和73.3%（44/60耳）。多因素logistic回归分析显示，年龄≥50岁、临床分期为Ⅲ~Ⅳ期、放疗剂量>70 Gy、肿瘤侵犯咽鼓管咽口是鼻咽癌患者放疗所致乳突炎发生的独立危险因素（OR＝1.75、2.73、2.07、1.83，P<0.05）。腭帆张肌在放疗后12和24个月时的萎缩程度与乳突炎的发生有关（t=-3.32、2.99，P<0.05）。结论 鼻咽癌患者乳突炎的发生率在放疗后3个月时明显增加，在放疗后12个月时明显下降。75.9%的放疗所致乳突炎在放疗后24个月时自然缓解。年龄≥50岁、临床分期为Ⅲ~Ⅳ期、放疗剂量>70 Gy、肿瘤侵犯咽鼓管咽口是鼻咽癌患者放疗所致乳突炎发生的独立危险因素。腭帆张肌在放疗后12和24个月时的萎缩程度与乳突炎的发生有关。 |
| 英文摘要: |
| Objective To analyze the effects of radiotherapy on the onset and progression of mastoiditis in patients with nasopharyngeal carcinoma (NPC) using magnetic resonance imaging (MRI) and to explore the risk factors for the onset of mastoiditis after radiotherapy.Methods The onset and progression of mastoiditis of 204 NPC patients 3, 12, and 24 months after radiotherapy were analyzed based on MRI images. The multi-factor logistic regression analysis was applied to explore the risk factors of the onset of mastoiditis after radiotherapy. The cross-sectional area of the tensor veli palatini muscle was measured and the relationship between the atrophy degrees of the tensor veli palatini muscle and the onset of mastoiditis was analyzed.Results The incidence of mastoiditis before radiotherapy was 20.6% (84/408, ears), and was 41.1% (168/408, ears), 22.3% (91/408, ears), and 19.6% (80/408, ears), respectively 3, 12, and 24 months after radiotherapy. The incidence of radiotherapy-induced mastoiditis was 35.8% (116/324, ears), 18.2% (59/324, ears), and 16.4% (53/324, ears), respectively 3, 12, and 24 months after radiotherapy. The remission rate of 63 patients (83 ears) who developed mastoiditis 3 months after radiotherapy was 63.9% (53/83, ears) and 75.9% (63/83, ears), respectively 12 and 24 months after radiotherapy. The remission rate of 54 patients (60 ears) who suffered mastoiditis before radiotherapy was 43.3% (26/60, ears), 65.0% (39/60, ears), and 73.3% (44/60, ears) 3, 12, and 24 months after radiotherapy. The multivariate analysis showed that the independent risk factors for radiotherapy-induced mastoiditis included age ≥ 50, clinical stages Ⅲ-Ⅳ, radiotherapy dose > 70 Gy, and tumors invading pharyngeal ostium of the eustachian tube. In addition, the atrophy degree of tensor veli palatini muscle 12 and 24 months after radiotherapy correlated with the onset of mastoiditis.Conclusions The incidence of mastoiditis significantly increased 3 months after radiotherapy and significantly decreased 12 months after radiotherapy for NPC patients. The natural remission rate of radiotherapy-induced mastoiditis 12 months after radiotherapy was over 70%. The independent risk factors for radiotherapy-induced mastoiditis include age ≥ 50, clinical stages Ⅲ-Ⅳ, radiotherapy dose >70 Gy, and tumor invading pharyngeal ostium of the eustachian tube. The atrophy degree of the tensor veli palatini muscle 12 and 24 months after radiotherapy correlates with the onset of mastoiditis. |
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