刘佳,王兰,郭春辉,焦旸,孙亮,夏林云,秦建军,居敏,蔡依玲,王坚.低剂量放疗治疗8例重型/危重型新冠肺炎的初步临床观察[J].中华放射医学与防护杂志,2024,44(5):374-378
低剂量放疗治疗8例重型/危重型新冠肺炎的初步临床观察
Preliminary clinical observations of low-dose radiotherapy for eight cases of severe/critical COVID-19
投稿时间:2023-08-10  
DOI:10.3760/cma.j.cn112271-20230810-00039
中文关键词:  新型冠状病毒  低剂量放射治疗  肺炎
英文关键词:COVID-19  Low-dose radiotherapy  Pneumonia
基金项目:江苏省卫生健康委员会重点科研项目(ZD2021053);江阴市科技局社会发展科技示范项目(JY0603A021014210005PB);国家自然科学基金青年项目(82000012);无锡市卫生健康委中青年拔尖人才资助计划(BJ2023101);放射医学与辐防护国家重点实验室科研创新项目(GZC00402);无锡市卫生健康委员会青年科研项目(Q202333) 临床试验注册: 中国临床试验注册中心,ChiCTR2300070643
作者单位E-mail
刘佳 南通大学附属江阴医院放疗科, 江阴 214400  
王兰 南通大学附属江阴医院呼吸科, 江阴 214400  
郭春辉 南通大学附属江阴医院感染性疾病科, 江阴 214400  
焦旸 苏州大学苏州医学院放射医学与防护学院 省部共建放射医学与辐射防护国家重点实验室, 苏州 215123  
孙亮 苏州大学苏州医学院放射医学与防护学院 省部共建放射医学与辐射防护国家重点实验室, 苏州 215123  
夏林云 南通大学附属江阴医院放疗科, 江阴 214400  
秦建军 南通大学附属江阴医院放疗科, 江阴 214400  
居敏 南通大学附属江阴医院放疗科, 江阴 214400  
蔡依玲 南通大学附属江阴医院放疗科, 江阴 214400  
王坚 南通大学附属江阴医院放疗科, 江阴 214400 1627879372@qq.com 
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中文摘要:
      目的 探讨全肺低剂量放疗(LDRT)治疗重型/危重型新型冠状病毒(COVID-19)肺炎的疗效和不良反应。方法 本研究为单臂Ⅰ期临床研究,对2023年1月至6月南通大学附属江阴医院收治的经内科治疗后病情恶化或无改善的8例重型/危重型新型COVID-19肺炎患者行全肺LDRT。患者取仰卧或俯卧位,前后对穿照射,剂量权重为1∶1,全肺LDRT剂量0.5~1.5 Gy。分析患者放疗前后氧合状况、炎症指标和影像学变化,观察患者急性放射性不良反应。结果 LDRT后1周,7例(87.5%)患者的SaO2/FiO2或PaO2/FiO2指标上升,7例(87.5%)患者C反应蛋白(CRP)、白介素6(IL-6)等炎性指标下降,胸部CT/胸片扫描显示5例(62.5%)肺部炎症受累范围显著减少。未观察到明显急性放射性不良反应。结论 对内科治疗效果欠佳的重型/危重型新型COVID-19肺炎患者进行全肺0.5~1.5 Gy剂量的LDRT治疗,有助于降低炎症指标,改善临床症状,促进炎症吸收且无明显急性不良反应。
英文摘要:
      Objective To investigate the efficacy and adverse reactions of whole-lung low-dose radiotherapy (LDRT) in patients with severe/critical coronavirus disease 2019 (COVID-19). Methods Eight patients with severe/critical COVID-19 treated in the Jiangyin Hospital Affiliated to Nantong University from January to June 2023 who were treated with whole-lung LDRT after deteriorating or failing to improve post-medical treatment were enrolled in this single-arm phase I clinical trial. They received anterior-posterior penetrating radiation in a supine or prone position, with a total dose range from 0.5 to 1.5 Gy and a dose weight ratio of 1∶1. The oxygenation status, inflammatory markers, and imaging changes before and after radiotherapy were analyzed, and patients were followed up for acute radiation-induced adverse reactions. Results One week after LDRT, the SaO2/FiO2 or PaO2/FiO2 indices increased in seven patients (87.5%), inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) decreased in seven patients (87.5%), and chest CT/chest radiographs revealed a significant reduction in the extent of pneumonia involvement in 5 patients (62.5%). No evident acute radiation-related adverse reactions were observed. Conclusions Whole-lung LDRT with a dose range from 0.5 to 1.5 Gy can reduce inflammatory markers, improve clinical symptoms, and promote inflammatory absorption in patients with severe/critical COVID-19 who responded poorly to medical treatment while not inducing acute adverse reactions.
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