本文選題：鼻咽癌 + 放療��； 參考：《福建醫(yī)科大學(xué)》2012年碩士論文

【摘要】：[目的] 分析鼻咽癌患者放療前的營(yíng)養(yǎng)狀況，探討患者的營(yíng)養(yǎng)狀況與放射敏感性的關(guān)系，尋找一項(xiàng)可以改變的指標(biāo)預(yù)測(cè)放射敏感性，從而有利于提高鼻咽癌放療的療效。 [方法] 選擇福建醫(yī)科大學(xué)附屬第一醫(yī)院放療科2008年10月至2011年12月期間收治的接受調(diào)強(qiáng)放射治療的鼻咽癌初診患者作為研究對(duì)象，采用自編的調(diào)查表，收集患者的人口學(xué)資料（年齡、性別、居住地、婚姻狀況、職業(yè)、學(xué)歷、家庭人均月收入、醫(yī)療費(fèi)用、吸煙、飲酒）、臨床資料（臨床分期、慢性病史、病理、有無(wú)遠(yuǎn)處轉(zhuǎn)移、放療前化療史、放療劑量）、營(yíng)養(yǎng)狀況（身高、體重、上臂圍、三頭肌皮褶厚度、體質(zhì)指數(shù)以及血液指標(biāo)：白蛋白、淋巴細(xì)胞、紅細(xì)胞、血紅蛋白、前白蛋白、轉(zhuǎn)鐵蛋白）。根據(jù)患者放療后3個(gè)月的磁共振成像（MRI）檢查結(jié)果，依據(jù)WHO實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)進(jìn)行近期療效評(píng)價(jià)。采用成組t檢驗(yàn)、卡方檢驗(yàn)及Fisher精確概率法和兩獨(dú)立樣本非參數(shù)檢驗(yàn)對(duì)放射敏感性的影響因素進(jìn)行單因素分析；運(yùn)用主成分分析方法建立營(yíng)養(yǎng)指數(shù)模型評(píng)價(jià)患者的營(yíng)養(yǎng)狀況并對(duì)營(yíng)養(yǎng)指數(shù)進(jìn)行ROC曲線分析以及擬合分布分析，探索營(yíng)養(yǎng)指數(shù)評(píng)價(jià)營(yíng)養(yǎng)狀況的診斷界值；采用非條件Logistic回歸進(jìn)行多因素分析。采用Epidata3.1軟件進(jìn)行數(shù)據(jù)的錄入，全部統(tǒng)計(jì)分析都在SPSS13.0軟件包上進(jìn)行。 [結(jié)果] 1、有完整臨床資料及MRI檢查資料的鼻咽癌患者共97例。根據(jù)WHO實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)，放射敏感的有73例（占75.3%）,放射不敏感的有24例（占24.7%）。其中無(wú)慢性病史的患者放射敏感性好于有慢性病史的患者（χ2=5.118,p=0.024）；放射敏感組和放射不敏感組間的病理分類的差異也有統(tǒng)計(jì)學(xué)意義（p=0.028）。 2、單因素分析結(jié)果顯示營(yíng)養(yǎng)指標(biāo)：上臂圍、白蛋白、血紅蛋白、前白蛋白以及營(yíng)養(yǎng)指數(shù)在放射敏感組和放射不敏感組之間有統(tǒng)計(jì)學(xué)差異，t值分別為-2.763，-2.145，-2.531，-2.261，-2.667; p分別為0.007，0.034，0.013,0.026，0.009且放射敏感組好于放射不敏感組。 3、ROC曲線分析以及擬合分布分析顯示，營(yíng)養(yǎng)指數(shù)取值為0.431為最佳診斷臨界值，靈敏度=0.917，特異度=0.370。 4、Logistic回歸分析顯示：慢性病史和營(yíng)養(yǎng)指數(shù)是放射敏感性獨(dú)立的影響因素。 [結(jié)論] 1、慢性病史、病理分類和營(yíng)養(yǎng)狀況是鼻咽癌放射敏感性的影響因素。 2、營(yíng)養(yǎng)狀況差與鼻咽癌放射不敏感之間存在一定的相關(guān)性，營(yíng)養(yǎng)狀況可成為判斷鼻咽癌放射敏感性的預(yù)測(cè)指標(biāo)。 3、當(dāng)患者的營(yíng)養(yǎng)指數(shù)小于0.431時(shí)，，臨床上應(yīng)給予營(yíng)養(yǎng)干預(yù)，而患者營(yíng)養(yǎng)指數(shù)大于等于0.431時(shí)可暫不干預(yù)。
[Abstract]:Purpose of the project

The nutritional status of patients with nasopharyngeal carcinoma ( NPC ) was analyzed , the relationship between the nutritional status and radiosensitivity of patients with nasopharyngeal carcinoma ( NPC ) was analyzed , and the radiosensitivity of NPC patients was predicted .

Methodology

The patient ' s demographic data ( age , sex , place of residence , marital status , occupation , education , family ' s monthly income , medical expenses , smoking , alcohol consumption ) , clinical data ( clinical stage , history of radiotherapy ) , nutritional status ( height , body weight , pre - radiotherapy chemotherapy history , radiation dose ) , nutritional status ( height , body weight , upper arm circumference , triceps skinfold thickness , body mass index and blood index : albumin , lymphocyte , red blood cell , hemoglobin , prealbumin , transferrin ) were selected as the subject of study . Based on the results of magnetic resonance imaging ( MRI ) examination for 3 months after radiotherapy , a short - term curative effect evaluation was carried out according to WHO solid tumor efficacy evaluation standard . A group of t - test , chi - square test and Fisher exact probability method and two independent sample non - parametric tests were used to analyze the influencing factors of radiation sensitivity .
The nutrition index model was established to evaluate the nutritional status of the patients by using the principal component analysis method and the ROC curve analysis and the fit distribution analysis were carried out on the nutrition index .
Non - conditional logistic regression was used to analyze the multi - factor . Epidata 3.1 software was used for data entry . All statistical analysis was carried out on SPSS 13.0 software package .

The result is not valid .

1 . There were 97 patients with nasopharyngeal carcinoma with complete clinical data and MRI examination data . According to the WHO solid tumor efficacy evaluation standard , there were 73 cases ( 75.3 % ) of radiation sensitivity and 24 cases ( 24 . 7 % ) of radiosensitivity . Among them , the radiosensitivity of patients without chronic disease history was better than those with chronic disease history ( 蠂 2 = 5.118 , p = 0 . 024 ) .
The difference in the pathological classification between the radiation - sensitive group and the radiation - insensitive group was also statistically significant ( p = 0.028 ) .

2 . The results of single factor analysis showed that the nutrition index : upper arm circumference , albumin , hemoglobin , prealbumin and nutrition index had statistical difference between the radiation - sensitive group and the radiation - insensitive group , t - value was - 2.763 , - 2.145 , - 2.531 , - 2.261 , - 2.667 ; p was 0.007 , 0.034 , 0.013 , 0.026 , 0.009 , respectively , and the radiation - sensitive group was better than radiation - insensitive group .

3 銆

本文編號(hào)：2050275