發(fā)布時(shí)間：2019-04-16 08:48

【摘要】：背景與目的： 由于放射治療技術(shù)的進(jìn)步和綜合治療的采用，鼻咽癌的治療效果有了一定的提高。放射性腦病、頸動(dòng)脈損傷等各種并發(fā)癥的發(fā)生率隨之升高。本研究就鼻咽癌患者放療后頸動(dòng)脈損傷的各影響因素及頸動(dòng)脈狹窄與放射性腦病的關(guān)系進(jìn)行探討。 方法： 將2011年1月至2012年2月隨診的113例接受過(guò)放療的鼻咽癌患者作為實(shí)驗(yàn)組，并將29例初治診斷為鼻咽癌而未接受放療的患者作為對(duì)照組。采用彩色多普勒超聲觀察患者頸部動(dòng)脈損傷情況，同時(shí)進(jìn)行血糖、血脂及磁共振檢查，收集高血壓、吸煙、心腦血管事件等各因素資料。 結(jié)果： 兩組患者基本臨床資料無(wú)顯著差異。實(shí)驗(yàn)組頸動(dòng)脈損傷的發(fā)生率為50/113（44.25%），，顯著高于對(duì)照組的6/29（20.69%）（P=0.021）。頸內(nèi)、頸總動(dòng)脈損傷較對(duì)照組更常見(jiàn)（P分別為0.026，0.046）。頸動(dòng)脈狹窄≥50%僅見(jiàn)于實(shí)驗(yàn)組（9.73%：0%），但兩組無(wú)顯著差異。Logistic多因素回歸分析發(fā)現(xiàn)放療間隔時(shí)間（5年）、年齡（50歲）是頸動(dòng)脈損傷和狹窄≥50%的獨(dú)立危險(xiǎn)因素。放療5年以上患者的頸動(dòng)脈、頸總動(dòng)脈狹窄發(fā)生率顯著高于對(duì)照組。反復(fù)排除偏倚因素進(jìn)行分析，頸動(dòng)脈狹窄≥50%與放射性腦病的相關(guān)性尚不明確。 結(jié)論： 鼻咽癌放療可導(dǎo)致頸動(dòng)脈損傷，而且損傷多見(jiàn)于頸內(nèi)、頸總動(dòng)脈。頸動(dòng)脈損傷可能開始于放療后的3至5年。年齡50歲、放療間隔5年以上是頸動(dòng)脈損傷和狹窄的獨(dú)立危險(xiǎn)因素。頸動(dòng)脈狹窄≥50%與放射性腦病的相關(guān)性需要進(jìn)一步研究。鼻咽癌放療長(zhǎng)期生存的患者行頸部血管彩超篩查是有必要的。
[Abstract]:Background & objective: the therapeutic effect of nasopharyngeal carcinoma (NPC) has been improved due to the progress of radiotherapy technology and the use of comprehensive therapy. The incidence of radiation encephalopathy, carotid artery injury and other complications increased. In this study, the influence factors of carotid artery injury after radiotherapy and the relationship between carotid stenosis and radiation encephalopathy in patients with nasopharyngeal carcinoma (NPC) were studied. Methods: 113 NPC patients who received radiotherapy from January 2011 to February 2012 were selected as the experimental group and 29 newly diagnosed NPC patients without radiotherapy as the control group. The cervical artery injury was observed by color Doppler ultrasound, blood glucose, blood lipid and magnetic resonance imaging (MRI) were performed. The data of hypertension, smoking, cardio-cerebral vascular events and other factors were collected. Results: there was no significant difference in the basic clinical data between the two groups. The incidence of carotid artery injury in the experimental group was 50% (44.25%), which was significantly higher than that in the control group (6 / 29 (20.69%) (P < 0.021). The common carotid artery injury was more common in the internal neck than that in the control group (P = 0.026, P = 0.046, respectively). Carotid stenosis 鈮

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