本文選題：放射引起的視神經(jīng)病變 + 錳離子增強的磁共振掃描　； 參考：《復旦大學》2011年碩士論文

【摘要】：第一部分大鼠放射引起的視交叉損傷動物模型的建立 [目的]放療過程中由于視神經(jīng)/視交叉受到過量照射而引起的視神經(jīng)病變(Radiation-induced optic neuropathy, RION)是一種嚴重影響生活質量的并發(fā)癥,其主要表現(xiàn)為突然性、無痛性、不可逆性的視覺喪失。其發(fā)病機制目前尚未完全明了。臨床上尚無有效的治療方法,神經(jīng)營養(yǎng)因子及分子靶向治療藥物貝伐單抗具有潛在治療放射引起的視神經(jīng)病變的價值。本研究通過一次性大劑量30Gy照射大鼠視交叉,建立放射引起的視交叉損傷模型,為研究放射引起的視神經(jīng)病變發(fā)病機制及尋找其有效治療方法奠定基礎。 [材料與方法]34只大鼠,4只未進行放射作為對照組,30只進行視交叉放射,隨機分為放射后2個月組、放射后4個月組、放射后6個月組,分別于照射后2個月、4個月、6個月進行玻璃體內(nèi)錳離子注射,24小時后行錳離子增強的磁共振(Manganese-enhanced magnetic resonance imaging, MEMRI)掃描,掃描后處死大鼠并進行病理學分析。病理學分析包括HE染色及Luxol Fast blue染色。根據(jù)視覺通路強化程度不同,對MEMRI圖像進行評分。100倍光鏡下對Luxol Fast blue染色進行相對光密度值分析,400倍光鏡下對HE染色進行膠質細胞計數(shù)。部分大鼠進行電鏡分析。 [結果]入組大鼠在飼養(yǎng)過程中死亡4只,在MEMRI掃描前因麻醉意外死亡6只。對照組、放射后2個組、放射后4個月組、放射后6個月組進行MEMRI掃描的分別有4只、5只、4只、11只,共24只；進行病理分析的分別有3只、7只、4只、7只,共21只。放射后6個月組所有大鼠視交叉均產(chǎn)生了明顯的病理學變化,主要表現(xiàn)為：脫髓鞘病變,毛細血管增生,星形膠質細胞增多及間質纖維化。相關性分析顯示,MEMRI圖像視覺通路評分與放射后時間呈負相關,p=0.000; MEMRI圖像中以視覺通路評分5分定義為RION,對照組、放射后2個組、放射后4個月組、放射后6個月組發(fā)生RION的比例分別為0/3,1/5,2/4,11/11,行卡方檢驗,x2=15.443,p=0.001；400倍光鏡下Luxol Fast blue染色相對光密度值與視交叉放射后時間呈負相關,p=0.000;各組100倍光鏡視野下星形細胞數(shù)分別為194±65、234±19、124±11,及345±98,相關性分析顯示細胞數(shù)與放射后時間呈負相關,P=0.005。MEMRI圖像顯示放射后2個月組的5只大鼠中,1只出現(xiàn)視神經(jīng)傳導功能喪失,但病理學較其余4只未見明顯改變。 [結論]本研究采用單次大劑量30Gy照射大鼠視交叉的方法,在放射后6個月時,觀察到所有大鼠均明顯地出現(xiàn)了視神經(jīng)損傷相應的病理學改變,說明大鼠RION模型建立成功,達到預期目的。應用MEMRI對視覺通路功能完整性進行隨訪和半定量評估,可在視神經(jīng)結構發(fā)生病理改變之前直觀地提示視神經(jīng)功能是否發(fā)生傳導障礙,這為將來研究RION提供了一種良好的無創(chuàng)性功能檢查方法。 第二部分鼻腔副鼻竇腫瘤調強適形放療后放射引起的視神經(jīng)病變體積-劑量學分析 [目的]評估鼻腔副鼻竇腫瘤調強適形放療(intensity modulated radiotherapy, IMRT)后放射引起的視神經(jīng)病變(RION)的發(fā)生率及其與視神經(jīng)/視交叉體積-劑量學參數(shù)的關系,從而為闡明RION在調強適形放療條件下的耐受劑量及其相關危險因素提供參考依據(jù)。 [材料與方法]本研究納入在2004年4月至2009年11月間,我院放療科頭頸部腫瘤治療組采用IMRT治療的59例無遠處轉移的鼻腔副鼻竇腫瘤患者。所有患者均隨訪滿12個月且其TPS治療計劃資料皆完整。根據(jù)分割劑量、是否二次放療將59例患者分為三組：初治常規(guī)分割治療組(49例),初治大分割治療組(6例),二次放療組(4例)。采用Pinnacle 3治療計劃系統(tǒng)采集視神經(jīng)/視交叉及靶區(qū)的體積-劑量學參數(shù)。 [結果]隨訪至2011年3月,59例鼻腔副鼻竇腫瘤患者中位隨訪時間27.3個月(范圍：12-68)。3年局部控制率、無遠處轉移生存率、無進展生存率及總生存率分別為79.1%、77.9%、67.2%及75.5%。初治常規(guī)分割治療組中1例患者發(fā)生RION,視神經(jīng)、視交叉最大受量分別為69.28Gy和66.54Gy。二次放療組中1例患者于第二次放療后8個月發(fā)生右眼RION,該患者的右側視神經(jīng)、視交叉最大受量分別為65.86Gy和65.52Gy(第二次放療分割次數(shù)為30次；初次放療時間為15年前,當時的處方劑量為56Gy)。大分割放療組中無發(fā)生RION病例。 [結論]采用IMRT治療鼻腔副鼻竇腫瘤獲得了較好的的近期療效,但隨訪到2例患者發(fā)生RION。視神經(jīng)／視交叉的最大受量、分割劑量及其是否進行二次放療等為影響RION發(fā)生的危險因素,在制定放療計劃時應予充分考慮。
[Abstract]:The first part is the establishment of rat model of radiation induced optic chiasma injury.
[Objective] Radiation-induced optic neuropathy (RION), which is caused by excessive exposure to optic nerve / optic chiasma, is a serious complication which affects the quality of life seriously. Its main manifestations are sudden, painless, and irreversible visual loss. The pathogenesis is not yet fully understood. No effective treatment, neurotrophic factor and molecular targeted drug bevacizumab are of potential value for the treatment of optic neuropathy caused by radiation. In this study, a radiation induced optic cross injury model was established by irradiating the optic chiasma in rats with a one-time large dose of 30Gy, and the pathogenesis and the search for the optic neuropathy caused by radiation were studied. It lays the foundation for the effective treatment.
[materials and methods]34 rats, 4 without radiation as the control group, 30 of the optic chiasma radiation, randomly divided into 2 months after radiation, 4 months after radiation, 6 months after radiation, 2 months, 4 months, 6 months after the irradiation of manganese ions in the body, 24 hours after manganese enhanced magnetic resonance (Manganese-enhanced Magnetic resonance imaging, MEMRI) were scanned, and the rats were executed and the pathological analysis was performed. The pathological analysis included HE staining and Luxol Fast blue staining. According to the different enhancement degree of the visual pathway, the MEMRI image was scored by.100 times light microscopy, and the relative light density was analyzed for Luxol Fast, and 400 times the light mirror under the microscope. The glial cells were counted by color. Some rats were analyzed by electron microscope.
[results] 4 rats were killed during the feeding process, and 6 were killed by anaesthesia before MEMRI scan. The control group, 2 groups after radiation, 4 months after radiation and 6 months after radiation, 4, 5, 4, 11, 24, 3, 7, 4, 7, respectively. The main manifestations were demyelinating disease, capillary proliferation, astrocytosis, and interstitial fibrosis. The correlation analysis showed that the visual pathway score of MEMRI images was negatively correlated with the post radiation time, and the visual pathway score of 5 was defined as RION in the MEMRI image, p=0.000. In the control group, 2 groups after radiation and 4 months after radiation, the proportion of RION in 6 months after radiation was 0/3,1/5,2/4,11/11, respectively, with chi square test, x2=15.443, p=0.001; the relative light density value of Luxol Fast blue staining under 400 times of light microscopy was negatively correlated with the time after optic cross radiation, p=0.000, and the number of astrocytes under the 100 times of the optical microscope in each group, respectively. For 194 + 65234 + 19124 + 11 and 345 + 98, the correlation analysis showed that the number of cells was negatively correlated with the time after radiation. P=0.005.MEMRI images showed that 1 of the 5 rats in the 2 month group were lost in the optic nerve conduction function, but there were no significant changes in pathology compared with the rest of 4.
[Conclusion] in this study, a single large dose of 30Gy was used to irradiate the optic chiasma in rats. The pathological changes of the optic nerve injury were observed in all rats at 6 months after radiation, indicating that the rat model of RION was successfully established and achieved the desired purpose. The functional integrity of the visual pathway was followed up and half quantified by MEMRI. Evaluation can directly indicate whether the optic nerve function has conduction disturbance before the optic nerve structure changes, which provides a good method of noninvasive functional examination for the future study of RION.
The second part volume dosimetry analysis of radiation induced optic neuropathy after intensity modulated radiation therapy for sinonasal paranasal sinuses
[Objective] to evaluate the relationship between the incidence of optic neuropathy (RION) and the relationship with optic nerve / optic cross volume and dosimetry parameters after intensity modulated radiotherapy (IMRT), so as to clarify the tolerance dose and related risk factors of RION under the condition of intensity adjustment and conformal therapy. A reference.
[materials and methods] from April 2004 to November 2009, 59 cases of nasal paranasal sinus tumor without distant metastasis were treated by IMRT in the head and neck tumor treatment group of the Department of radiotherapy in our hospital. All patients were followed up for 12 months and the data of the TPS treatment plan were complete. According to the cut dose, 59 patients were divided by two radiotherapy. Three groups: the primary treatment group (49 cases), the primary treatment group (6 cases) and the two radiotherapy group (4 cases). The volume and dosimetry parameters of optic nerve / optic chiasma and target area were collected by the Pinnacle 3 treatment planning system.
[results] follow up to March 2011, 59 cases of nasal paranasal sinus tumor patients were followed up for 27.3 months (range: 12-68).3 years local control rate, no distant metastasis survival rate, no progression survival rate and total survival rate of 79.1%, 77.9%, 67.2% and 75.5%. primary treatment group of 1 patients with RION, optic nerve, optic chiasma maximum receiving The right eye RION was found in 1 patients in the two radiotherapy group of 69.28Gy and 66.54Gy., respectively, 8 months after second radiotherapy. The right optic nerve, the maximum optic chiasm was 65.86Gy and 65.52Gy (second times of radiotherapy 30 times; the initial radiotherapy time was 15 years ago, then the prescription dose was 56Gy). There were no cases of RION.
[Conclusion] the use of IMRT to treat nasal paranasal sinus tumors has obtained good short-term effect, but follow-up to the maximum dose of RION. optic nerve / optic chiasma in 2 patients, divided dose and two radiotherapy are the risk factors affecting the occurrence of RION, and should be fully considered in the formulation of the radiotherapy plan.

【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R774.6

【參考文獻】

相關期刊論文 前2條

1 盛天金，，魏世輝;放射性視神經(jīng)病變的診斷及復方樟柳堿治療[J];眼科新進展;1996年01期

2 宋琛,李星星,王紅,韓素義,張驥遠,王森林;復方樟柳堿治療快中子輻射性視網(wǎng)膜損傷——ROG、ERG、及FFA變化實驗研究[J];實用眼科雜志;1992年09期

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