本文選題：電離輻射 + 鼻咽癌�。� 參考：《汕頭大學》2010年碩士論文

【摘要】：目的 鼻咽癌是我國南方高發(fā)惡性腫瘤,目前公認和有效的根治性治療手段為放射治療,或以放療為主的綜合治療。早期一般采用單純放射治療,晚期采用同步放化療。我們通過研究常規(guī)放射劑量(66~70Gy)的電離輻射對鼻咽癌患者鼻腔黏膜的損傷程度,觀察、比較不同時間點(包括放療前,放療結(jié)束后1個月,放療結(jié)束后6個月)受損黏膜組織修復能力的差異,探討如何有效地預(yù)防和減少放療后并發(fā)癥,促進黏膜上皮修復,進一步恢復鼻腔粘液纖毛傳輸系統(tǒng)功能,改善患者生活質(zhì)量,并為放射治療后產(chǎn)生的相應(yīng)并發(fā)癥提供治療依據(jù)。 對象與方法 1.隨機抽取的入選觀察對象均為2008年2月至2008年12月于廣東省人民醫(yī)院耳鼻咽喉頭頸外科活檢、病理科確診為鼻咽非角化性未分化型癌的患者,行鼻咽部、顱底、頸部磁共振平掃加增強掃描檢查,明確腫瘤侵犯范圍;行胸片正側(cè)位X線片、肝膽脾胰腎加泌尿系統(tǒng)彩色超聲、全身骨掃描明確無遠處轉(zhuǎn)移;經(jīng)UICC2002(UICC,international union against cancer,國際抗癌聯(lián)盟)分期確診為鼻咽非角化行未分化型癌T2N1M06名,T2N0M024名,;經(jīng)廣東省人民醫(yī)院放療科定位,鼻咽部照射野為面頸聯(lián)合野,鼻咽部腫瘤劑量66~70Gy。 2.分三個時間點隨機抽取觀察對象:放射治療前10例,男性7例,女性3例,年齡21~61歲,平均47.3歲,用作對照組;放射治療后1個月10例,男性7例,女性3例,年齡34~70歲,平均55.3歲;放射治療后6個月10例,男性9例,女性1例,年齡30~59歲,平均45.1歲。入選患者既往無慢性鼻竇炎、鼻息肉病史,無變應(yīng)性鼻炎、萎縮性鼻炎和鼻腔、鼻竇手術(shù)史;無Kartagener綜合征(原發(fā)性纖毛不動綜合征,包括慢性鼻竇炎,支氣管擴張,內(nèi)臟轉(zhuǎn)位)病史,經(jīng)談話后患者自愿并在知情同意書上簽字。 3.三組患者行下鼻甲黏膜石蠟切片HE染色、電鏡分析觀察其形態(tài)學差異;測量SOD活性(SOD, Superoxidismutase,過氧化物歧化酶)及MDA(MDA,Malondialdehyde,丙二醛)含量的差異。 4.所得數(shù)據(jù)通過SPSS13.0軟件處理,根據(jù)資料及設(shè)計類型采用單因素的方差分析檢驗方法,p0.05認為組間差異有統(tǒng)計學意義。 結(jié)果 1.下鼻甲黏膜石蠟切片HE染色光鏡下可見,放療前,上皮層以纖毛柱狀上皮為主,纖毛排列致密、整齊,固有層內(nèi)可見漿液腺、粘液腺,無萎縮,以漿液腺為主;放療結(jié)束后一個月,纖毛上皮細胞排列疏松,纖毛結(jié)構(gòu)大部分被破壞,基底膜增厚。固有層內(nèi)漿液腺及粘液腺均減少,腺體萎縮;放療結(jié)束后半年,纖毛上皮形態(tài)有所恢復,但排列仍舊紊亂,密度不均勻�；啄ぴ龊�,漿液腺較放療結(jié)束后一個月有所恢復,未見明顯粘液腺。 2.掃描電鏡下可見,放療前的鼻咽癌患者下鼻甲黏膜上皮纖毛分布均勻、致密,“9+2”微管結(jié)構(gòu)清晰;放療結(jié)束后一個月下鼻甲黏膜上皮可見大量纖毛脫落、倒伏,上皮細胞壞死;放療結(jié)束后半年下鼻甲黏膜上皮可見纖毛密度紊亂,生長不良,“9+2”微管結(jié)構(gòu)不清晰。 3.(1)SOD活性及MDA含量的測定:鼻咽癌患者放療前的SOD活性均值104.356±2.509u/mgprot ;放療后一個月SOD活性均值60.790±2.928 u/mgprot;放療后半年SOD活性均值102.695±2.874 u/mgprot。鼻咽癌患者放療前MDA含量均值60.243±1.874nmol/mgprot放療后一個月MDA含量均值86.051±2.551nmol/mgprot放療后半年MDA含量均值61.782±2.049nmol/mgprot。(2)鼻咽癌患者放療前與放療后一個月的SOD活性差異有顯著性(p0.05),MDA含量差異有顯著性(p0.05);放療后一個月與放療后半年的SOD活性差異有顯著性(p0.05),MDA含量差異有顯著性(p0.05);放療前與放療后半年的SOD活性差異無統(tǒng)計學意義( p=0.6760.05 ) , MDA含量差異無統(tǒng)計學意義(p=0.6210.05)。 結(jié)論 1.放射治療結(jié)束后一個月的鼻咽癌患者,在本次研究中出現(xiàn)最為嚴重的電離輻射損傷,同時期,黏膜中的SOD活性為三組中最低,MDA含量最高;放療結(jié)束后半年電離輻射損傷出現(xiàn)修復,纖毛上皮形態(tài)有所恢復,但生長紊亂。同時期的SOD活性升高,與放療前差異無統(tǒng)計學意義(p=0.6760.05)。MDA含量差異無統(tǒng)計學意義(p=0.6210.05)。 2.鼻腔粘膜及纖毛上皮形態(tài)可以得到一定程度的恢復,放射治療半年后鼻咽癌患者抗氧化功能基本恢復到放療前水平。
[Abstract]:objective
Nasopharyngeal carcinoma (NPC) is a high incidence of malignant tumor in the south of China. At present, the accepted and effective radical treatment is radiotherapy, or radiotherapy based comprehensive treatment. The early use of simple radiotherapy and advanced radiotherapy in the late stage, we studied the damage of nasal mucosa in patients with nasopharyngeal carcinoma by the ionizing radiation of conventional radiation dose (66~70Gy). The degree of injury was observed and the differences in the repair ability of damaged mucosa were compared at different time points (including before radiotherapy, 1 months after radiotherapy, 6 months after radiotherapy), to explore how to effectively prevent and reduce complications after radiotherapy, promote mucosal epithelium repair, further restore the function of nasal mucociliary transmission system, and improve the quality of life of the patients. Provide basis for therapy and corresponding complications after radiotherapy is generated.
Objects and methods
1. randomly selected subjects were all selected from the Department of Otolaryngology, Guangdong General Hospital, from February 2008 to December 2008, and the patients with nasopharyngeal non keratinized undifferentiated carcinoma in the Department of pathology were diagnosed with nasopharynx, skull base, neck magnetic resonance scan and enhanced scan to clarify the range of tumor invasion. The liver, spleen and spleen, pancreas, kidney and urinary system color ultrasound, whole body bone scan clearly without distant metastasis; through UICC2002 (UICC, International Union against cancer, international anticancer alliance) diagnosis of nasopharyngeal non keratinized undifferentiated carcinoma T2N1M06 name, T2N0M024 name, the radiation field of the nasopharynx is the joint field of the face and neck through the Radiotherapy Department of Guangdong General Hospital 66~70Gy., nasopharyngeal tumor dose
2. points and three time points were randomly selected: 10 cases before radiotherapy, 7 men, 3 women, age 21~61 years, average 47.3 years old, for 1 months, 10 cases, 7 men, 3 women, age 34~70, average 55.3 years, 6 months after radiation therapy, male 9, women, 30~59 years, the average age. The patient had no history of chronic sinusitis, a history of nasal polyps, no allergic rhinitis, atrophic rhinitis, nasal, sinus surgery, and no Kartagener syndrome (primary ciliated syndrome, including chronic sinusitis, bronchiectasis, visceral transposition), and after the conversation, the patient volunteered and signed the informed consent.
3. three groups of patients underwent paraffin paraffin paraffin section HE staining. The morphological differences were observed by electron microscopy. The differences in the content of SOD activity (SOD, Superoxidismutase, peroxidase) and MDA (MDA, Malondialdehyde, malondialdehyde) were measured.
4. the data were processed by SPSS13.0 software, and a single factor analysis of variance was used according to the data and design type. P0.05 thought the difference between the groups was statistically significant.
Result
1. the paraffin section of the inferior turbinate was shown by HE staining light microscope. Before radiotherapy, the epithelial layer was mainly ciliated columnar epithelium, and the cilia was arranged dense and tidy. The serous glands, mucous glands, no atrophy, mainly in serous glands were seen in the propria, and the fine cells of ciliary epithelium were loosely arranged, most of the ciliary structure was destroyed and the basement membrane thickened. After the end of radiotherapy, the morphology of ciliated epithelium recovered, but the arrangement was still disorderly, the density was not uniform, the basal membrane was thickened, the serous gland was recovered more than one month after the end of the radiotherapy, and no obvious mucous gland was found.
2. scanning electron microscope showed that the cilium of the inferior turbinate mucosa of patients with nasopharyngeal carcinoma before radiotherapy was evenly distributed and dense, and the structure of "9+2" microtubule was clear. Good, "9+2" microtubular structure is not clear.
3. (1) SOD activity and determination of MDA content: the mean value of SOD activity before radiotherapy in nasopharyngeal carcinoma patients was 104.356 + 2.509u/mgprot, and the mean value of SOD activity was 60.790 + 2.928 u/mgprot after radiotherapy, and the mean value of SOD activity in the six months after radiotherapy was 102.695 + 2.874 u/mgprot. of nasopharyngeal carcinoma patients. The mean value of MDA before radiotherapy was 60.243 + 1.874nmol/mgprot after radiotherapy. The mean value of MDA in 86.051 + 2.551nmol/mgprot after radiotherapy was 61.782 + 2.049nmol/mgprot. (2). There was significant difference in SOD activity between before radiotherapy and one month after radiotherapy (P0.05), and the difference of MDA content was significant (P0.05). The difference of SOD activity between one month after radiotherapy and six months after radiotherapy was significant (P0.05) and the difference of MDA content There was significant (P0.05); there was no significant difference in SOD activity before radiotherapy and radiotherapy after six months (p=0.6760.05), no statistically significant differences in the content of MDA (p=0.6210.05).
conclusion
1. patients with nasopharyngeal carcinoma in one month after radiotherapy were the most serious ionizing radiation injury in this study. At the same time, the SOD activity in the mucous membrane was the lowest in the three group and the highest in the MDA. After the end of the radiotherapy, the ionizing radiation damage appeared and the ciliated epithelium was restored, but the growth disorder. The SOD activity in the same period was raised. High, no significant difference before and after radiotherapy (p=0.6760.05) there was no significant difference in.MDA content (p=0.6210.05).
2. the mucosa and ciliated epithelium of the nasal cavity can be recovered to a certain extent. After six months of radiotherapy, the antioxidant function of the patients with nasopharyngeal carcinoma basically recovered to the level before radiotherapy.
【學位授予單位】：汕頭大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R739.63

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