鼻咽癌的放射敏感性与营养状况的相关性研究

发布时间：2018-06-21 22:25

  本文选题：鼻咽癌 + 放疗　； 参考：《福建医科大学》2012年硕士论文

【摘要】：[目的] 分析鼻咽癌患者放疗前的营养状况，探讨患者的营养状况与放射敏感性的关系，寻找一项可以改变的指标预测放射敏感性，从而有利于提高鼻咽癌放疗的疗效。 [方法] 选择福建医科大学附属第一医院放疗科2008年10月至2011年12月期间收治的接受调强放射治疗的鼻咽癌初诊患者作为研究对象，采用自编的调查表，收集患者的人口学资料（年龄、性别、居住地、婚姻状况、职业、学历、家庭人均月收入、医疗费用、吸烟、饮酒）、临床资料（临床分期、慢性病史、病理、有无远处转移、放疗前化疗史、放疗剂量）、营养状况（身高、体重、上臂围、三头肌皮褶厚度、体质指数以及血液指标：白蛋白、淋巴细胞、红细胞、血红蛋白、前白蛋白、转铁蛋白）。根据患者放疗后3个月的磁共振成像（MRI）检查结果，依据WHO实体瘤疗效评价标准进行近期疗效评价。采用成组t检验、卡方检验及Fisher精确概率法和两独立样本非参数检验对放射敏感性的影响因素进行单因素分析；运用主成分分析方法建立营养指数模型评价患者的营养状况并对营养指数进行ROC曲线分析以及拟合分布分析，探索营养指数评价营养状况的诊断界值；采用非条件Logistic回归进行多因素分析。采用Epidata3.1软件进行数据的录入，全部统计分析都在SPSS13.0软件包上进行。 [结果] 1、有完整临床资料及MRI检查资料的鼻咽癌患者共97例。根据WHO实体瘤疗效评价标准，放射敏感的有73例（占75.3%）,放射不敏感的有24例（占24.7%）。其中无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）；放射敏感组和放射不敏感组间的病理分类的差异也有统计学意义（p=0.028）。 2、单因素分析结果显示营养指标：上臂围、白蛋白、血红蛋白、前白蛋白以及营养指数在放射敏感组和放射不敏感组之间有统计学差异，t值分别为-2.763，-2.145，-2.531，-2.261，-2.667; p分别为0.007，0.034，0.013,0.026，0.009且放射敏感组好于放射不敏感组。 3、ROC曲线分析以及拟合分布分析显示，营养指数取值为0.431为最佳诊断临界值，灵敏度=0.917，特异度=0.370。 4、Logistic回归分析显示：慢性病史和营养指数是放射敏感性独立的影响因素。 [结论] 1、慢性病史、病理分类和营养状况是鼻咽癌放射敏感性的影响因素。 2、营养状况差与鼻咽癌放射不敏感之间存在一定的相关性，营养状况可成为判断鼻咽癌放射敏感性的预测指标。 3、当患者的营养指数小于0.431时，，临床上应给予营养干预，而患者营养指数大于等于0.431时可暂不干预。
[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

本文编号：2050275