电离辐射对鼻咽癌患者鼻腔黏膜损伤机制的研究

发布时间：2018-06-15 11:34

本文选题：电离辐射 + 鼻咽癌　；参考：《汕头大学》2010年硕士论文

【摘要】：目的鼻咽癌是我国南方高发恶性肿瘤,目前公认和有效的根治性治疗手段为放射治疗,或以放疗为主的综合治疗。早期一般采用单纯放射治疗,晚期采用同步放化疗。我们通过研究常规放射剂量(66~70Gy)的电离辐射对鼻咽癌患者鼻腔黏膜的损伤程度,观察、比较不同时间点(包括放疗前,放疗结束后1个月,放疗结束后6个月)受损黏膜组织修复能力的差异,探讨如何有效地预防和减少放疗后并发症,促进黏膜上皮修复,进一步恢复鼻腔粘液纤毛传输系统功能,改善患者生活质量,并为放射治疗后产生的相应并发症提供治疗依据。对象与方法 1.随机抽取的入选观察对象均为2008年2月至2008年12月于广东省人民医院耳鼻咽喉头颈外科活检、病理科确诊为鼻咽非角化性未分化型癌的患者,行鼻咽部、颅底、颈部磁共振平扫加增强扫描检查,明确肿瘤侵犯范围;行胸片正侧位X线片、肝胆脾胰肾加泌尿系统彩色超声、全身骨扫描明确无远处转移;经UICC2002(UICC,international union against cancer,国际抗癌联盟)分期确诊为鼻咽非角化行未分化型癌T2N1M06名,T2N0M024名,;经广东省人民医院放疗科定位,鼻咽部照射野为面颈联合野,鼻咽部肿瘤剂量66~70Gy。 2.分三个时间点随机抽取观察对象:放射治疗前10例,男性7例,女性3例,年龄21~61岁,平均47.3岁,用作对照组;放射治疗后1个月10例,男性7例,女性3例,年龄34~70岁,平均55.3岁;放射治疗后6个月10例,男性9例,女性1例,年龄30~59岁,平均45.1岁。入选患者既往无慢性鼻窦炎、鼻息肉病史,无变应性鼻炎、萎缩性鼻炎和鼻腔、鼻窦手术史;无Kartagener综合征(原发性纤毛不动综合征,包括慢性鼻窦炎,支气管扩张,内脏转位)病史,经谈话后患者自愿并在知情同意书上签字。 3.三组患者行下鼻甲黏膜石蜡切片HE染色、电镜分析观察其形态学差异;测量SOD活性(SOD, Superoxidismutase,过氧化物歧化酶)及MDA(MDA,Malondialdehyde,丙二醛)含量的差异。 4.所得数据通过SPSS13.0软件处理,根据资料及设计类型采用单因素的方差分析检验方法,p0.05认为组间差异有统计学意义。结果 1.下鼻甲黏膜石蜡切片HE染色光镜下可见,放疗前,上皮层以纤毛柱状上皮为主,纤毛排列致密、整齐,固有层内可见浆液腺、粘液腺,无萎缩,以浆液腺为主;放疗结束后一个月,纤毛上皮细胞排列疏松,纤毛结构大部分被破坏,基底膜增厚。固有层内浆液腺及粘液腺均减少,腺体萎缩;放疗结束后半年,纤毛上皮形态有所恢复,但排列仍旧紊乱,密度不均匀。基底膜增厚,浆液腺较放疗结束后一个月有所恢复,未见明显粘液腺。 2.扫描电镜下可见,放疗前的鼻咽癌患者下鼻甲黏膜上皮纤毛分布均匀、致密,“9+2”微管结构清晰;放疗结束后一个月下鼻甲黏膜上皮可见大量纤毛脱落、倒伏,上皮细胞坏死;放疗结束后半年下鼻甲黏膜上皮可见纤毛密度紊乱,生长不良,“9+2”微管结构不清晰。 3.(1)SOD活性及MDA含量的测定:鼻咽癌患者放疗前的SOD活性均值104.356±2.509u/mgprot ;放疗后一个月SOD活性均值60.790±2.928 u/mgprot;放疗后半年SOD活性均值102.695±2.874 u/mgprot。鼻咽癌患者放疗前MDA含量均值60.243±1.874nmol/mgprot放疗后一个月MDA含量均值86.051±2.551nmol/mgprot放疗后半年MDA含量均值61.782±2.049nmol/mgprot。(2)鼻咽癌患者放疗前与放疗后一个月的SOD活性差异有显著性(p0.05),MDA含量差异有显著性(p0.05);放疗后一个月与放疗后半年的SOD活性差异有显著性(p0.05),MDA含量差异有显著性(p0.05);放疗前与放疗后半年的SOD活性差异无统计学意义( p=0.6760.05 ) , MDA含量差异无统计学意义(p=0.6210.05)。结论 1.放射治疗结束后一个月的鼻咽癌患者,在本次研究中出现最为严重的电离辐射损伤,同时期,黏膜中的SOD活性为三组中最低,MDA含量最高;放疗结束后半年电离辐射损伤出现修复,纤毛上皮形态有所恢复,但生长紊乱。同时期的SOD活性升高,与放疗前差异无统计学意义(p=0.6760.05)。MDA含量差异无统计学意义(p=0.6210.05)。 2.鼻腔粘膜及纤毛上皮形态可以得到一定程度的恢复,放射治疗半年后鼻咽癌患者抗氧化功能基本恢复到放疗前水平。
[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.
【学位授予单位】：汕头大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63

【参考文献】