肺癌放射性肺炎危险因素的Meta分析

    Risk Factors on Radiation Pneumonitis: A Meta-Analysis

    • 摘要: 目的 探讨影响放射性肺炎发生的因素,为更好地指导临床治疗、减少放射性肺炎的发生提供依据。 方法 计算机检索PubMed数据库、EMBASE数据库、Cochrane协作网和CNKI数据库,并辅以手工检索等方法,应用RevMan 5.1软件对截止2012年2月发表的预测肺癌放疗后发生放射性肺炎的文献数据进行Meta分析。 结果 共纳入文献75篇。暴露因素包括患者自身因素(性别、年龄、慢性肺疾病、肺功能、合并糖尿病)、肿瘤部位、治疗方案(放疗前有无手术、是否行联合放化疗及使用放疗增敏剂阿米福汀)。Meta分析结果显示其比值比及其95%可信区间分别为: 性别0.970.82,1.15,年龄0.900.63,1.28,合并慢性肺疾病2.181.59,3.00,放疗前肺功能0.270.11,0.65,合并糖尿病2.461.33,4.58,左下肺部肿瘤0.710.57,0.90,放疗前肺部手术0.920.67,1.25,放化疗联合1.411.17,1.71,使用放疗增敏剂阿米福汀2.381.79,3.16。 结论 影响放射性肺炎发生的因素有合并慢性肺疾病、放疗前肺功能、糖尿病、左下肺部肿瘤、放化疗联合以及使用放疗增敏剂阿米福汀。本项研究的结果认为肺功能较好且无慢性肺疾病和糖尿病等合并症的上肺肺癌患者,在单纯放疗的基础上加用放疗增敏剂阿米福汀,可以降低患者的放射性肺炎发生率。

       

      Abstract: Objective To study the risk factors of radiation pneumonitis in order to find prognostic parameters and provide reference standard for the best clinical treatment plan. Methods The database of PubMed, EMBASE, Cochrane Library and CNKI were searched from the date of their establishments to Februɑry 2012, and other supplied sources were also retrieved. Meta-analysis on literatures predicting radiation pneumonitis after radiotherapy were conducted by using RevMan 5.1 software. Results A total of 75 studies were included. The exposure factors included the patient's own factors (sex, age, chronic lung disease, pulmonary function, diabetes), tumor site, therapeutic schedule (operation before radiotherapy, combined radiochemotherapy, using radiotherapy sensitization agent Amifostine). Meta-analysis results showed that the OR and 95%CI of each factors were: 0.970.82,1.15, 0.900.63,1.28, 2.181.59,3.00, 0.270.11,0.65, 2.461.33,4.58, 0.710.57,0.90, 0.920.67,1.25, 1.411.17,1.71, 2.381.79,3.16, respectively. Conclusions The risk factors of radiation pneumonitis are chronic lung disease, pulmonary function, diabetes, tumor located in left lower lung, combined radiochemotherapy and using radiotherapy sensitization agent Amifostine. The study results indicate that upper lung cancer patients with good pulmonary function and without comorbidity such as diabetes or chronic pulmonary disease have less chance getting radiation pneumonitis based on the simple radiotherapy added with Amifostine—a radiotherapy sensitizer.

       

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