高、低剂量放射治疗对低级别脑胶质瘤患者术后健康影响的跟踪研究

doi:10.3877/cma.j.issn.2095-123X.2019.01.006

中华脑科疾病与康复杂志(电子版) ›› 2019, Vol. 09 ›› Issue (01) : 25 -29. doi: 10.3877/cma.j.issn.2095-123X.2019.01.006

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临床研究

高、低剂量放射治疗对低级别脑胶质瘤患者术后健康影响的跟踪研究

王昊¹, 张溢华¹, 王旭辉¹, 张楠¹, 贺绪智¹, 陈广鑫¹, 杨东虹¹, 易良¹, 许民辉¹, 徐伦山¹^,^†(

)

^1. 400042　重庆，陆军军医大学第三附属医院神经外科

收稿日期:2018-11-28 出版日期:2019-02-15
通信作者: 徐伦山
基金资助:
重庆市基础科学前沿技术专项重点项目(cstc2017jcyjB0164)

Follow up study on the quality of life and emotion in patients with low-grade gliomas through high or low dose radiotherapy after postoperative

Hao Wang¹, Yihua Zhang¹, Xuhui Wang¹, Nan Zhang¹, Xuzhi He¹, Guangxin Chen¹, Donghong Yang¹, Liang Yi¹, Minhui Xu¹, Lunshan Xu¹^,^†()

^1. Department of Neurosurgery, Institute of Field Surgery, The Third Affiliated Hospital of Army Medical University, Chongqing 400042, China

Received:2018-11-28 Published:2019-02-15
Corresponding author: Lunshan Xu
About author:
Corresponding author: Xu Lunshan, Email: xuliu559@163.com

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引用本文：

王昊, 张溢华, 王旭辉, 张楠, 贺绪智, 陈广鑫, 杨东虹, 易良, 许民辉, 徐伦山. 高、低剂量放射治疗对低级别脑胶质瘤患者术后健康影响的跟踪研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2019, 09(01): 25-29.

Hao Wang, Yihua Zhang, Xuhui Wang, Nan Zhang, Xuzhi He, Guangxin Chen, Donghong Yang, Liang Yi, Minhui Xu, Lunshan Xu. Follow up study on the quality of life and emotion in patients with low-grade gliomas through high or low dose radiotherapy after postoperative[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2019, 09(01): 25-29.

目的

探讨不同剂量的放射治疗对低级别胶质瘤术后患者生存质量产生的影响，为低级别胶质瘤患者的治疗决策提供有利依据。

方法

选取陆军军医大学第三附属医院神经外科自2012年1月至2016年1月收治的低级别胶质瘤患者132例，进行完全随机化分组治疗，分为高剂量放射治疗组41例、低剂量放射治疗组32例和观察组（未进行放射治疗）59例。3组患者均未进行化学治疗药物的干预。对3组患者进行为期1年的随访，采用健康生活简表（SF-36）、焦虑自评量表（SAS）和抑郁自评量表(SDS)评估术前1周内、术后1个月、3个月、6个月及1年的健康质量和心理状态。

结果

SF-36量表结果显示，高剂量放射治疗组术后的生理机能、躯体疼痛、精力和社会功能方面低于低剂量放射治疗组和观察组，差异具有统计学意义（P<0.05），在生理职能、总体健康状态、情感职能和精神健康方面，3组间差异无统计学意义（P>0.05）。SAS、SDS量表评分显示高剂量放射治疗组和低剂量放射治疗组患者比观察组有明显焦虑、抑郁倾向，差异具有统计学意义（P<0.05）。

结论

低级别脑胶质瘤术后行高剂量放射治疗对患者短期生存质量有一定影响，且恢复期长。建议对低级别胶质瘤术后的患者进行低剂量的放射治疗。而且对于年纪较轻且预后良好的患者，建议术后观察随访，避免生活存量的下降和射线造成的潜在影响。

关键词: 低级别胶质瘤, 放射治疗, 生存质量, 焦虑, 抑郁

Objective

To investigate the quality of life and psychological condition of patients with low-grade glioma undergoing surgery combined radiotherapy by the MOS item short from health survey (SF-36), anxiety scale (SAS) and self-rating depression scale (SDS) to assessment of patients with physical, psychological, mental, emotional state, etc. Investigate the effect of different doses of radiotherapy on the quality of life of patients with low-grade gliomas after operation, and to provide a favorable basis for the treatment of patients with low-grade glioma.

Methods

A total of 132 patients with low-grade glioma were recruited in the Department of Neurosurgery, Third Affiliated Hospital of Army Medical University from January 2012 to January 2016. All patients were randomized into three groups: 41 patients in the high dose radiotherapy group, 32 patients in the low dose radiotherapy group and 59 patients in the observation group (without radiotherapy, chemotherapy and other drugs after surgical resection of the tumor). Three groups of patients were followed up for 1 year, the quality of life and psychological assessed by SF-36, SAS and SDS were collected and statistical analyses.

Results

The results of SF-36 scale showed that the physiological function, physical pain, energy and social function of the high-dose radiation group were lower than those of the low-dose radiation group and the observation group (P<0.05). There was no significant difference among the three groups in physiological function, general health status, emotional function and mental health (P>0.05). The scores of SAS and SDS showed that the patients in the high dose radiation group and the low dose radiation group had more anxiety and depression tendency than those in the observation group, and the difference was statistically significant (P<0.05).

Conclusion

High-dose radiotherapy after low-grade glioma surgery has a certain impact on short-term quality of life of patients, and the recovery period is long. It is suggested that low-dose radiotherapy be given to patients with low-grade glioma after surgery. For younger patients with good prognosis, it is suggested that follow-up be observed after surgery to avoid the decline of life stock and the potential impact of radiation.

Key words: Low-grade glioma, Radiation therapy, Quality of life, Anxiety, Depression.

表1 纳入研究的低级别胶质瘤患者的一般资料分析[例（%）]

项目		观察组（n=59）	低剂量组（n=32）	高剂量组（n=41）	χ²/F值	P值
年龄（岁，Mean±SD）		43.28±5.5	42.31±7.8	39.75±6.2^a	3.823	0.024
女性		28（47.75）	14（43.75）	21（51.22）	0.405	0.817
肿瘤最大直径（mm，Mean±SD）		40±11	44±17	40±7^a	1.359	0.252
功能区受累		3（5.08）	9（28.13）^a	13（31.71）^a	13.489	0.001
病理结果		?	?	?	31.030	<0.001
?	星形细胞瘤	46	14^a	38^b	23.277	<0.001
?	少突胶质瘤	13	5	16	5.920	0.052
手术切除程度		?	?	?	?	?
?	全切	57（96.61）	12（37.50）^a	33（80.49）^ab	41.627	<0.001
?	非全切	2（3.39）	12（37.50）^a	16（39.02）^a	22.940	<0.001

表1 纳入研究的低级别胶质瘤患者的一般资料分析[例（%）]

项目		观察组（n=59）	低剂量组（n=32）	高剂量组（n=41）	χ²/F值	P值
年龄（岁，Mean±SD）		43.28±5.5	42.31±7.8	39.75±6.2^a	3.823	0.024
女性		28（47.75）	14（43.75）	21（51.22）	0.405	0.817
肿瘤最大直径（mm，Mean±SD）		40±11	44±17	40±7^a	1.359	0.252
功能区受累		3（5.08）	9（28.13）^a	13（31.71）^a	13.489	0.001
病理结果		?	?	?	31.030	<0.001
?	星形细胞瘤	46	14^a	38^b	23.277	<0.001
?	少突胶质瘤	13	5	16	5.920	0.052
手术切除程度		?	?	?	?	?
?	全切	57（96.61）	12（37.50）^a	33（80.49）^ab	41.627	<0.001
?	非全切	2（3.39）	12（37.50）^a	16（39.02）^a	22.940	<0.001

表2 3组胶质瘤患者的SF-36生活质量评估量化表

时间	组别	生理机能	生理职能	一般健康状况	情感职能	躯体疼痛	精力	精神健康	社会功能
?	观察组	59±5.61	58±6.25	46±3.34	45±4.04	54±6.17	52±4.19	50±3.62	48±3.22
?	低剂量组	64±10.21^a	62±6.61^a	42±5.56^a	31±6.23^a	54±7.36	56±5.75^a	52±3.50^a	45±1.98^a
术前	高剂量组	64±6.69^a	62±5.65^a	34±3.22^ab	32±4.33^a	55±3.65	56±4.52^a	54±3.78^ab	43±5.42^ab
?	F值	7.684	6.876	111.877	131.464	0.412	11.772	14.706	21.295
?	P值	0.001	0.001	<0.001	<0.001	0.663	<0.001	<0.001	<0.001
?	观察组	61±6.62	52±4.33	42±4.29	41±4.95	42±7.22	42±5.23	47±5.17	43±4.67
?	低剂量组	64±6.13^a	59±5.73^a	41±5.31	41±5.05	34±6.35^a	42±3.38	50±5.03^a	44±3.55^a
1个月	高剂量组	60±5.56^b	54±3.27^ab	41±3.18	39±3.52	32±4.33^a	34±3.61^ab	55±5.92^ab	34±4.12^a
?	F值	3.994	26.041	0.897	2.694	35.794	47.394	26.758	68.867
?	P值	0.021	<0.001	0.410	0.071	<0.001	<0.001	<0.001	<0.001
?	观察组	67±5.94	61±6.71	50±5.11	44±4.68	47±6.03	47±4.47	54±4.25	50±4.66
?	低剂量组	71±2.52^a	63±3.55	49±5.55	44±2.50	41±3.14^a	48±4.56	59±4.04^a	49±2.19
3个月	高剂量组	67±3.10^b	59±4.24^b	49±5.52	43±4.05	39±2.82^a	43±1.78^ab	59±2.22^a	41±1.09^ab
?	F值	9.521	5.019	0.571	0.860	40.775	18.579	30.053	94.59
?	P值	<0.001	0.008	0.566	0.426	<0.001	<0.001	<0.001	<0.001
?	观察组	73±4.66	72±6.70	56±4.65	53±3.77	49±5.55	52±4.77	67±4.54	64±3.59
?	低剂量组	73±3.16	72±2.87	55±6.01	52±4.11	49±3.19	52±5.33	67±4.17	48±4.75
6月	高剂量组	73±3.39	67±3.33^ab	52±2.36^ab	51±4.19^a	42±4.01^ab	49±3.92^ab	67±2.46	47±5.17^a
?	F值	<0.001	13.801	9.861	3.069	32.541	5.829	<0.001	229.885
?	P值	>0.999	<0.001	<0.001	0.049	<0.001	0.004	>0.999	<0.001
?	观察组	78±4.68	78±4.29	66±4.73	64±4.03	55±5.15	57±3.78	72±5.81	67±4.07
?	低剂量组	78±4.68	78±3.88	64±4.22	63±3.73	54±4.08	56±4.29	68±3.22	51±5.07
1年	高剂量组	76±3.07^ab	75±3.15^ab	61±3.11^ab	62±2.21^a	49±3.16^ab	50±5.28^ab	69±2.37^a	49±3.62^a
?	F值	3.135	8.497	17.442	4.011	24.249	32.581	10.400	272.465
?	P值	0.047	<0.001	<0.001	0.020	<0.001	<0.001	<0.001	<0.001

表2 3组胶质瘤患者的SF-36生活质量评估量化表

时间	组别	生理机能	生理职能	一般健康状况	情感职能	躯体疼痛	精力	精神健康	社会功能
?	观察组	59±5.61	58±6.25	46±3.34	45±4.04	54±6.17	52±4.19	50±3.62	48±3.22
?	低剂量组	64±10.21^a	62±6.61^a	42±5.56^a	31±6.23^a	54±7.36	56±5.75^a	52±3.50^a	45±1.98^a
术前	高剂量组	64±6.69^a	62±5.65^a	34±3.22^ab	32±4.33^a	55±3.65	56±4.52^a	54±3.78^ab	43±5.42^ab
?	F值	7.684	6.876	111.877	131.464	0.412	11.772	14.706	21.295
?	P值	0.001	0.001	<0.001	<0.001	0.663	<0.001	<0.001	<0.001
?	观察组	61±6.62	52±4.33	42±4.29	41±4.95	42±7.22	42±5.23	47±5.17	43±4.67
?	低剂量组	64±6.13^a	59±5.73^a	41±5.31	41±5.05	34±6.35^a	42±3.38	50±5.03^a	44±3.55^a
1个月	高剂量组	60±5.56^b	54±3.27^ab	41±3.18	39±3.52	32±4.33^a	34±3.61^ab	55±5.92^ab	34±4.12^a
?	F值	3.994	26.041	0.897	2.694	35.794	47.394	26.758	68.867
?	P值	0.021	<0.001	0.410	0.071	<0.001	<0.001	<0.001	<0.001
?	观察组	67±5.94	61±6.71	50±5.11	44±4.68	47±6.03	47±4.47	54±4.25	50±4.66
?	低剂量组	71±2.52^a	63±3.55	49±5.55	44±2.50	41±3.14^a	48±4.56	59±4.04^a	49±2.19
3个月	高剂量组	67±3.10^b	59±4.24^b	49±5.52	43±4.05	39±2.82^a	43±1.78^ab	59±2.22^a	41±1.09^ab
?	F值	9.521	5.019	0.571	0.860	40.775	18.579	30.053	94.59
?	P值	<0.001	0.008	0.566	0.426	<0.001	<0.001	<0.001	<0.001
?	观察组	73±4.66	72±6.70	56±4.65	53±3.77	49±5.55	52±4.77	67±4.54	64±3.59
?	低剂量组	73±3.16	72±2.87	55±6.01	52±4.11	49±3.19	52±5.33	67±4.17	48±4.75
6月	高剂量组	73±3.39	67±3.33^ab	52±2.36^ab	51±4.19^a	42±4.01^ab	49±3.92^ab	67±2.46	47±5.17^a
?	F值	<0.001	13.801	9.861	3.069	32.541	5.829	<0.001	229.885
?	P值	>0.999	<0.001	<0.001	0.049	<0.001	0.004	>0.999	<0.001
?	观察组	78±4.68	78±4.29	66±4.73	64±4.03	55±5.15	57±3.78	72±5.81	67±4.07
?	低剂量组	78±4.68	78±3.88	64±4.22	63±3.73	54±4.08	56±4.29	68±3.22	51±5.07
1年	高剂量组	76±3.07^ab	75±3.15^ab	61±3.11^ab	62±2.21^a	49±3.16^ab	50±5.28^ab	69±2.37^a	49±3.62^a
?	F值	3.135	8.497	17.442	4.011	24.249	32.581	10.400	272.465
?	P值	0.047	<0.001	<0.001	0.020	<0.001	<0.001	<0.001	<0.001

表3 3组胶质瘤患者术后SAS、SDS量表得分情况

项目	组别	1个月	3个月	6个月	12个月
?	观察组	51.420±5.099	40.820±3.885	37.980±2.487	37.980±3.287
?	低剂量放射治疗组	52.043±4.708	41.903±3.219	38.642±3.236	37.612±1.676
SAS	高剂量放射治疗组	52.346±7.478	42.923±2.529^a	39.462±2.626^a	38.146±2.366
?	F值	0.323	4.803	3.577	0.363
?	P值	0.725	0.010	0.031	0.696
?	观察组	49.420±5.099	37.820±3.885	36.080±2.487	35.938±3.856
?	低剂量放射治疗组	50.342±5.418	38.223±3.229	36.672±3.606	35.436±2.686
SDS	高剂量放射治疗组	50.792±6.352	39.000±3.671	37.250±4.003	36.012±2.230
?	F值	0.779	1.256	1.537	0.351
?	P值	0.461	0.288	0.219	0.705

表3 3组胶质瘤患者术后SAS、SDS量表得分情况

项目	组别	1个月	3个月	6个月	12个月
?	观察组	51.420±5.099	40.820±3.885	37.980±2.487	37.980±3.287
?	低剂量放射治疗组	52.043±4.708	41.903±3.219	38.642±3.236	37.612±1.676
SAS	高剂量放射治疗组	52.346±7.478	42.923±2.529^a	39.462±2.626^a	38.146±2.366
?	F值	0.323	4.803	3.577	0.363
?	P值	0.725	0.010	0.031	0.696
?	观察组	49.420±5.099	37.820±3.885	36.080±2.487	35.938±3.856
?	低剂量放射治疗组	50.342±5.418	38.223±3.229	36.672±3.606	35.436±2.686
SDS	高剂量放射治疗组	50.792±6.352	39.000±3.671	37.250±4.003	36.012±2.230
?	F值	0.779	1.256	1.537	0.351
?	P值	0.461	0.288	0.219	0.705

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Follow up study on the quality of life and emotion in patients with low-grade gliomas through high or low dose radiotherapy after postoperative

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Follow up study on the quality of life and emotion in patients with low-grade gliomas through high or low dose radiotherapy after postoperative