鼻咽癌放射治疗后长期生存病人的记忆力减退与脑损伤相关性的研究
中华放射肿瘤学杂志 1999年第2期第8卷 论 著
作者：欧广飞 蔡伟明
单位：100021 北京，中国医学科学院中国协和医科大学肿瘤医院放射治疗科
关键词：鼻咽肿瘤；放射疗法；脑损伤；记忆力测定
【摘要】 目的 研究放射治疗后鼻咽癌患者记忆力下降与脑损伤之间关系，探索记忆力检测作为放射性脑损伤早期发现方法的可行性。方法 测定了24例放射治疗后长期生存的鼻咽癌患者的记忆力指数，同时进行脑的影像学观察来研究记忆力下降与脑形态损伤之间的相关性，并设30例正常人作为对照。结果 全组病人记忆商较正常人明显减退，其中指向记忆、联想学习和图像自由回忆3个分项的得分下降最明显。记忆力的减退程度与脑损伤影像学表现的严重程度成正比：24例病人中记忆商 ＞80分的15例病人CT或MRI检查均未发现脑萎缩和脑软化； 65～80分的5例病人中2例脑萎缩；＜65分的4例均发生了脑软化。另外，记忆力减退随放射治疗后生存时间的延长而加重，相关系数为-0.72 (P＜0.001)。结论 放射治疗后长期生存的鼻咽癌患者记忆力下降与放射性脑损伤程度成正比，初步提示放射治疗后进行记忆力动态评测有助于早期发现鼻咽癌病人的放射性脑损伤。
Relationship of memory loss and brain injury in the long-term survivors of
nasopharyngeal carcinoma after radiotherapy.
OU Guangfei, CAI Weiming.
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021
【Abstract】 Objective To design a new useful tool for early detection of serious brain injury in long-term survivors of nasopharyngeal carcinoma after radiotherapy. Methods Memory test was used in 24 long-term survivors after irradiation for nasopharyngeal carcinoma, while CT scan (or MRI) of brain was used to detect morphological brain injury. Thirty normal people were matched as control. The relationship between memory loss and brain injury was analyzed. Results The memory loss was significant in the patients, especially the performance of directional memory, association tests, as well as picture memory. No brain atrophy or necrosis was found in cases whose memory quotient (MQ) was higher than 80; brain atrophy was observed in 2 of 5 patients whose MQ was 80～65; and brain necrosis was found in all 4 patients whose MQ was lower than 65. The severity of memory loss was in direct proportion to the survival time after radiotherapy with a relative coefficient of -0.72 (P＜0.001). Conclusions Memory test is a valuable tool to early detect and diagnose serious brain injury such as brain atrophy and necrosis in long-term survivors of nasopharyngeal carcinoma after radiotherapy.
【Key words】 Nasopharyngeal neoplasms/radiotherapy;Brain injury;Memory test
放射性脑损伤（如脑萎缩和脑软化）是鼻咽癌放射治疗后严重的晚期并发症［1］。研究其早期临床征象和指标对及时发现、诊断、治疗这些并发症，提高患者的生存质量具有重要意义。头颈部肿瘤放射治疗后记忆力减退的程度与放射治疗引起的脑损伤成正比，一般明显的记忆力减退都早于脑实质形态损伤的发生［2］。本研究拟通过观察鼻咽癌放射治疗后长期生存患者的记忆力变化和脑损伤出现的频率及严重程度，了解记忆力减退与鼻咽癌放射治疗后脑损伤之间的相关关系，从而探索记忆力测定作为放射性脑损伤早期发现指标的可能性。
1 材料与方法
1.1 分组：分观察组和对照组。观察组为我院1964～1992年治疗的24例鼻咽癌病人，存活时间均在5年以上（包括5年），其中1例放射治疗前CT