检索历史 清除

目的:探讨高压氧（HBO）联合大剂量地塞米松治疗鼻咽癌放疗后晚期放射性脑病（RE）的临床疗效及其作用机制。方法:选取2015年4月至2023年4月烟台市蓬莱人民医院肿瘤科收治的鼻咽癌放疗后晚期RE患者108例作为研究对象，按照随机数字表法分为联合组（ n=54）和对照组（ n=54）。对照组患者予以大剂量地塞米松治疗；联合组患者在对照组治疗的基础上联合HBO治疗。采用头颅MRI扫描患者治疗前后颅脑病灶体积的变化，并统计临床疗效；采用简易精神状态检查（MMSE）量表和改良Barthel指数（MBI）评定患者治疗前后的认知功能和日常生活自理能力；采用世界卫生组织生存质量测定简表（WHOQOL-bref）评价2组患者治疗前后生存质量各因子评分的变化；采用酶联免疫吸附法测定患者治疗前后血清白细胞介素-6（IL-6）、血管内皮生长因子（VEGF）、低氧诱导因子-1α（HIF-1α）及血管紧张素转换酶（ACE）的水平。 结果:联合组患者治疗后颅脑病灶体积明显小于对照组（ P<0.05），临床总有效率（87.04%）明显高于对照组（74.07%），差异有统计学意义（ χ2=4.112， P=0.031）；联合组患者治疗后MMSE和MBI评分均明显高于对照组（ P<0.05），生理领域、心理领域、社会环境关系、健康总评分和生活总评分明显高于对照组（ P<0.05）。与治疗前比较，2组患者治疗后血清ACE水平均明显提高，VEGF、HIF-1α、IL-6水平明显降低（ P<0.01或 P<0.01）；联合组患者治疗后血清ACE水平较对照组明显提高，VEGF、HIF-1α、IL-6水平明显降低（ P<0.05或 P<0.01）。 结论:HBO联合大剂量地塞米松治疗鼻咽癌放疗后晚期RE临床疗效显著，能明显缩小患者颅脑病灶体积，提高认知功能和日常生活自理能力，其主要是通过上调血清ACE表达，抑制VEGF、HIF-1α、IL-6的表达实现的。

Objective:To explore the clinical efficacy and mechanism of hyperbaric oxygen（HBO）combined with high-dose dexamethasone in the treatment of late stage radiation encephalopathy（RE）after radiotherapy for nasopharyngeal carcinoma.Methods:A total of 108 patients with late stage RE after radiotherapy for nasopharyngeal carcinoma，who were admitted to the Department of Oncology at Yantai Penglai People’s Hospital from April 2015 to April 2023，were selected as the study subjects. The 108 patients were divided into combined treatment group（ n=54）and control group（ n=54）acording to the random number table method. The patients in the control group were treated with high-dose dexamethasone，while the petients in the combination group received HBO therapy on the basis of treatment in the control group. Cranial MRI scans were conducted to assess changes in the volume of intracranial lesions in patients before and after treatment for evaluating the clinical efficacy. The cognitive function and activities of daily living of patients before and after treatment were evaluated using the mini-mental state examination（MMSE）scale and the modified Barthel index（MBI），respectively. Changes in the scores of various factors related to quality of life before and after treatment were evaluated using the World Health Organization quality of life-bref（WHO QOL-bref）. Levels of serum Interleukin 6（IL-6），vascular endothelial growth factor（VEGF），hypoxia-inducible factor-1α（HIF-1α），and angiotensin converting enzyme（ACE）before and after treatment were measured by enzyme-linked immunosorbent assay（ELISA）. Results:The combined treatment group demonstrated significantly smaller volume of intracranial lesions compared with the control group after treatment（ P<0.05）. The total effective rate in the combined treatment group（87.04%）was significantly higher than that in the control group（74.07%）after treatment，with a statistically significant difference（ χ2=4.112， P=0.031）. Both the MMSE and MBI scores in the combined treatment group were significantly higher than those in the control group after treatment（ P<0.05）. After treatment，the combined treatment group exhibited significantly higher scores in the physiological，psychological，social environment relationships，overall health，and life domains compared with the control group（ P<0.05 or P<0.01）. Compared with those before treatment，the levels of serum VEGF and ACE in both groups significantly increased after treatment，while HIF-1α and IL-6 levels decreased significantly（ P<0.01）. Compared with those in the control group after treatment，the levels of serum ACE in the combined treatment group significantly increased，but the levels of HIF-1α and IL-6 significantly decreased（ P<0.05 or P<0.01）. Conclusion:HBO therapy combined with high-dose dexamethasone in the treatment of late stage RE after radiotherapy for nasopharyngeal carcinoma significantly improves clinical outcomes by reducing the volume of intracranial lesions，enhancing cognitive function，and activities of daily living. The main mechanism of action is achieved through upregulation of serum ACE expressions，along with inhibitions of VEGF，HIF-1α，and IL-6 release.