低剂量放疗治疗8例重型/危重型新冠肺炎的初步临床观察
Preliminary clinical observations of low-dose radiotherapy for eight cases of severe/critical COVID-19
刘佳 1王兰 2郭春辉 3焦旸 4孙亮 4夏林云 1秦建军 1居敏 1蔡依玲 1王坚1
作者信息
- 1. 南通大学附属江阴医院放疗科,江阴 214400
- 2. 南通大学附属江阴医院呼吸科,江阴 214400
- 3. 南通大学附属江阴医院感染性疾病科,江阴 214400
- 4. 苏州大学苏州医学院放射医学与防护学院 省部共建放射医学与辐射防护国家重点实验室,苏州 215123
- 折叠
摘要
目的 探讨全肺低剂量放疗(LDRT)治疗重型/危重型新型冠状病毒(COVID-19)肺炎的疗效和不良反应.方法 本研究为单臂Ⅰ期临床研究,对2023年1月至6月南通大学附属江阴医院收治的经内科治疗后病情恶化或无改善的8例重型/危重型新型COVID-19肺炎患者行全肺LDRT.患者取仰卧或俯卧位,前后对穿照射,剂量权重为1∶1,全肺LDRT剂量0.5～1.5 Gy.分析患者放疗前后氧合状况、炎症指标和影像学变化,观察患者急性放射性不良反应.结果 LDRT后1周,7例(87.5％)患者的SaO2/FiO2或PaO2/FiO2指标上升,7例(87.5％)患者C反应蛋白(CRP)、白介素6(IL-6)等炎性指标下降,胸部CT/胸片扫描显示5例(62.5％)肺部炎症受累范围显著减少.未观察到明显急性放射性不良反应.结论 对内科治疗效果欠佳的重型/危重型新型COVID-19肺炎患者进行全肺0.5～1.5 Gy剂量的LDRT治疗,有助于降低炎症指标,改善临床症状,促进炎症吸收且无明显急性不良反应.
Abstract
Objective To investigate the efficacy and adverse reactions of whole-lung low-dose radiotherapy(LDRT)in patients with severe/critical coronavirus disease 2019(COVID-19).Methods Eight patients with severe/critical COVID-19 treated in the Jiangyin Hospital Affiliated to Nantong University from January to June 2023 who were treated with whole-lung LDRT after deteriorating or failing to improve post-medical treatment were enrolled in this single-arm phase Ⅰ clinical trial.They received anterior-posterior penetrating radiation in a supine or prone position,with a total dose range from 0.5 to 1.5 Gy and a dose weight ratio of 1∶1.The oxygenation status,inflammatory markers,and imaging changes before and after radiotherapy were analyzed,and patients were followed up for acute radiation-induced adverse reactions.Results One week after LDRT,the SaO2/FiO2 or PaO2/FiO2 indices increased in seven patients(87.5％),inflammatory markers such as C-reactive protein(CRP)and interleukin-6(IL-6)decreased in seven patients(87.5％),and chest CT/chest radiographs revealed a significant reduction in the extent of pneumonia involvement in 5 patients(62.5％).No evident acute radiation-related adverse reactions were observed.Conclusions Whole-lung LDRT with a dose range from 0.5 to 1.5 Gy can reduce inflammatory markers,improve clinical symptoms,and promote inflammatory absorption in patients with severe/critical COVID-19 who responded poorly to medical treatment while not inducing acute adverse reactions.
关键词
新型冠状病毒/低剂量放射治疗/肺炎Key words
COVID-19/Low-dose radiotherapy/Pneumonia引用本文复制引用
基金项目
江苏省卫生健康委重点科研项目(ZD2021053)
江阴市科技局社会发展科技示范项目(JY0603A021014210005PB)
国家自然科学基金青年基金(82000012)
无锡市卫生健康委中青年拔尖人才资助计划(BJ2023101)
放射医学与辐防护国家重点实验室科研创新项目(GZC00402)
无锡市卫生健康委青年科研项目(Q202333)
出版年
2024
NETL
NSTL
万方数据