肺癌放疗患者发生放射性肺炎的影响因素

The Influencing Factors of Radiation Pneumonia in Lung Cancer Patients Undergoing Radiotherapy

摘要: 目的：分析肺癌放疗患者发生放射性肺炎(RP)的影响因素。方法：选取2024年4月至2025年3月该院收治的143例肺癌放疗患者进行横断面研究，统计肺癌放疗患者RP发生情况。采用Logistic回归分析肺癌放疗患者发生RP的影响因素。结果：143例肺癌放疗患者中，发生≥2级RP的患者为51例，发生率为35.66%；患者年龄，糖尿病史，吸烟史，既往胸部疾病，免疫治疗与≥2级RP相关(P ≤ 0.05)；其余的临床因素包括性别，高血压史，饮酒史，病理类型，分期，手术治疗，同步或序贯化疗，CD4/CD8，放疗处方剂量，肺剂量学参数(双肺V10，双肺V20，双肺V30)均无统计学意义(P > 0.05)。剂量学因素中患肺MLD，双肺MLD，患肺V10，患肺V20，患肺V30与≥2级RP相关(P ≤ 0.05)。Logistic回归分析结果显示，吸烟史，既往胸部疾病，免疫治疗，患肺MLD，双肺MLD是发生2级以上RP的危险因素(P ≤ 0.05)。ROC曲线分析得出患肺MLD和双肺MLD的AUC分别为0.683和0.593结论：吸烟史，既往胸部疾病，免疫治疗，患肺MLD，双肺MLD是发生2级以上RP的危险因素，患肺MLD对放射性肺炎的预测价值更高。

Abstract: Objective: To analyze influencing factors for radiation pneumonitis (RP) in lung cancer patients receiving radiotherapy. Methods: A cross-sectional study was conducted on 143 lung cancer patients treated with radiotherapy at our hospital from April 2024 to March 2025. The incidence of RP was recorded, and Logistic regression was used to identify influencing factors. Results: Among the 143 patients, 51 (35.66%) developed grade ≥ 2 RP. Factors significantly associated with grade ≥ 2 RP included age, history of diabetes, smoking history, pre-existing thoracic diseases, and immunotherapy (all P ≤ 0.05). Other clinical factors (gender, hypertension history, alcohol consumption, pathological type, cancer stage, surgery, concurrent/sequential chemotherapy, CD4/CD8 ratio, prescription dose, and dosimetric parameters V10/V20/V30 of bilateral lungs) showed no statistical significance (P > 0.05). Among dosimetric parameters, mean lung dose of the affected lung (MLD_affected), mean dose to both lungs (MLD_total), and the V10/V20/V30 of the affected lung were correlated with grade ≥ 2 RP (P ≤ 0.05). Logistic regression identified smoking history, pre-existing thoracic diseases, immunotherapy, MLD_affected, and MLD_total as independent risk factors for grade ≥ 2 RP (P ≤ 0.05). ROC analysis showed AUC values for MLD_affected and MLD_total were 0.683 and 0.593, respectively. Conclusion: Smoking history, pre-existing thoracic diseases, immunotherapy, MLD_affected, and MLD_total are risk factors for grade ≥ 2 RP. MLD_affected demonstrates higher predictive value for RP.