Objective To analyze the changes of immune function in lung cancer patients treated with volumetric modulated arc therapy (VMAT)and the correlation between acute radiation pneumonitis(ARP)and immune parameters. Methods Lung cancer patients treated with VMAT from 2013 through 2015 were reviewed. RP was graded according to Common Terminology Criteria for Adverse Events(CTCEA)v.4. The changes of immune function in a week before and after radiation and the correlation with ARP were analyzed. Results Thoracic radiotherapy with VMAT was administered in 77 lung cancer patients. The CD4+T cells,B cells and CD4/CD8 ratio were significantly falling post-radiotherapy compared with pre-radiotherapy and(P<0.05). CD8+T cells,activated CD8+T cells and complement C4 were significantly increased post-radiotherapy compared with pre-radiotherapy and(P<0.05). The overall incidence of symptomatic ARP(Grade≥2 by CTCAE)was 28.6%. The complement C4 was significant higher in acute radiation pneumonitis patients(P=0.000). Conclusion The levels of cellular immunity and humoral immunity indexes in lung cancer patients treated with volumetric modulated arc therapy are obviously abnormal,and complement C4 might be an important factor for predicting and diagnosis of ARP. Further mechanism research may provide more ideas for radiotherapy combined immunotherapy.%目的 分析肺癌患者基于容积旋转调强放疗(VMAT)技术的胸部放疗后免疫功能变化及与急性放射性肺炎(ARP)的相关性.方法 回顾性分析2013年1月至2015年12月77例经细胞学或病理组织学证实的肺癌患者的病历资料,分析放疗前后免疫功能指标变化,并根据CTCAE 4.0标准进行ARP分级,评价免疫功能变化与有症状ARP发生的相关性.结果 77例患者接受VMAT胸部放疗,放疗后较放疗前CD4+T细胞(P=0.003)、CD4/CD8比例(P=0.004)、B细胞(P=0.014)下降;CD8+T细胞(P=0.003)、CD8+T细胞活化(P=0.001)、补体C4(P=0.049)升高.VMAT胸部放疗后有症状ARP的发生率28.6%,有症状ARP组补体C4水平明显升高(P=0.000).结论 VMAT胸部放疗后细胞免疫和体液免疫水平均发生明显变化,其中补体C4水平增高对于预测和诊断有症状ARP有一定的价值,进一步机制研究可能为放疗联合免疫治疗提供更多思路.
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