Roberts C M, Foulcher E, Zaunders J J, Bryant D H, Freund J, Cairns D, Penny R, Morgan G W, Breit S N
St. Vincent's Hospital, University of New South Wales, Australia.
Ann Intern Med. 1993 May 1;118(9):696-700. doi: 10.7326/0003-4819-118-9-199305010-00006.
To determine if unilateral thoracic irradiation results in a lymphoid alveolitis in both irradiated and unirradiated lung fields.
A prospective, nonrandomized study.
Women receiving postoperative radiotherapy for carcinoma of the breast were evaluated both before and 4 to 6 weeks after radiotherapy. Findings after radiotherapy in 15 asymptomatic patients were compared with findings in a group of patients with clinical radiation pneumonitis.
History, physical examination, chest radiograph, quantitative gallium lung scanning, respiratory function tests, bronchoalveolar lavage, and lavage lymphocyte subset analysis.
After irradiation, lavage lymphocytes increased significantly (34.5% versus 46.8%; P = 0.01) in the 17 patients studied prospectively. There was an associated reduction in vital capacity (102.5% versus 95.5%; P = 0.04). Comparison of results in patients before treatment, after treatment without clinical pneumonitis, and after treatment with clinical pneumonitis showed a dramatic increase in total lymphocytes after irradiation (6.3 versus 9.4 versus 35.2 million, respectively; P = 0.005), particularly in those with clinical pneumonitis. Only in those with clinical pneumonitis was this accompanied by an increase in the gallium index (3.7 versus 3.4 versus 9.0, respectively; P < 0.001). Vital capacity was also progressively reduced (102.5% versus 96.9% versus 76.7%, respectively; P = 0.04), as was diffusing capacity (98.6% versus 91.4% versus 72.6%, respectively; P = 0.003). No statistical differences existed between irradiated and unirradiated sides of the chest in either lavage or gallium lung scan studies.
In most patients, a lymphocytic alveolitis develops in both lung fields after strictly unilateral thoracic irradiation; this is more pronounced in patients developing clinical pneumonitis. These findings suggest that radiotherapy may cause a generalized lymphocyte-mediated hypersensitivity reaction.
确定单侧胸部照射是否会在照射野和未照射野均导致淋巴细胞性肺泡炎。
一项前瞻性、非随机研究。
接受乳腺癌术后放疗的女性在放疗前及放疗后4至6周接受评估。将15例无症状患者放疗后的结果与一组临床放射性肺炎患者的结果进行比较。
病史、体格检查、胸部X线片、定量镓肺扫描、呼吸功能测试、支气管肺泡灌洗及灌洗淋巴细胞亚群分析。
在17例前瞻性研究的患者中，照射后灌洗淋巴细胞显著增加（34.5%对46.8%；P = 0.01）。肺活量相应降低（102.5%对95.5%；P = 0.04）。对治疗前、无临床肺炎的治疗后及有临床肺炎的治疗后患者的结果进行比较，结果显示照射后总淋巴细胞显著增加（分别为630万、940万和3520万；P = 0.005），在有临床肺炎的患者中尤其明显。仅在有临床肺炎的患者中，这伴随着镓指数的增加（分别为3.7、3.4和9.0；P < 0.001）。肺活量也逐渐降低（分别为102.5%、96.9%和76.7%；P = 0.04），弥散功能亦是如此（分别为98.6%、91.4%和72.6%；P = 0.003）。在灌洗或镓肺扫描研究中，胸部照射侧与未照射侧之间不存在统计学差异。
在大多数患者中，严格单侧胸部照射后双侧肺野均会发生淋巴细胞性肺泡炎；在发生临床肺炎的患者中更为明显。这些发现表明放疗可能会引起全身性淋巴细胞介导的超敏反应。
