山东大学耳鼻喉眼学报 ›› 2025, Vol. 39 ›› Issue (4): 77-84.doi: 10.6040/j.issn.1673-3770.0.2025.156

• 临床研究 • 上一篇    下一篇

基于计算机断层扫描血管造影术评估鼻咽癌放疗后引起颈内动脉狭窄状况及其影响因素的研究

朱瑞楷1,2,吴家荣1,孙芳1,3,谢楚波1,邱前辉1   

  1. 广东省医学科学院)耳鼻咽喉头颈外科, 广东 广州 510080;
    2.珠海市中西医结合医院 耳鼻喉科, 广东 珠海 519000;
    3.汕头大学医学院, 广东 汕头 515041
  • 出版日期:2025-07-20 发布日期:2025-08-11
  • 通讯作者: 邱前辉. E-mail:qiuqianhui@gdph.org.cn
  • 基金资助:
    2025年度广州市校(院)企联合资助项目(2025A03J4502)

Computed tomography angiography-based assessment of internal carotid artery stenosis after radiotherapy for nasopharyngeal carcinoma and its associated factors

ZHU Ruikai1,2, WU Jiarong1, SUN Fang1,3, XIE Chubo2, QIU Qianhui1   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, Guangdong Provincial People's Hospital (Guanadong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong, China2. Department of Otorhinolaryngology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai 519000, Guangdong, China3. Shantou University Medical College, Shantou 515041, Guangdong, China
  • Online:2025-07-20 Published:2025-08-11

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摘要： 目的 探讨基于计算机断层扫描血管造影术(computed tomography angiography, CTA)评估鼻咽癌放疗后颈内动脉(internal carotid artery, ICA)狭窄的发生率及其影响因素,为早期筛查和干预提供依据。 方法 选取2018年2月至2022年11月广东省人民医院耳鼻咽喉头颈外科收治的151例鼻咽癌放疗后患者资料,151例均进行头颈部CTA检查,分析患者ICA狭窄发生情况;并依据鼻咽癌放疗后患者ICA状态分为正常组(无狭窄)77例与异常组(重度及完全闭塞、中度、轻度)74例,统计对比两组临床特征,再采用Logistic回归分析鼻咽癌放疗后ICA狭窄的影响因素,主要观察指标包括性别、年龄、高血压、糖尿病、高血脂、吸烟史、放疗后间隔时间、放疗疗程、TNM分期等。 结果 151例鼻咽癌放疗后患者中,根据北美症状性颈动脉内膜切除试验法(North American Symptomatic Carotid Endarterectomy Trail, NASCET)评估颈动脉狭窄程度分度方法,ICA无狭窄占50.99%、轻度狭窄占12.58%、中度狭窄占27.15%、重度狭窄占5.31%、完全闭塞占3.97%;单因素分析显示,正常组和异常组患者中不同性别、年龄分布、伴或不伴高血压、吸烟史、放疗后间隔时间、放疗疗程和TNM分期差异有统计学意义(P<0.05);Logistic回归分析显示,年龄(51~70岁)(OR=7.917,95%CI:5.913~9.921)、女性(OR=3.394,95%CI:1.980~4.808)、高血压(OR=2.872,95%CI:1.640~4.104)、吸烟(OR=2.219,95%CI:1.103~3.335)、放疗后间隔时间(>10年)(OR=4.125,95%CI:2.081~6.169)、二程放疗(OR=5.912,95%CI:4.474~7.350)、局部/区域复发(OR=3.056,95%CI:1.790~4.332)均是影响鼻咽癌放疗后患者ICA发生狭窄的独立危险因素(P<0.05),与ICA狭窄显著相关。 结论 对于鼻咽癌放疗后患者,特别是年龄>50岁、女性、伴有高血压、吸烟、放疗后间隔时间>10年、二程放疗和局部/区域复发,应定期进行ICA狭窄的筛查和监测,以利于早期发现并干预,从而改善患者预后,提高生活质量。

关键词: 鼻咽癌, 放射治疗, 颈内动脉狭窄, 计算机断层扫描血管造影术

Abstract: Objective To investigate the incidence and risk factors of internal carotid artery(ICA)stenosis after radiotherapy for nasopharyngeal carcinoma(NPC)based on computed tomography angiography(CTA)evaluation, and to provide a basis for early screening and intervention. Methods Clinical data of 151 NPC patients who underwent radiotherapy and were admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Provincial People's Hospital, between February 2018 and November 2022, were retrospectively analyzed. All patients underwent head and neck CTA to assess ICA stenosis. Patients were categorized into a normal group(no stenosis, n=77)and an abnormal group(including mild, moderate, severe stenosis, or complete occlusion, n=74)based on post-radiotherapy ICA status. Clinical characteristics were compared between these groups, and Logistic regression analysis was used to identify potential influencing factors, such as gender, age, hypertension, diabetes mellitus, hyperlipidemia, smoking history, post-radiotherapy interval, radiotherapy course, and TNM staging. Results Among the 151 NPC patients after radiotherapy, ICA stenosis severity was evaluated using the North American Symptomatic Carotid Endarterectomy Trial(NASCET)method. The distribution was as follows: no stenosis accounted for 50.99%, mild stenosis for 12.58%, moderate stenosis for 27.15%, severe stenosis for 5.31%, and complete occlusion for 3.97%. Univariate analysis revealed statistically significant differences between the normal and abnormal groups in terms of gender, age distribution, presence or absence of hypertension, smoking history, post-radiotherapy interval, radiotherapy course, and TNM stage(P<0.05). Logistic regression analysis indicated that age(51-70 years)(OR=7.917, 95%CI: 5.913-9.921), female gender(OR=3.394, 95%CI: 1.980-4.808), hypertension(OR=2.872, 95%CI: 1.640-4.104), smoking history(OR=2.219, 95%CI: 1.103-3.335), post-radiotherapy interval(>10 years)(OR=4.125, 95%CI: 2.081-6.169), re-irradiation(OR=5.912, 95%CI: 4.474-7.350), and local/regional recurrence(OR=3.056, 95%CI: 1.790-4.332)were all identified as independent risk factors significantly associated with ICA stenosis in NPC patients after radiotherapy(P< 0.05). Conclusion Regular screening for ICA stenosis is recommended for NPC survivors, especially those aged >50 years, female, with hypertension, a history of smoking, a post-radiotherapy interval >10 years, undergoing re-irradiation, or experiencing local/regional recurrence, to enable early intervention and improve prognosis and quality of life.

Key words: Nasopharyngeal Carcinoma, Radiation Therapy, Internal Carotid Artery Stenosis, Computed Tomography Angiography

中图分类号: 

  • R739.63
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