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目的分析三维适形放疗(3DCRT)致胸部肿瘤放射性肺炎(RP)的相关因素。方法对西安长安医院的1200例胸部肿瘤患者行3DCRT的临床资料回顾性统计分析，包括病种、性别、年龄、吸烟史、PS评分、临床分期、病理类型，有无化疗、糖尿病、慢性阻塞性肺疾病(COPD)、阻塞性肺炎、阻塞性肺不张等，记录双肺平均剂量(MLD)、V20、V30等物理参数，记录放疗结束6月~1.5年内发生的RP，比较这些相关因素与RP发生的关系。结果放疗前行化疗的患者138/720例发生RP，未行化疗的患者42/480例发生RP；患糖尿病的患者108/198例发生RP，无糖尿病的患者72/1002例发生RP；患COPD患者102/380例发生RP，无COPD患者的78/820例发生RP；患阻塞性肺炎患者128/240例发生RP，无阻塞性肺炎的患者52/960例发生RP；患阻塞性肺不张患者118/202例发生RP，无阻塞性肺不张的患者62/998例发生RP。各组配对数据比较均有显著性差异(<0.05)。MLD≥15Gy 48/68例发生RP，MLD<15Gy 132/1132例发生RP；V20≥25%98/138例发生RP，V20<25%82/1062例发生RP；V30≥20%78/168例发生RP，V30<20%102/1032例发生RP。各组配对数据比较均有显著性差异(<0.05)。180例RP中1级119例(66%)，2级43例(24%)，3级14例(8%)，4级4例(2%)。结论胸部肿瘤3DCRT致RP以1~2级为主，致残或致死率在可控范围内，放疗前化疗、合并糖尿病、COPD、阻塞性肺炎、阻塞性肺不张为RP的高危因素，MLD、V20、V30是RP的重要物理影响因素，患者的病种、性别、年龄、吸烟史、PS评分、临床分期、病理类型与RP的发生无明显相关性。“,”Objective It is to approach the risk fators of radiation pneumonitis (RP) after three-dimensional conformal radiotherapy (3DCRT) in thoracic tumors. Metheds The clinical data of 1200 thoracic tumors patients in xi an Chang An Hospitai underging three-dimensional conformal radiotherapy was retrospectively analyzed,including disease,gender,age, smoking history, PS,clinical stage, histological type, with or without chemotherapy, diabetes,chronic obstructive pulmonary disease(COPD), obstructive pneumonia,obstructive atelectasis, etc;lung volume of lung receiving 20Gy(V20), 30Gy (V30), MDL,and other physical parameters were recorded;these patients were fol owed up at 6 month~1.5 years after therapy;and the relationships of them with RP were analyzed. Results There were 138 cases with RP among 720 cases that underwent chemotherapy before radiotherapy and 42 case among 480 patients that didn't line chemotherapy,108 cases among 198 cases with diabetes and 72 cases among 1002 patients without diabetes,102 cases among 380 cases with COPD and 78 cases among 820 patients without COPD,128 cases among 240 cases with obstructive pneumonia and 52 cases among 960 patients without obstructive pneumonia,118 cases among 202 cases with obstructive atelectasis and 62 cases among 998 patients without obstructive atelectasis, 48 cases with RP among 68 patients for MLD≥15 Gy and 132cases among 1132 patients for MLD<15Gy,98 cases with RP among 138 patients for V20≥25% and 82cases among 1062 patients for V20<25%,78 cases with RP among 168 patients for V30≥20% and 102cases among 1032 patients for V30<20%.The former was significantly higher than the incidence of the lat er ( al <0.05).180 patients had RP among 1200 patients that RP grade of 1,2,3 and 4 occur ed in 119(66%),43(24%),14(8%) and 4(2%) cases in al the 180 cases RP patients,respectively. Conclusion Thoracic tumor three dimensional conformal radiotherapy induced radiation pneumonitis in 1 ~2 levels of radiation pneumonia, disability or death rate in the control able range.Patients with chemotherapy,diabetes ,COPD , obstructive pneumonia and obstructive atelectasis are risk factors of RP.Physical planning parameters MLD ,V20 and V30 are important factors to the occurrence of RP. The incidence of RP has no cor elation with patients' disease,gender,age, smoking history, PS,clinical stage and histological type.