头颈癌放射治疗口腔感染病原菌的特点及危险因素分析

Characteristics and risk factors of oral infection caused by radiotherapy for head and neck cancer

目的探讨头颈癌放射治疗口腔感染病原菌的特点及危险因素分析。方法回顾性分析2017年1月—2020年1月邢台市人民医院收治的头颈部恶性肿瘤行放射治疗的636例患者临床资料。分析患者口腔感染情况和病原菌分布特点,从性别、年龄、文化程度、职业、肿瘤分期、肿瘤部位、口腔环境、口腔自洁习惯、化学治疗、糖尿病、高血压、住院时间、抗生素使用、口腔黏膜保护剂使用情况等方面分析影响头颈癌放射治疗患者口腔感染的危险因素。结果头颈癌放射治疗患者中124例发生口腔感染,口腔感染发生率19.50%。真菌感染最多,有71例(39.01%)。两组患者年龄、文化程度、肿瘤分期、口腔环境、口腔自洁习惯、化学治疗、糖尿病、抗生素使用情况比较,差异有统计学意义(P<0.05)。两组患者性别、肿瘤部位、高血压、口腔黏膜保护剂使用情况比较,差异无统计学意义(P>0.05)。多因素Logistic回归模型结果显示:年龄大[OR=2.517(95%CI:1.362,4.364)]、肿瘤分期高[OR=2.953(95%CI:1.473,6.201)]、口腔环境差[OR=2.805(95%CI:1.339,5.955)]、口腔自洁习惯差[OR=2.979(95%CI:1.817,7.509)]、化学治疗[OR=3.164(95%CI:2.072,9.116)]、合并糖尿病[OR=4.102(95%CI:2.239,10.254)]、使用抗生素[OR=2.331(95%CI:1.261,3.889)]是影响头颈癌放射治疗患者口腔感染的危险因素(P<0.05)。结论头颈癌放射治疗患者口腔易发生真菌感染,年龄大、肿瘤分期高、口腔环境差、口腔自洁习惯差、化学治疗、合并糖尿病、未使用抗生素是头颈癌放射治疗患者发生口腔感染的高危因素。

Objective To investigate the characteristics and risk factors of oral infection caused by radiotherapy for head and neck cancer. Methods The clinical data of 636 patients with head and neck cancer undergoing radiotherapy in Xingtai People’s Hospital from January 2017 to January 2020 were retrospectively analyzed. The incidence of the oral infection and the distribution of pathogens were identified. In addition, the risk factors of oral infection in these patients were screened out from the aspects of gender, age, education level, occupation, tumor stage, tumor site, oral environment, oral hygiene habits, chemotherapy, diabetes mellitus, hypertension, length of hospital stay, and use of antibiotics and oral mucosal protectants. Results Oral infection occurred in 124 patients undergoing radiotherapy for head and neck cancer, with the incidence of oral infection being 19.50%. Fungal infection was the most common, accounting for 39.01%(71 cases) of all the cases. There were differences in age, educational level,tumor stage, oral environment, oral hygiene habit, chemotherapy, diabetes mellitus and the use of antibiotics between those with and without oral infection(P < 0.05). On the contrary, patients with oral infection and those without oral infection were not different in the gender, tumor site, hypertension, or the use of oral mucosal protectants. Multivariate Logistic regression analysis revealed that advanced age [OR= 2.517(95% CI: 1.362, 4.364)], higher tumor stage[OR= 2.953(95% CI: 1.473, 6.201)], unhealthy oral environment [OR= 2.805(95% CI: 1.339, 5.955)], poor oral hygiene habits [OR = 2.979(95% CI: 1.817, 7.509)], chemotherapy [OR= 3.164(95% CI: 2.072, 9.116)], diabetes mellitus [OR= 4.102(95% CI: 2.239, 10.254)] and the use of antibiotics [OR= 2.331(95% CI: 1.261, 3.889)] were risk factors of oral infection in patients undergoing radiotherapy for head and neck cancer(P < 0.05). Conclusions Head and neck cancer patients undergoing radiotherapy are prone to oral fungal infection. An advanced age, a higher tumor stage, the unhealthy oral environment, poor oral hygiene habits, chemotherapy, diabetes mellitus, and the use of antibiotics are risk factors for oral infections in patients receiving radiotherapy for head and neck cancer.