IFN-γ治疗放射性颞颌关节功能障碍的前瞻性临床研究

The Prospective Self Controlled Study Using Interferon-γto Remedy the Temporomandibular Joint Dysfunction Induced by Radiotherapy

目的探讨干扰素-γ(IFN-γ)是否能有效地治疗放射性颞颌关节功能障碍。方法对放疗引起张口困难而致门齿距<3cm的43例鼻咽癌首程放疗后患者进行IFN-γ治疗的前瞻性自身前后对照研究。采用SPSS10.0软件进行统计分析。结果经配对t检验,自IFN-γ治疗开始日起计算6个月、1年、1.5年和2年门齿距并与IFN-γ治疗前门齿距比较均有显著性差异(P=0.000)。患者门齿距增宽至≥3cm者,1,2,3,6个月,1年和2年时分别为27.9%,41.9%,51.2%,62.8%,55.8%和44.2%。张口困难较疗前明显改善。但1年和2年时门齿距较6个月时有缩小,具有显著性差异(P<0.05)。IFN-γ治疗疗效与疗前门齿距情况,用药时间长短和或距放射治疗结束时间相关。讨论干扰素-γ具有一定的改善患者张口困难的作用,但随着治疗结束时间的延长,张口困难又有进展。因此,何时用药和用药时间长短以及如何巩固疗效值得进一步探讨。

Objective To detect whether Interferon gamma （IPN-γ） can be ettective or not to remedy the temporomandibular joint dysfunction induced by radiotherapy,nowadays which with no effective ways to heal. Methods The prospective self controlled study,using IFN-γ to heal 43 patients suffering from the dysfunction（DG〈3 cm）, was done from Jun 2001 to Dec 2002. The follow-up interval is over 2 years. Results The results of paired-samples t test show DDIM（the distance between two incisivus medialis） in the sixth,twelfth,eighteenth and twenty-forth month from the beginning of the injection of IFN-γis significantly increased than in the beginning（P〈0.005）. The rates of the patients whose DDIM is larger than or equal to 3 cm are respectively 27.9%,41.9%,51.2%,62.8% ,55.8% and 44.2%. However,DDIM in the twelfth and twenty-forth month is significantly decreased than in the sixth month（P〈0.05）. The results of the linear regression（stepwise） show DDIM in the sixth,the twelfth and the twenty-forth months is significantly related to DDIM in the beginning, the duration using IFN-γ,in the former two also to the term from the terminate of radiotherapy. Conclusion IFN-γ can be effective to significantly improve the dysfunction in some degree.