黄连生地方防治放射性唾液腺损伤的临床观察

Clinical observation of Huanglianshengdi decoction in prevention and treatment of radiation-induced salivary gland dysfunction

目的观察黄连生地方治疗放射性口腔干燥症的疗效,旨在为防治放射性唾液腺损伤提供新的治疗手段。方法 64例病理组织学证实的鼻咽癌放疗初治患者进行了随机对照研究,分中药+放疗组(中放组)34例和单放组30例。中药为复方制剂黄连生地方,每日1剂,自放疗开始第1天至全程结束后4周。放疗为6MV-X线常规分割照射,鼻咽根治剂量DT70Gy。临床症状(口干)评价标准为RTOG和Nishioka分级标准,唾液腺功能检测包括唾液动、静态流率测定和99TcmO4-同位素检测,并对治疗前后肝、肾功能进行检测。结果中放组口干症状在放疗后不同时段均较单放组减轻,差异有统计学意义;两组患者酸反应排泄率(ER)在放疗结束时和结束4周均较放疗前明显下降,差异有统计学意义;中放组在放疗结束时和结束4周的ER值明显高于单放组,差异有统计学意义。中放组和单放组治疗结束后复查肝、肾功能均无明显异常。结论中药复方制剂黄连生地方使用安全、方便,能有效减轻患者口干症状,可作为临床防治放射性唾液腺损伤的一种新的治疗手段。

Objective To investigate the effectiveness of Huanglianshengdi decoction in treatment of radiation-induced xerostomia,in order to provide a new method in prevention and treatment of radiation-induced salivary gland dysfunction.Methods In this randomized controlled study,64 untreated nasopharyngeal carcinoma patients confirmed by histopathology were enrolled.Thirty-four patients received traditional Chinese medicine and radiotherapy（TCMRT group）,30 patients received radiotherapy without traditional Chinese medicine（RT group）.The traditional Chinese medicine Huanglianshengdi decoction was given one pack per day,from the beginning of radiotherapy on day 1 to 4 weeks after radiotherapy.All patients were irradiated by 6MV-X ray with the conventional segmentation,and the total dose of nasopharynx was 70Gy.The observed items： graded according to RTOG and Nishioka T criteria to determine the clinical symptoms of dry mouth,by testing the salivary flow rate of dynamic-static and 99TcmO-4 to determine the salivary gland function,testing of liver and kidney functions.Results The clinical symptoms of dry mouth in TCMRT group beginning at 2 weeks,4 weeks after radiotherapy,and 0 week,4 weeks after the end of radiotherapy,were significantly alleviated than those in RT group（P0.05）.The salivary flow rate of arteriovenous in both groups after the end of radiotherapy 0 week and 4 weeks was significantly decreased compared with no radiotherapy（P0.05）.Comparison of radiotherapy after the end of 0 week and 4 weeks,the static flow rate between the two groups showed no statistical significance,but the dynamic flow rate of TCMRT group was higher than group RT（P0.05）.There was no statistical significance between the two groups in parotid gland uptake ratio.Excretion rate of acid response in both groups after the end of radiotherapy 0 week and 4 weeks was significantly decreased compared with no radiotherapy,also after the end of radiotherapy 0 week and 4 weeks,excretion rate of acid response in TCMRT group was significantly higher than that in RT group（P0.05）.The functions of liver and kidney were all normal level in the two groups by the end of treatment.Conclusion Huanglianshengdi decoction can not only effectively reduce the symptoms of dry mouth in patients undergoing radiotherapy,but also is safe and convenient.It can be used as a prevention and treatment of radiation-induced salivary gland dysfunction to promote new treatments.