氨磷汀在鼻咽癌放疗后预防口咽并发症的价值探讨

Value of amifostine in the prevention of oropharynx complications after radiotherapy for nasopharyngeal cancer

目的探讨氨磷汀在鼻咽癌放疗后预防口咽并发症的临床价值。方法选择2010年1月至2013年6月收治的鼻咽癌患者100例,随机分为两组各50例,观察组在每次放疗30min前均使用氨磷汀200mg/(m2·d)静脉缓慢推注15分钟,并予重组人白介素-11 1.5mg稀释加入0.9%氯化钠溶液50ml中含漱;对照组仅给予重组人白介素-11 1.5mg稀释加入0.9%氯化钠溶液50ml中含漱。比较两组患者唾液腺分泌及口渴情况以及治疗后不同时间点口腔疼痛视觉模拟(VAS)评分。结果观察组干预后唾液量减少50%以上的比率显著低于对照组(P<0.01),同时出现口渴的比率显著低于对照组(P<0.01)。观察组治疗后1、3及7天的口腔疼痛VAS评分均显著低于对照组(P<0.01),两组从治疗后第1天开始起口腔疼痛VAS评分即显著低于治疗前(P<0.01)。结论氨磷汀联合白介素-11含漱液含漱能有针对性地保护鼻咽癌患者放射治疗后损伤的口腔黏膜及唾液腺,减轻患者疼痛,值得临床推广。

Objective To investigate the value of amifostine in the prevention of oropharynx complications after ra-diotherapy for nasopharyngeal cancer.Methods 100 patients with nasopharyngeal cancer, who were admitted to the hospital from January,2010 to June, 2013, were randomly divided into the observation group and the control group, with 50 cases in each group.30 min before every radiotherapy,the observation group were given 200 mg/（m^2 · d） of amifostine by slow intravenous injection for 15 minutes and 1.5 mg of diluted recombinant human interleukin-llwas added to 50 ml of sodium chloride（0.9%） solution which was used to gargle by the patients. However, the control group only gargled with 50 ml of sodium chloride（0.9%） solution to which 1.5 mg diluted recombinant human inter-leukin-llwas added.Then, salivary secretion and ulcer of oral mucosa as well as oral pain VAS scores at different points in time of the two groups were compared after treatment.Results After treatment, the ratio that the salivary secretion reduced by more than 50% in the observation group was significantly lower than that in the control group （ P 〈0. 01） and the observation group＇s incidence of symptoms of dry mouth was also significantly lower than that of the control group（ P〈0.01）.In additon,the oral pain VAS scores after one day, three days and seven days of treat-ment in the observation group were significantly lower than those in the control group （ P 〈0. 01）.Moreover the oral pain VAS score from the first day after treatment of both groups were all obviously lower than those before treatment （ P 〈0. 01）.Conclusion Amifostine combined with interleukin-11can specifically protect damaged oral mucosa and salivary gland of patients with nasopharyngeal cancer after radiotherapy, and reduce their pain.Thus,it is worthy of promotion in clinic.