鼻咽癌同期放化疗中急性皮肤黏膜反应的临床观察及其相关因素分析

Clinical observation of acute skin and oral mucous membrane reactions in patients with nasopharyngeal carcinoma treated with concurrent radiochemotherapy and correlated factors

目的 探讨鼻咽癌患者同期放化疗中急性皮肤及黏膜反应的影响因素,对主要相关因素进行分析.方法 对85例接受同期放化疗的鼻咽癌患者进行研究,观察并记录BMI、每周放疗剂量、口腔黏膜及颈部皮肤反应情况、血常规等15项临床指标及实验室指标,并进行单因素分析和多因素分析,筛选决定性影响因素.结果 与急性放射性口腔黏膜反应发生密切相关的危险因素,有吸烟史（OR=3.467,P＜0.05）和原发灶GTV单次量＞2.15 Gy（OR =3.393,P＜0.05）;与急性放射性皮肤反应发生密切相关的危险因素,有糖尿病史（OR=87.859,P＜0.05）,放疗前1周血红蛋白值＞ 130 g/L（OR=21.404,P＜0.05）.结论 对于同期放化疗的鼻咽癌患者,吸烟史和原发灶GTV单次量为急性放射性口腔黏膜反应的独立影响因素,糖尿病史和放疗前1周的血红蛋白值为急性放射性皮肤反应的独立影响因素.

Objective To observe the acute skin and mucous membrane reactions in patients treated with concurrent radiochemotherapy for nasopharyngeal carcinoma,and to analyze the influencing factors.Methods A total of 85 nasopharyngeal carcinoma cases treated with concurrent radiochemotherapy were enrolled in the study.Fifteen clinical and laboratory indexes,including BMI,radiation dose,degree of acute oral mucous and skin reactions and blood routine test were observed weekly.Univariate and multivariate regression analysis were performed to assess the factors,and screen the independent factors.Results Multiple-factor analysis showed that the risk factors cloesly related with acute radioactive oral mucosa reactions were smoking history（OR =3.467,P ＜ 0.05）,single-dose of gross tumor volume （GTV） ＞2.15 Gy（OR =3.393,P ＜ 0.05）,while those with acute radiation skin reactions were diabetes history（OR =87.859,P ＜ 0.05） and hemoglobin values 1 week before radiotherapy ＞ 130 g/L （OR =21.404,P ＜ 0.05）.Conclusions In the patients treated with concurrent radiochemotherapy for nasopharyngeal carcinoma,smoking history and single-dose of GTVnx is the independent risk factors of acute radiation oral mucosa reactions,while diabetes history and hemoglobin values I week before radiotherapy are the independent factors of acute skin reactions.