鼻咽癌放疗致急性口腔黏膜反应的相关因素分析

Correlation analysis of acute oral mucosa in nasopharyngeal carcinoma radiation

目的:探讨鼻咽癌患者放疗中急性口腔黏膜反应的影响因素。方法 :观察并记录76例接受放疗的鼻咽癌患者原发灶放疗剂量、腮腺受照剂量、口腔黏膜反应、血常规、血糖等临床指标及实验室指标,并进行单因素和多因素分析,筛选决定性的影响因素。结果:单因素分析结果显示,有吸烟史、糖尿病、鼻咽原发肿瘤靶区(gross tumor volumenasopharynx,GTVnx)分次剂量、腮腺受照剂量、同期化疗、放疗前1周血红蛋白值与急性放射性口腔黏膜反应发生及严重程度密切相关(均P<0.05)。将这些有意义的因素纳入多因素Logistic回归分析,结果显示有吸烟史(OR=3.521,P<0.05)、GTVnx分次剂量>2.15 Gy(OR=3.403,P<0.05)、腮腺受照剂量>26 Gy(OR=2.938,P<0.05)、同期化疗(OR=3.103,P<0.05)是急性放射性口腔黏膜反应的独立影响因素。结论:鼻咽癌患者放疗中,吸烟史、GTVnx分次剂量、腮腺受照剂量、同期化疗为急性放射性口腔黏膜反应的独立影响因素。临床上应根据患者的具体病情实行个体化干预。

Objective： To investigate the influence factors of acute oral mucosa reaction in nasopharyngeal carcinoma patients who received radiotherapy. Methods ： A total of 76 cases of nasopharyngeal carcinoma patients who received radiotherapy were enrolled in this study. The dose of primary tumor and parotid gland, oral mucosa, blood routine, blood glucose and other clinical and laboratory indexes were recorded. Univariate analysis and multivariate analysis were used to screen these factors. Results： Univariate analysis showed that smoking history, diabetes mellitus, single dose of gross tumor volume-nasopharynx（GTVnx）, total dose of parotid gland, concurrent chemotherapy, and and the concentration of hemoglobin1 week before radiotherapy were colsely related to acute radiation-induced oral mucosa（P〈0.05）. Logistic regression analysis of these factors showed that smoking history（OR=3.521, P〈0.05）, single radiation dose of GTVnx2.15 Gy（OR=3.403, P〈0.05）,total radiation dose of parotid gland 〉26 Gy（OR=2.938, P〈0.05） and concurrent chemoradiation（OR =3.103, P〈 0.05） were independent factors of acute radiation-induced oral mucosa. Conclusion： In the radiotherapy of nasopharyngeal carcinoma,smoking history, single radiation dose of primary tumor, total radiation dose of parotid gland, and concurrent chemotherapy were independent factors of acute radiation-induced oral mucosa.