重组人表皮生长因子凝胶防治放射性口腔黏膜炎的临床疗效观察

Preventive and therapeutic effects of rhEGF gel on radiation-induced oral mucositis:A clinical observation

目的有关防治口腔癌术后放疗引起的放射性口腔黏膜炎报道较少。文中旨在观察重组人表皮生长因子(rhEGF)凝胶对放疗所致的放射性口腔黏膜炎的治疗效果。方法选择2012年11月至2016年3月于承德医学院附属医院肿瘤科口腔癌放疗所致放射性口腔黏膜炎患者68例。随机分为2组:凝胶组(涂擦rhEGF凝胶,保持20~30 min漱口,3~5次/d)、漱口液组(给予硼砂漱口液治疗,含漱5 min,3~4次/d),每组34例。观察患者的放射性口腔黏膜损伤程度、口腔放射性疼痛程度、口腔感染情况及放疗完成时间等。结果放疗第3周,凝胶组放射性口腔黏膜炎以轻、中度为主,漱口液组以中、重度为主;第6周,凝胶组以中度为主,漱口液组以重度为主;2组间不同程度放射性口腔黏膜炎发生率比较差异均有统计学意义(P=0.000)。凝胶组发生放射性疼痛以0、Ⅰ度为主,漱口液组以Ⅱ、Ⅲ度为主;Ⅰ、Ⅱ、Ⅲ度凝胶组、漱口液组放射性疼痛发生率比较差异均有统计学意义[47.1%vs 20.6%、17.6%vs 32.4%、2.9%vs 20.6%,P=0.00]。凝胶组出现口腔感染、行抗菌素治疗的比例分别为23.5%、11.8%,漱口液组分别为38.2%、26.5%,2组间比较差异均有统计学意义(P<0.05)。凝胶组平均放疗完成时间较漱口液组明显缩短[(42.37±3.14)vs(48.47±4.39)d],差异有统计学意义(P<0.05)。结论 rhEGF凝胶可明显减轻放射性口腔黏膜炎严重程度,减轻了患者的症状,保证了放疗完成时间,可广泛应用于临床。

Objective Few studies are reported on the prevention and management of oral mucositis （OM） induced by postoperative radiotherapy in patients with oral cavity cancer. This study aimed to investigate the therateutic effect of the recombinant human epidermal growth factor （rhEGF） gel on radiation-induced OM.Methods Sixty-eight cases of radiation-induced OM after surgery for oral cavity cancer were randomly divided into an experimental and a control group of equal number, the former treated with rhEGF gel while the latter with borax mouthwash. Comparisons were made between the two groups of patients in the severity of oral cavity mucous membrane injury, the intensity of radiation-induced oral pain, the incidence of oral cavity infection, and the duration of radiotherapy.Results At 3 weeks of radiotherapy, the patients of the experimental group showed mainly mild and moderate OM while the controls chiefly moderate and severe OM, and at 6 weeks, the former exhibited mainly moderate while the latter chiefly severe OM, with statistically significant differences in the incidence rate between the two groups （P〈0.01）. The experimental group, compared with the controls, had a significantly higher incidence rate of grade-Ⅰ radiation-induced pain （47.1% vs 20.6%, P〈0.01）, but lower rates of grade-Ⅱ （17.6% vs 32.4%, P〈0.01） and grade-Ⅲ pain （2.9% vs 20.6%, P〈0.01）. The rates of oral infection and antibiotics medication were remarkably lower in the experimental group than in the controls （23.5% vs 38.2% and 11.8% vs 26.5%, P〈0.05）, and the duration of radiotherapy was markedly shorter in the former than in the latter （／[42.37±3.14／] d vs ／[48.47±4.39／] d, P〈0.05）.Conclusion The rhEGF gel can significantly reduce the severity of radiation-induced oral mucositis, improve its symptoms, and shorten the time of postoperative radiotherapy for patients with oral cavity cancer.