粒细胞-巨噬细胞集落刺激因子漱口液含漱并吞咽预防造血干细胞移植患者预处理后口腔黏膜炎的效果观察

Effect of granulocyte-macrophage colony-stimulating factor gargle and deglutition to prevent oral mucositis in patients after conditioning of hematopoietic stem cell transplantation

目的观察使用粒细胞-巨噬细胞集落刺激因子(GM-CSF)漱口液含漱并吞咽对预防造血干细胞移植(HSCT)患者预处理后口腔黏膜炎(OM)的效果。方法于2013年1月至12月,将在中国医学科学院北京协和医院血液科行HSCT的74例患者用随机数字发生器分为试验组(n=38)和对照组(n=36)。预处理方案:单纯化学治疗61例;全身放射治疗+化学治疗13例。对照组从预处理首日起,进行口腔护理及醋酸氯己定溶液含漱,均3次/d;试验组在对照组实施措施的基础上,从预处理首日起同时使用GM-CSF漱口液(GM-CSF 150 g,加入100 m L 0.9%氯化钠溶液中)含漱大于3 min/次,含漱后分次小口吞咽,每日4次,每次25 m L。组间比较采用χ~2检验及秩和检验。结果实验组与对照组的OM发病率分别为68.4%(26/38)、72.2%(26/36),两组比较差异无统计学意义(χ~2=0.128,P=0.721);两组患者中、重度OM发病率比较差异均无统计学意义(χ~2=1.312、0.499,P=0.252、0.480);两组患者轻、中、重度OM的持续时间比较,差异均无统计学意义(Z=-0.900、-0.501、-0.894,P=0.368、0.616、0.371)。在预处理接受全身放射治疗+化学治疗的13例患者中,试验组7例患者发生重度OM 2例,对照组6例患者发生重度OM 6例,两组重度OM发病率比较,差异有统计学意义(χ~2=6.964,P=0.008)。结论在接受全身放射治疗+化学治疗的HSCT患者中,在常规口腔护理的基础上,使用GM-CSF漱口液含漱并吞咽,对预防重度OM发生有一定作用。

Objective To observe the effect of granulocyte-macrophage colony-stimulating factor（ GM-CSF） gargle and deglutition to prevent oral mucositis（ OM） in patients after conditioning of hematopoietic stem cell transplantation（ HSCT）. Methods From January to December in 2013,in Department of Hepatology,Chinese Academy of Medical Science,Peking Union Medical College Hospital,74 patients in conditioning of HSCT were divided into treatment group（ n = 38） and control group（ n = 36）by random number generator. Sixty-one patients accepted only chemotherapy as conditioning regimen,and total body irradiation plus chemotherapy for the other 13 patients. From the first day of conditioning,the patients of control group accepted routine oral care and chlorhexidine acetate solution gargled three times a day. To the patients of treatment group,25 m L GM-CSF solution（ 150 g GM-CSF in 100 m L 0. 9% sodium chloride solution） gargle for more than 3 minutes a time and a small deglutition four times a day were added. The differences between the two groups were compared with chi-square test and Mann-Whitney Test.Results The incidence of OM in the treatment group and the control group were 68. 4%（ 26/38） and72. 2%（ 26/36）. There was no significant difference between the two groups（ χ2= 0. 128,P = 0. 721）,either mild or moderate-severe oral mucositis（ χ~2= 1. 312,0. 499; P = 0. 252,0. 480）. For the duration of OM,there were no significant differences between the two groups among mild,moderate or severe oral mucositis（ Z =-0. 900,-0. 501,-0. 894; P = 0. 368,0. 616,0. 371）. Among 13 patients who received total body irradiation plus chemotherapy,severe OM in the treatment group and the control group were（ 2/7）and（ 6/6）. There was significant difference between the two groups（ χ~2= 6. 964, P = 0. 008）.Conclusion Patients who received total body irradiation and chemotherapy,on the basis of routine oral care,GM-CSF solution gargle and deglutition had some benefit to prevent severe OM.