中国人群癌症放化疗并发口腔黏膜炎危险因素Meta分析

Risk factors of oral ulcers after chemoradiotherapy in China:A Meta analysis

目的口腔黏膜炎是癌症放化疗的常见并发症之一,严重影响患者生活质量。本研究通过Meta分析探讨中国人癌症放化疗并发口腔黏膜炎的危险因素,为口腔黏膜炎预防提供理论指导。方法检索万方数据库、维普中文科技期刊全文数据(VIP)、中国知网(CNKI)、中国生物医学文献检索数据库(CBM)和PubMed、EMbase、Cochrone数据库自建库至2017-12中英文文献,检索得到的文献由2人进行文献质量评价,应用RevMan 5.3分析软件进行Meta分析,采用固定效应或随机效应模型计算合并后的综合效应。结果共纳入9篇文献,Meta分析结果显示,影响癌症放化疗并发口腔黏膜炎的重要危险因素有口腔环境差(OR=0.37,95%CI为0.18~0.75)、有义齿(OR=2.55,95%CI为1.81~3.58)、口腔pH值≤6.5(OR=2.75,95%CI为2.01~3.77)、有口腔疾患(OR=2.19,95%CI为1.59~3.01)、有吸烟史(OR=2.32,95%CI为1.32~4.07)、临床分期Ⅲ~Ⅳ期(OR=0.55,95%CI为0.39~0.79)、口腔自洁习惯差(OR=1.69,95%CI为1.27~2.26)、白细胞计数Ⅲ~Ⅳ度(OR=0.34,95%CI为0.24~0.49)、年龄≥60岁(OR=2.75,95%CI为1.88~4.03),差异均有统计学意义,P<0.01。结论口腔环境差、有义齿、口腔pH值≤6.5、有口腔疾患、有吸烟史、临床分期Ⅲ~Ⅳ期、口腔自洁习惯差、白细胞计数Ⅲ~Ⅳ度和年龄≥60岁是影响口腔黏膜炎发生的重要危险因素,为临床上癌症放化疗并发口腔黏膜炎的发生早期提供预防依据。

OBJECTIVE Oral ulcer is one of the common complications of cancer radiotherapy and chemotherapy,which seriously affect the quality of life of patients with cancer.This study aimed to use Meta analysis to evaluate the risk factors of oral ulcers after radiotherapy and chemotherapy.METHODS Chinese database such as Wanfang,VIP,CNKI,CBM,Pubmed,Embase,and Cochrane library were searched.Quality of the studies was assessed in terms of study design,meta-analysis was conducted by using Revman 5.3.Cumulative effects were calculated by using either fixed or random effects models.RESULTS A total of 9 articles were included,the key risk factors such as oral environment（OR=0.37,95%CI：0.18-0.75）,denture（OR=2.55,95%CI：1.81-3.58）,oral pH value（OR=2.75,95%CI：2.01-3.77）,oral disease（OR=2.19,95%CI：1.59-3.01）,smoking history（OR=2.32,95%CI：1.32-4.07）,clinical staging（OR=0.55,95%CI：0.39-0.79）,oral hygiene habits（OR=1.69,95%CI：1.27-2.26）,leucocyte count（OR=0.34,95%CI：0.24-0.49）,age（OR=2.75,95%CI：1.88-4.03）affected the happening of oral ulcers,P〈0.01.CONCLUSIONS Oral environment,denture,oral pH value,oral disease,smoking history,clinical staging,oral hygiene habits,leucocyte count and age are primarily determined as the important risk factors of oral ulcers,which can provide the reference for the early prevention of oral ulcers after chemoradiotherapy occurred in clinic.