沙利度胺预防鼻咽癌放射性口腔粘膜炎的效果及对患者血清TNF-α的影响

The Effect of Thalidomide in Preventing Radiation-induced Oral Mucositis of Nasopharyngeal Carcinoma and Its Influence on Patients'Serum TNF-α

目的观察沙利度胺预防鼻咽癌(NPC)急性放射性口腔黏膜炎(RIOM)的疗效及对患者血清肿瘤坏死因子-α(TNF-α)的影响。方法选取2019年1月~2020年4月南华大学附属邵阳医院72例初次行根治性放疗的鼻咽癌患者,随机将其分为对照组和试验组,各36例,对照组从放疗期间予以碳酸氢钠漱口,试验组在对照组的基础上口服沙利度胺。比较两组急性放射性口腔黏膜炎发生时间、程度及不良反应,评估两组患者放疗前后卡氏(KPS)评分并检测放疗前后血清TNF-α水平。结果试验组RIOM的发生率及发生程度低于对照组,差异有统计学意义(P<0.05);试验组首次发生RIOM的时间晚于对照组,差异有统计学意义(P<0.05);放疗后,两组血清TNF-α水平均较放疗前升高,且对照组高于试验组,差异有统计学意义(P<0.05);两组不良反应发生情况比较,差异无统计学意义(P>0.05);放疗后两组KPS评分较放疗前均降低,且对照组低于试验组,差异有统计学意义(P<0.05)。结论沙利度胺可降低鼻咽癌患者急性放射性口腔黏膜炎的发生率及严重程度,推迟其发生时间,降低患者血清TNF-α的水平,减轻炎症反应,改善鼻咽癌患者放疗后的体力状态。

Objective To observe the efficacy of thalidomide in preventing nasopharyngeal carcinoma(NPC)acute radiation-induced oral mucositis(RIOM)and its effect on serum tumor necrosis factor-α(TNF-α).Methods From January 2019 to April 2020,72 patients with nasopharyngeal carcinoma who received radical radiotherapy at the Shaoyang Hospital of University of South China were selected and randomly divided into a control group and a test group,with 36 cases in each group.The control group received treatment from the radiotherapy period.Sodium bicarbonate was used to gargle,and the test group was given thalidomide orally on the basis of the control group.The occurrence time,degree and adverse reactions of acute radiation oral mucositis between the two groups were compared,the Karnofsky(KPS)scores before and after radiotherapy were evaluated and the serum TNF-αlevels were detected before and after radiotherapy.Results The incidence and extent of RIOM in the test group were lower than those in the control group,the difference was statistically significant(P<0.05);the first occurrence of RIOM in the test group was later than the control group,the difference was statistically significant(P<0.05);after radiotherapy,levels of serum TNF-αin the two groups were higher than those before radiotherapy,and the control group was higher than the test group,the difference was statistically significant(P<0.05);the difference in the occurrence of adverse reactions between the two groups was not statistically significant(P>0.05);KPS scores in the two groups after radiotherapy were lower than before radiotherapy,and the control group was lower than the test group,the difference was statistically significant(P<0.05).Conclusion Thalidomide can reduce the incidence and severity of acute radiation-induced oral mucositis in patients with nasopharyngeal carcinoma,delay its occurrence,reduce the level of serum TNF-α,reduce inflammation,and improve the physical strength of patients with nasopharyngeal carcinoma after radiotherapy status.