鼻咽癌调强放疗发生重度口腔黏膜炎的危险因素分析

Analysis of Risk Factors for Severe Oral Mucositis in Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

目的探讨鼻咽癌患者调强放疗发生重度口腔黏膜炎的高危因素。方法选取2018年1月—2019年10月期间在黄石市中心医院完成调强放疗的115例初治鼻咽癌患者为研究对象,依据放疗后口腔黏膜炎的严重程度进行分组,将发生1~2级黏膜炎患者分为观察组,发生3~4级黏膜炎患者分为对照组。记录患者的性别、年龄、口腔pH值、同步化疗及药物使用情况等12项指标。运用单因素分析和多因素Logistic回归分析法分析重度放射性口腔黏膜炎的危险因素。结果115例患者均按计划完成了调强放疗。所有患者均发生了口腔黏膜炎,其中观察组1级5例,2级30例,共35例;对照组3级72例,4级8例,共80例,放射性口腔黏膜炎发生率为100%,轻度35例,占30.43%,重度80例,占69.57%。单因素分析显示,两组患者在性别、年龄、饮酒史、体质指数、病理类型及临床分期方面比较,差异无统计学意义(P>0.05),而在吸烟史、口腔pH值、同步化疗、口腔黏膜照射剂量、抗生素及康复新液使用方面比较,差异均有统计学意义(P<0.05)。多因素Logistic分析结果显示,两组患者在吸烟史、口腔pH值、同步化疗、口腔黏膜照射剂量及康复新液使用方面比较,差异均有统计学意义(P<0.05)。结论有吸烟史、口腔pH值≤6.5、同步化疗、口腔黏膜照射剂量≥32Gy及未使用康复新液是鼻咽癌调强放疗发生重度口腔黏膜炎的高危因素,临床工作中应采取相应的干预措施。

Objective To investigate the high-risk factors of severe oral mucositis in patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy.Methods A total of 115 patients with nasopharyngeal carcinoma who had completed intensity-modulated radiotherapy at Huangshi Central Hospital from January 2018 to October 2019 were selected as the research subjects.They were grouped according to the severity of oral mucositis after radiotherapy,and the occurrence of 1~1 Patients with grade 2 mucositis were divided into observation group,and patients with grade 3 to 4 mucositis were divided into control group.There were 12 indicators including sex,age,oral pH,concurrent chemotherapy,drug use,and so on,were recorded and analyzed by univariate analysis and multivariate logistic regression analysis,respectively.Results All 115 patients completed IMRT as planned.All patients had oral mucositis,including 5 cases of grade 1 and 30 cases of grade 2 in the observation group,a total of 35 cases;72 cases of grade 3 and 8 cases of grade 4 in the control group,a total of 80 cases.The incidence of radiation oral mucositis was 100%,35 mild cases accounted for 30.43%,80 severe cases accounted for 69.57%.Univariate analysis showed that there was no statistically significant difference between the two groups of patients in terms of gender,age,drinking history,body mass index,pathological type,and clinical staging(P>0.05).However,there was no statistically significant difference between the two groups in terms of smoking history,oral pH,concurrent chemotherapy.The differences in oral mucosal radiation dose,antibiotics and Kangfuxin liquid use were statistically significant(P<0.05).The results of multivariate logistic analysis showed that the two groups of patients had statistically significant differences in smoking history,oral pH,concurrent chemotherapy,oral mucosal radiation dose,and use of Kangfuxin liquid(P<0.05).Conclusion Smoking history,oral pH≤6.5,concurrent chemotherapy,radiation dose of oral mucosa≥32 Gy and non-use of Kangfuxin liquid are high risk factors for severe RIOM for patients with nasopharyngeal carcinoma,which can provide the reference for the early prevention.