中国头颈部癌症患者行放疗后放射性口腔黏膜炎影响因素的Meta分析

Relevant factors of radiation-induced oral mucositis of patients with head and neck cancer in China:A Meta-analysis

目的:对中国地区头颈部恶性肿瘤患者行放射治疗后发生放射性口腔黏膜炎的影响因素进行Meta分析,探讨影响因素的作用,为放射性口腔黏膜炎的风险预测提供参考。方法:检索PubMed、Web of Science、万方数据库(WanFang Data)、CBM、中国知网(CNKI)、维普数据库(VIP)和中国医院知识仓库(CHKD)进行文献搜集。检索时限为2005年01月至2020年12月。完成文献筛选后使用Review Manager 5.3软件及stata16软件进行Meta分析。结果:共检索到1681篇文献,排除不符合标准文献及重复文献,最终纳入17篇文献,其中中文文献16篇,英文文献1篇,共包括3471例研究对象。多因素分析效应值合并的Meta分析结果显示:吸烟史(OR=1.66,95%CI:1.40~1.97,I^(2)=23%,P=0.23)、联合化疗(OR=3.92,95%CI:2.82~5.44,I^(2)=0%,P=0.89)、口腔pH≤7.0(OR=1.55,95%CI:1.14~2.10,I^(2)=57%,P=0.04)、口腔卫生状况差(OR=2.34,95%CI:1.60~3.43,I^(2)=0%,P=0.84)、N分期高(OR=1.58,95%CI:1.10~2.27,I^(2)=52%,P=0.12)、饮酒史2(OR=1.42,95%CI:1.09~1.86,I=0%,P=0.64)、BMI>24.0 kg/m^(2)(OR=1.36,95%CI:1.11~1.66,I=8%,P=02.35)、糖尿病史(OR=1.48,95%CI:1.12~1.96,I^(2)=22%,P=0.28)、年龄(OR=1.01,95%CI:0.96~1.05,I=20%,P=0.29)、性别(OR=1.14,95%CI:0.89~1.46,I^(2)=0%,P=0.45)、使用抗生素(OR=0.34,95%CI:0.23~0.52,I^(2)=0%,P=0.87)、使用口腔黏膜保护剂(OR=0.50,95%CI:0.24~1.07,I^(2)=79%,P=0.008)。结论:吸烟、联合化疗、口腔pH≤7.0、口腔卫生状况差、N分期高、饮酒史、BMI>24.0kg/m^(2)、糖尿病史是中国地区放射性口腔黏膜炎的主要危险因素,并发感染时使用抗生素是保护因素,年龄、性别、使用口腔黏膜保护剂不是其相关因素。

Objective:To provide reference for risk prediction for radiation-induced oral mucositis of patients in China with head and neck cancer,this Meta-analysis was performed to analyse the relevant factors.Methods:By searching the literature stored in PubMed database,Web of Science,WanFang Data,Sinomed database,CNKI database,VIP database and Chinese Hospital Knowledge Warehouse(CHKD)and tracing the literature,we collected the relevant studies about the relevant factors of radiation-induced oral mucositis from January 2005 to December 2020.After studies screening,we used the software Review Manager 5.3 and stata 16 to perform the Meta-analysis.Results:We got a total of 1681 literatures and after literature screening,17 literatures were included,consisting of 16 Chinese literatures and 1 English literature,including 3471 patients.According to the meta-analysis,the OR value for the related factors for radiation-induced oral mucositis were as follows:Smoking history(OR=1.66,95%CI:1.40~1.97,I^(2)=23%,P=0.23),concurrent chemotherapy(OR=3.92,95%CI:2.82~5.44,I^(2)=0%,P=0.89),oral pH value≤7.0(OR=1.55,95%CI:1.14~2.10,I^(2)=57%,P=0.04),bad oral hygiene status(OR=2.34,95%CI:1.60~3.43,I^(2)=0%,P=0.84),high N staging(OR=1.58,95%CI:1.10~2.27,I^(2)=52%,P=0.12),drinking history(OR=1.42,95%CI:1.09~1.86,I^(2)=0%,P=0.64),BMI>24.0 kg/m^(2)(OR=1.36,95%CI:1.11~1.66,I^(2)=8%,P=0.35),diabetes(OR=1.48,95%CI:1.12~1.96,I^(2)=22%,P=0.28),age(OR=1.01,95%CI:0.96~1.05,I^(2)=20%,P=0.29),gender(OR=1.14,95%CI:0.89~1.46,I^(2)=0%,P=0.45),using antibiotic(OR=0.34,95%CI:0.23~0.52,I^(2)=0%,P=0.87),using protective agents of mucosa(OR=0.50,95%CI:0.24~1.07,I^(2)=79%,P=0.008).Conclusion:The main risk factors for radiation-induced oral mucositis in China includes:Smoking history,concurrent chemotherapy,oral pH value≤7.0,bad oral hygiene status,high N staging,drinking history,BMI>24.0 kg/m^(2),diabetes.The main protective factor includes using antibiotic.However,age,gender and using protective agents of mucosa are not relevant factors of RIOM.