重组人表皮生长因子联合氨磷汀对口咽癌靶区优化调强放疗患者黏膜修复及免疫功能水平的影响

Effects of recombinant human epidermal growth factor combined with amifostine on mucosal repair and immune function in patients with oropharyngeal carcinoma treated by intensity modulated radiation therapy

目的观察重组人表皮生长因子(rhEGF)联合氨磷汀对口咽癌靶区优化调强放疗患者黏膜修复及免疫功能水平的影响。方法前瞻性选取2018年2月至2022年2月在宣城市人民医院接受靶区优化调强放疗的口咽癌患者80例,采用随机数字表法分为两组,单组40例。氨磷汀组采取氨磷汀治疗,rhEGF组采取rhEGF联合氨磷汀治疗,均连续治疗4周。比较两组疗效、口腔黏膜损伤恢复时间及口腔黏膜视觉模拟评分法(VAS)评分、pH值、患者体重、免疫功能指标差异。结果rhEGF组总有效率为90.00%,高于氨磷汀组的72.50%,差异有统计学意义(P<0.05)。rhEGF组Ⅰ+Ⅱ级、Ⅲ+Ⅳ级口腔黏膜损伤恢复时间分别为(14.74±2.95)、(19.66±3.77)d,均短于氨磷汀组[(17.25±4.03)、(24.56±4.51)d],差异有统计学意义(P<0.05)。治疗后,两组VAS评分、pH值及氨磷汀组治疗后体重均较治疗前下降,差异均有统计学意义(P<0.05);rhEGF组口腔黏膜VAS评分、pH值分别为(1.61±0.62)分、6.03±0.24,均低于氨磷汀组[(2.12±0.87)分、6.72±0.29],体重为(64.01±7.15)kg,高于氨磷汀组[(60.88±6.62)kg],差异均有统计学意义(P<0.05)。治疗后,两组CD4^(+)、CD4^(+)/CD8^(+)及氨磷汀组治疗后CD3^(+)均较治疗前下降,氨磷汀组治疗后CD8^(+)较治疗前升高,差异均有统计学意义(P<0.05);rhEGF组CD4^(+)、CD4^(+)/CD8^(+)分别为(37.23±4.03)%、1.16±0.19,均高于氨磷汀组[(34.21±3.56)%、1.16±0.19],CD8^(+)为(27.11±4.13)%,低于氨磷汀组[(29.44±4.54)%],差异均有统计学意义(P<0.05),CD3^(+)与氨磷汀组比较,差异无统计学意义(P>0.05)。结论rhEGF联合氨磷汀可减轻口咽癌靶区优化调强放疗引起的口腔黏膜疼痛,促进黏膜修复,有利于细胞免疫功能的恢复。

Objective To observe the effect of recombinant human epidermal growth factor(rhEGF)combined with amifostine on mucosal repair and immune function in patients with oropharyngeal carcinoma treated by intensity modulated radiotherapy(IMRT).Methods In this study,80 patients with oropharyngeal cancer who received target optimized intensity modulated radiotherapy in Xuancheng People's Hospital from February 2018 to February 2022 were prospectively selected and divided into two groups by random number table method,with 40 cases in each group.The amifostine group was treated with amifostine,the rhEGF group was treated with rhEGF combined with amifostine,all of which were treated continuously for 4 weeks.The therapeutic effect,recovery time of oral mucosa injury,visual analogue visual analogue scal(VAS)score,pH value,body weight and immune function indexes were compared between the two groups.Results The total effective rate of the rhEGF group was 90.00%,which was higher than that of the amifostine group(72.50%),the difference was statistically significant(P<0.05).The recovery time of gradeⅠ+Ⅱand gradeⅢ+Ⅳoral mucosa injury in rhEGF group was(14.74±2.95)and(19.66±3.77)d,which were shorter than those in the amfostine group[(17.25±4.03)and(24.56±4.51)d],and the differences were statistically significant(P<0.05).After treatment,the VAS score,pH value in both groups and body weight of the amifostine group which were higher than those before treatment,the VAS score and pH value of the oral mucosa in rhEGF group were(1.61±0.62)points and 6.03±0.24,which were lower than those in the amfostine group[(2.12±0.87)points and 6.72±0.29],and the body weight was(64.01±7.15)kg,which was higher than that in the amfostine group[(60.88±6.62)kg],and the differences were statistically significant(P<0.05).After treatment,CD4^(+),CD4^(+)/CD8^(+)in the two groups and CD3^(+)in the amifostine group were lower than those before treatment,while CD8^(+)in the amifostine group was higher than that before treatment;CD4^(+),CD4^(+)/CD8^(+)in the rhEGF group were(37.23±4.03)%,1.16±0.19,which were higher than those in the amfostine group[(34.21±3.56)%,1.16±0.19],CD8^(+)was(27.11±4.13)%,which was lower than that in the amfostine group[(29.44±4.54)%],the difference was statistically significant(P<0.05),there was no statisticaliy significant difference in CD3^(+)between the rhEGF group and amfostine group(P>0.05).Conclusion RhEGF combined with amifostine can alleviate the pain of oral mucosa caused by intensity modulated radiotherapy in the target area of oropharyngeal cancer,promote the repair of mucosa,and help the recovery of cellular immune function.