氨磷汀对鼻咽癌放射治疗中唾液腺功能的保护作用

Protective effect of amifostine on salivary gland function in radiotherapy of nasopharyngeal carcinoma

目的探讨氨磷汀在鼻咽癌患者放射治疗过程中对唾液腺功能的保护作用以及安全性。方法选择2015年1月—2018年6月在我院治疗的80例鼻咽癌患者,随机分为对照组和观察组,每组各40例。两组患者均给予放射治疗,以面颈联合野为主,肿瘤照射剂量60～70Gy;观察组患者在每次照射前30 min静脉注射200 mg/m^2氨磷汀;对照组患者给予同剂量的葡萄糖;观察组两组患者治疗前后的唾液腺功能变化情况及毒副作用。结果治疗后,两组患者腮腺的UR30、EF、ER均较治疗前明显降低(P<0.05),但观察组患者的各项指标明显高于对照组(P<0.05),而治疗后观察组患者的UR30、ER较治疗前无明显改变(P>0.05),仅EF有所降低(P<0.05),各项指标均明显高于对照组(P<0.05);放疗后,观察组患者13例(32.50%)患者未出现口干症状,而对照组所有患者均出现不同程度的口干,两组患者口干程度比较差异显著(P<0.05),;观察组患者的口腔粘膜炎严重程度明显低于对照组(P<0.05),但观察组患者恶心呕吐Ⅱ级以上的患者明显多于对照组(P<0.05)。结论氨磷汀在鼻咽癌患者放疗过程中能够明显改善患者的口干症状,减轻放疗对患者腮腺、颌下腺功能的影响,但会增加患者的消化道反应。

Objective To investigate the protective effect and safety of amifostine on salivary gland function in patients with nasopharyngeal carcinoma undergoing radiotherapy.Methods Eighty patients with nasopharyngeal carcinoma treated in our hospital from January 2015 to June 2018 were randomly divided into control group and observation group,with 40 cases in each group.Radiotherapy was given to both groups of patients,mainly in the combined field of face and neck with tumor irradiationdose of 60~70 Gy.The patients in observation groupreceived an intravenous dose of 200 mg/m^2 amifostine 30 minutes before each irradiation while patients in control groupwere given the same dose of glucose so as to observethe changes of salivary gland function and toxic side effect before and after the treatment.Results After treatment,the UR30,EF and ER of parotid gland of the two groups were significantly lower than those before treatment(P<0.05),but the indexes of the observation group were significantly higher than those of the control group(P<0.05),as shown in Table 2.The UR30 and ER of the observation group had no significant changes(P>0.05),but EF was decreased(P<0.05).After radiotherapy,13 patients(32.50%)in the observation group had no symptoms of xerostomia,while all patients in the control group had different degrees of xerostomia.There was a significant difference in the degree of xerostomia between the two groups(P<0.05).The severity of oral mucositis in the observation group was significantly lower than that in the control group(P<0.05),but the number of patients with nausea and vomiting above grade II in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Amfostine can improve the dry mouth symptoms and alleviate the effects of radiotherapy on parotid and submandibular glands,but it increasesthe digestive tract reaction.