低剂量激光疗法预防放化疗相关口腔黏膜炎的Meta分析

Effect of low-level laser therapy on prevention of oral mucositis in patients treated with radiotherapy and chemotherapy

目的系统评价低剂量激光疗法(LLLT)预防放化疗相关口腔黏膜炎的有效性。方法按照PICOS原则,计算机检索国内外数据库收录的使用LLLT预防放化疗相关口腔黏膜炎临床效果的随机对照试验(RCT)文献,时限为2008年11月—2018年11月,应用RevMan5.3软件进行Meta分析。结果共纳入12篇RCT,英文11篇,中文1篇。Meta分析结果显示:LLLT可降低放化疗引起的重症口腔黏膜炎发生率[RR=0.11,95%CI(0.08,0.15),P<0.01]、口腔黏膜炎发生率[RR=0.53,95%CI(0.35,0.80),P<0.01]、非计划治疗中断发生率[RR=0.28,95%CI(0.12,0.64),P<0.01]、疼痛发生率[RR=0.61,95%CI(0.48,0.78),P<0.01]、无法经口进食发生率[RR=0.70,95%CI(0.60,0.81),P<0.01]。结论低剂量激光疗法可有效预防放化疗相关口腔黏膜炎发生,减轻口腔黏膜疼痛程度,减少非计划治疗中断和无法进口进食的发生率。

Objective To systematically review the effect of low-level laser therapy on prevention of oral mucosal inflammation in patients treated with radiotherapy and chemotherapy. Methods According to the PICOS principle, randomized controlled trials of low-level laser therapy for prevention of radiotherapy-and chemotherapy-induced oral mucositis were collected by computer in domestic and foreign databases. The time limit was from 2008 to 2018, and Meta analysis was performed using RevMan5.3 software. Results A total of 12 RCTs were included, 11 in English and 1 in Chinese. Meta-analysis showed that low-level laser therapy could reduce the incidence of severe oral mucositis(RR=0.30, 95% CI: 0.25-0.37, P<0.05), the incidence of oral mucositis(RR=0.53, 95%CI: 0.35-0.80, P<0.05), unplanned treatment interruption rate(RR = 0.28, 95% CI: 0.12-0.64, P< 0.05), occurrence of pain(RR=0.61, 95% CI: 0.48-0.78, P<0.05) and failure rate of oral feeding(RR=0.70, 95% CI: 0.60-0.81, P<0.05). Conclusion The low-level laser therapy can effectively prevent the incidence of radiotherapy-and chemotherapy-induced oral mucositis, reduce pain degree of patients, risk of unplanned treatment interruptions and the failure rate of oral feeding.