国际肿瘤学杂志

国际肿瘤学杂志 ›› 2022, Vol. 49 ›› Issue (9): 521-525.doi: 10.3760/cma.j.cn371439-20220707-00101

• 论著 • 上一篇    下一篇

头颈部肿瘤患者化疗性口腔黏膜炎发生的多因素分析

陈怡(), 韩靓, 蔡雳   

  1. 江苏省南通市肿瘤医院头颈外科,南通 226001
  • 收稿日期:2022-07-07 修回日期:2022-08-08 出版日期:2022-09-08 发布日期:2022-10-21
  • 通讯作者: 陈怡 E-mail:springss@126.com
  • 基金资助:
    南通市卫生健康委员会课题(MS12021097)

Multivariate analysis of chemotherapy induced oral mucositis in patients with head and neck tumors

Chen Yi(), Han Liang, Cai Li   

  1. Department of Head and Neck Surgery, Nantong Tumor Hospital of Jiangsu Province, Nantong 226001, China
  • Received:2022-07-07 Revised:2022-08-08 Online:2022-09-08 Published:2022-10-21
  • Contact: Chen Yi E-mail:springss@126.com
  • Supported by:
    Nantong Municipal Health Commission(MS12021097)

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摘要：

目的 探讨头颈部肿瘤患者化疗性口腔黏膜炎（CIOM）发生的影响因素。方法 回顾性分析2017年7月至2021年7月江苏省南通市肿瘤医院收治的98例头颈部肿瘤患者的临床资料,根据化疗后患者是否发生CIOM将患者分为CIOM组（n=82）与无CIOM组（n=16）。比较两组患者一般临床资料,检测两组患者化疗前血清胱抑素C（Cys-C）、超敏C-反应蛋白（hs-CRP）及同型半胱氨酸（Hcy）水平并进行比较,采用多因素logistic回归分析探讨CIOM发生的影响因素。结果 CIOM组与无CIOM组患者体质量指数（BMI）（χ2=6.44,P=0.011）、口腔护理（χ2=4.36,P=0.037）、吸烟史（χ2=7.82,P=0.005）、口腔pH值（χ2=26.16,P<0.001）、放疗史（χ2=13.31,P<0.001）、化疗方案（χ2=4.53,P=0.033）、抗生素应用（χ2=14.53,P<0.001）及口腔黏膜保护剂应用（χ2=12.85,P=0.001）差异均具有统计学意义。CIOM组患者化疗前血清Cys-C [（1.43±0.36）mg/L vs. （1.05±0.28）mg/L]、hs-CRP [（19.64±2.05）μmol/L vs. （13.49±1.55）μmol/L]、Hcy [（14.34±1.71）μmol/L vs. （9.63±1.38）μmol/L]水平均高于无CIOM组,差异均具有统计学意义（t=3.88,P<0.001;t=11.38,P<0.001;t=10.36,P<0.001）。多因素logistic回归分析结果显示,BMI <18.5 kg/m2（OR=1.66,95%CI为1.18~2.14,P=0.005）、口腔护理差（OR=2.42,95%CI为1.70~4.36,P=0.013）、吸烟史（OR=1.53,95%CI为1.25~2.28,P=0.003）、口腔pH值≤7（OR=2.46,95%CI为1.48~4.06,P<0.001）、放疗史（OR=2.04,95%CI为1.60~3.44,P<0.001）、化疗方案含氟尿嘧啶（5-FU）（OR=1.81,95%CI为1.36~2.83,P=0.006）、化疗前Cys-C（OR=2.03,95%CI为1.40~3.02,P<0.001）、hs-CRP（OR=2.26,95%CI为1.64~3.19,P<0.001）及Hcy（OR=1.77,95%CI为1.27~2.53,P<0.001）升高均为头颈部肿瘤患者CIOM发生的独立危险因素,而抗生素应用（OR=0.76,95%CI为0.43~0.95,P<0.001）与口腔黏膜保护剂应用（OR=0.58,95%CI为0.27~0.88,P<0.001）均为头颈部肿瘤患者CIOM发生的独立保护因素。结论 BMI<18.5 kg/m2、口腔护理差、吸烟史、口腔pH值≤7、放疗史、化疗方案含5-FU、化疗前Cys-C、hs-CRP及Hcy升高均为头颈部肿瘤并发CIOM的独立危险因素,而抗生素应用与口腔黏膜保护剂应用均为其发生的独立保护因素。

关键词: 头颈部肿瘤, 药物疗法, 口炎

Abstract:

Objective To investigate the influencing factors of chemotherapy induced oral mucositis （CIOM） in patients with head and neck tumors. Methods The clinical data of 98 patients with head and neck tumors treated in Nantong Tumor Hospital of Jiangsu Province from July 2017 to July 2021 were analyzed retrospectively. The patients were divided into CIOM group （n=82） and non-CIOM group （n=16） according to whether CIOM occurred after chemotherapy. The general clinical data of the two groups were compared, and the levels of serum cystatin C （Cys-C）, hypersensitive C-reactive protein （hs-CRP） and homocysteine （Hcy） before chemotherapy of the two groups were detected and compared. Multivariate logistic regression analysis was used to explore the influencing factors of CIOM. Results There were statistically significant differences in body mass index （BMI） （χ2=6.44, P=0.011）, oral care （χ2=4.36, P=0.037）, smoking history （χ2=7.82, P=0.005）, oral pH value （χ2=26.16, P<0.001）, radiotherapy history （χ2=13.31, P<0.001）, chemotherapy regimen （χ2=4.53, P=0.033）, application of antibiotics （χ2=14.53, P<0.001） and application of oral mucosal protec-tive agents （χ2=12.85, P=0.001） between the CIOM group and non-CIOM group. The serum Cys-C [（1.43±0.36） mg/L vs. （1.05±0.28） mg/L], hs-CRP [（19.64±2.05） μmol/L vs. （13.49±1.55） μmol/L] and Hcy [（14.34±1.71） μmol/L vs. （9.63±1.38） μmol/L] before chemotherapy of the CIOM group were significantly higher than those of the non-CIOM group, with statistically significant differences （t=3.88, P<0.001; t=11.38, P<0.001; t=10.36, P<0.001）. Multivariate logistic regression analysis showed that BMI<18.5 kg/m2 （OR=1.66, 95%CI： 1.18-2.14, P=0.005）, poor oral care （OR=2.42, 95%CI： 1.70-4.36, P=0.013）, smoking history （OR=1.53, 95%CI： 1.25-2.28, P=0.003）, oral pH≤7 （OR=2.46, 95%CI： 1.48-4.06, P<0.001）, radiotherapy history （OR=2.04, 95%CI： 1.60-3.44, P<0.001）, chemotherapy regimen containing fluorouracil （5-FU） （OR=1.81, 95%CI： 1.36-2.83, P=0.006）, and increased Cys-C （OR=2.03, 95%CI： 1.40-3.02, P<0.001）, hs-CRP （OR=2.26, 95%CI： 1.64-3.19, P<0.001） and Hcy （OR=1.77, 95%CI： 1.27-2.53, P<0.001） before chemotherapy were independent risk factors for the occurrence of CIOM in patients with head and neck tumors, while the application of antibiotics （OR=0.76, 95%CI： 0.43-0.95, P<0.001） and oral mucosal protective agents （OR=0.58, 95%CI： 0.27-0.88, P<0.001） were independent protective factors for the occurrence of CIOM in patients with head and neck tumors. Conclusion BMI<18.5 kg/m2, poor oral care, smoking history, oral pH≤7, radiotherapy history, chemotherapy regimen containing 5-FU, increased Cys-C, hs-CRP and Hcy before chemotherapy are independent risk factors of head and neck tumors patients complicated with CIOM, while the application of antibiotics and oral mucosal protective agents are independent protective factors.

Key words: Head and neck neoplasms, Drug therapy, Stomatitis