【作者】 陈俏妍；

【导师】 夏纪严；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2008， 硕士

【摘要】 目的利用滋阴清热法治疗急性放射性口腔炎属阴虚内热证的鼻咽癌患者,通过观察其口腔黏膜反应程度与唾液中表皮生长因子(Epidermal Growth Factor,EGF)的动态变化,并利用欧洲癌症研究与治疗组织生存质量核心量表(European Organizationfor Researeh and Treatment of Cancer,EORTC)QLQ-C30评估患者的生存质量状况,客观评价滋阴清热法对急性放射性口腔炎的干预作用。方法将60例确诊为鼻咽癌并进行首次放疗的患者,遵从患者意愿纳入研究,治疗组31例,对照组29例。治疗组采用滋阴清热法治疗方案,对照组采用西医治疗方案。于DT 0、20、30、40、50、60Gy及放疗结束时,分度记录口腔黏膜情况,同时在DT 0、40与70Gy时检测唾液中EGF的含量,还有在放疗前后,用EORTC QLQ-C30评价患者生存质量。结果所有患者在放疗中均出现放射性口腔黏膜反应:治疗组放射性口腔黏膜反应轻于对照组(P＜0.01)。在DT 30Gy时,Ⅰ度、Ⅱ度黏膜反应组间比较有显著性差异(P＜0.01)。在DT 70Gy时,Ⅱ度、Ⅲ度黏膜反应组间比较有显著性差异(P＜0.01)。随着剂量的增加,两组唾液中EGF的含量呈下降趋势,在DT 40Gy时下降明显,至DT 70Gy时降到最低值,但治疗组下降程度均较对照组轻,差异有显著性差异(P＜0.01)。两组患者放疗后QLQ-C30生存质量比较显示:治疗组患者的生存质量总健康状况要高于对照组,两组比较有显著性差异(P＜0.01)。在情绪功能、社会功能这两个维度,治疗组显著优于对照组,两组的比较有显著性差异(P＜0.01)。在放疗后QLQ-C30中症状维度方面,疲倦、恶心呕吐、食欲丧失、腹泻方面,治疗组要优于对照组,两组比较有显著性差异(P＜0.01)。疼痛方面,治疗组症状较对照组为轻,两组比较有显著性差异(P＜0.05)。提示治疗组的总体生活质量情况优于对照组。结论(1)滋阴清热法可推迟放射性口腔炎出现的时间,减轻放疗反应,对防治急性放射性口腔黏膜炎有较好的疗效,具有一定的临床推广应用价值。(2)利用滋阴清热法治疗的患者唾液中EGF的含量增高,口腔黏膜的病变程度减轻。而唾液中的EGF主要来自腮腺和下颌下腺,推测滋阴清热法对放射野中的唾液腺有保护作用。(3)滋阴清热法治疗组在放疗后症状维度如疲倦、疼痛、恶心呕吐、食欲丧失、腹泻等,功能维度如角色功能、情绪功能、社会功能等方面的评分均优于对照组,提示滋阴清热法较单纯西医治疗更能改善患者总体生存质量。更多还原

【Abstract】 ObjectivesTo observe the change about the degree of injuried oral mucous and epidermal growth factor(EGF)in saliva,and to evaluate the quality of life(QOL)by (European Organization for Researeh and Treatment of Caneer,EORTC)QLQ-C30 with nasopharyngeal carcinoma patients who had acute radiation oral mucositis of yin deficiency inner heat treated by nourishing yin and clearing heat therapy.Methods60 cases of NPC treated with radiotherapy for the first time were assigned into two groups:treatment group(n=31)and control group(n=29),according to the desire of patients.The treatment group was treated with the method of nourishing yin and clearing heat therapy,and the control group was treated with standard medical therapy.The injuried oral mucous of patients at DT 0, 20,30,40,50,60Gy as well as at the end of radiation therapy,was observed. Moreover,the EGF in saliva of patients at DT 0,40 and 70Gy was detected by ELISA method,meanwhile the quality of life of patients by EORTC QLQ-C30 before and after the radiation therapy was evaluated.ResultsIn the process of radiotherapy,all cases occured the acute radiation oral mucositis.The condition of injuried oral mucous of treatment group was better than that of control group(P＜0.01).At DT 30Gy,bothⅠandⅡdegree of injuried oral mucous between two groups was statistically significant(P＜0.01). And bothⅡandⅢdegree of injuried oral mucous was statistically significant(P＜0.01)at DT 70Gy.With the dose increasing:,the EGF in saliva decreased.At 40Gy the EGF decreased significantly while the EGF decreasing to the minimum at 70Gy,indicating statistical difference between two groups (P＜0.01).The comparison of QLQ-C30 after radiotherapy between two groups showed that the domain of global health status of treatment was superior to control group (P＜0.01).In domains of emotional functioning and social functioning the treatment group was better than the control group(P＜0.01)While in domains of fatigue,nausea and vomiting,appetite loss,diarrhea,the scores of treatment group were higher than the control group(P＜0.01).Also in domain of pain,the treatment group was lighter than the control group(P＜0.05). It revealed that the QOL of treatment group was improved and was superior to control group.Conclusions1.The therapy of nourishing yin and clearing heat postponed the acute radiation oral mucositis,lessened the side effect caused by radiotherapy actually.Furthermore,this therapy has such pratical potentiality to promote.2.The EGF in saliva was increased after the therapy of nourishing yin and clearing heat,while the injuried of oral mucous decreased.Because EGF was originated from parotid gland and submandibular gland,it was assumed to protect the salivary gland among the radioactive area by therapy of nourishing yin and clearing heat.3.The scores both in symptom domain as fatigue,pain,nausea and vomiting, insomnia,appetite loss,as well as function domain as emotional functioning, social functioning of treatment group were higher than that of control group. It showed the effect of therapy of nourishing yin and clearing heat on the QOL of patients was better than that of modern medical therapy.更多还原