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目的探讨同期放化疗对鼻咽癌患者急性放射性皮肤反应和口腔黏膜反应的影响及相关危险因素。方法回顾性分析2010年9月至2013年9月期间收治的166例接受同期放化疗的鼻咽癌患者的临床资料,观察急性放射性皮肤反应和口腔黏膜反应的发生率及程度,对可能引起急性皮肤黏膜反应的临床相关因素进行单因素及Logistic多因素回归分析。结果单因素分析结果显示,糖尿病史、治疗前血红蛋白水平、体质指数、上颈临床靶区(CTV)单次量和下颈CTV单次量与急性放射性皮肤反应的发生及其严重程度有关(P均<0.01);同时,吸烟史、糖尿病史、治疗前血红蛋白水平、体质指数和白细胞计数与急性口腔黏膜反应的发生及其严重程度有关(P均<0.01)。将有意义的因素纳入多因素Logistic回归分析,结果显示有糖尿病史和治疗前血红蛋白水平高是急性放射性皮肤反应的独立危险因素(P均<0.01);有吸烟史和白细胞计数低是急性口腔黏膜反应的独立危险因素(P均<0.01)。结论有糖尿病史和治疗前血红蛋白水平高是鼻咽癌患者同期放化疗中发生急性放射性皮肤反应的独立危险因素,有吸烟史和白细胞计数低是急性口腔黏膜的独立危险因素,临床上应根据患者的病情实施临床干预,降低急性皮肤黏膜反应的发生率。
Objective To investigate the effects of concurrent chemoradiotherapy on acute radiation-induced skin reactions and oral mucosal reactions in patients with nasopharyngeal carcinoma and the related risk factors. Methods The clinical data of 166 patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy from September 2010 to September 2013 were retrospectively analyzed. The incidence and extent of acute radiation-induced skin reaction and oral mucosal reaction were observed. The clinical related factors of skin mucosal reaction were analyzed by single factor and Logistic multivariate regression analysis. Results The results of univariate analysis showed that the history of diabetes mellitus, hemoglobin level before treatment, body mass index, single target volume of CTV and single CTV of lower neck were related to the occurrence and severity of acute radiation-induced skin reaction (P (All P <0.01). Meanwhile, the history of smoking, history of diabetes, pretreatment hemoglobin, body mass index and white blood cell count were related to the occurrence and severity of acute oral mucosal reaction (all P <0.01). Logistic regression analysis showed that there was a significant difference in the history of diabetes mellitus and hemoglobin before treatment, which was an independent risk factor for acute radiation-induced skin reactions (all P <0.01). There was a history of smoking and low white blood cell count in acute oral mucosa The independent risk factors for response (P <0.01). Conclusions There is a history of diabetes mellitus and high hemoglobin level before treatment is an independent risk factor for acute radiation-induced skin reaction during radiotherapy and chemotherapy in patients with nasopharyngeal carcinoma. The smoking history and low leukocyte count are independent risk factors for acute oral mucosa. According to the patients The implementation of clinical interventions to reduce the incidence of acute skin mucosal reactions.