鼻咽癌放射性龋齿发病规律及相关因素分析  

Occurrence dynamics and analysis of influencing factors of radiation caries for the patients with nasopharyngeal carcinoma

作　　者：余意[1] 陈冬平[1] 邝燕好[2] 刘锦全[1] 何璐[1] 李铭仪[1] 

机构地区：[1]广州医科大学附属肿瘤医院放疗五区,广东广州510095 [2]广州医科大学附属肿瘤医院口腔科,广东广州510095

出　　处：《中华肿瘤防治杂志》2017年第6期379-382,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：广州市中医药和中西医结合科技项目(20152A011021)

摘　　要：目的放射性牙损伤是常见的放疗不良反应,严重影响患者的咀嚼和营养摄取。通过分析放射性龋齿的发病情况及相关因素,探讨如何减少和预防放射性牙损伤的发生。方法 2007-06-25-2013-04-31在广州医科大学附属肿瘤医院放疗五区行放疗的初治鼻咽癌患者中,选取有放疗结束2年后口腔随诊资料的254例患者为研究对象。口腔检查时间距离放疗2~8年,中位时间3.5年。记录龋失补牙数,分析比较不同性别、年龄、放疗技术、放疗后不同时间段的患龋率和龋均,以及不同放疗技术的常见患龋牙位。结果调强放疗组(intensity-modulated radiation therapy,IMRT)牙齿剂量为(33.31±6.77)Gy,三维适形组(3-dimentional conformal radiation therapy,3D-CRT)为(41.05±1.58)Gy,差异有统计学意义,P=0.039;IMRT组,3D-CRT组,二维放疗组(2-dimentional radiation therapy,2DRT)的龋均分别为6.51±7.18、9.03±8.12和13.79±9.96,差异有统计学意义,P=0.001;254例患者龋均为8.16±8.20,失牙率为33.43%,补牙率为17.27%;上下牙列的龋均为4.24±4.22和3.92±4.47,差异无统计学意义,P=0.944;后组磨牙与其他牙齿的龋均为4.98±4.12和3.18±4.68,年龄≥50岁与<50岁患者的龋均为11.63±9.09和5.41±6.48,放疗3年后与3年内的龋均为10.87±9.56和5.88±5.10,差异均有统计学意义,P<0.001;性别不是龋齿发生的影响因素(男7.88±7.97,女8.86±8.77),P=0.541。结论增强鼻咽癌患者的护齿意识和龋病治疗意识,放疗尽量采用调强放疗技术,降低牙齿受照剂量,重点关注中老年患者的牙齿健康,有可能减少放射性龋齿的发生。OBJECTIVE This study aimed to evaluate the incidence of radiation-induced dental caries and its associated factors, and explore the ways to reduce and prevent the occurrence of radiation-induced dental caries, which is a com- mon adverse effect of radiotherapy and seriously affect the chewing and nutritional intake of patients. METHODS From June 25, 2007 to April 31, 2013, five patients with nasopharyngeal carcinoma who underwent radiotherapy in our hospital were selected as the subjects of oral follow-up after 2 years of radiotherapy. Oral examination time was from 2 to 8 years of radiotherapy with the median time of 3.5 years. The number of decayed, missing and filled teeth （DT, MT, FT, DM-FT） were recorded. The caries rate and mean DMFT of different sex,age,radiotherapy and time were analyzed and compared, and the common caries position of different radiotherapy techniques was analyzed. RESULTS The mean number of radiation dose in teeth of patients treated with intensity-modulated radiation therapy （IMRT） was （33.31±6.77） Gy,and that of patients treated with 3-dimentional conformal radiation therapy（3D-CRT） was （41.05±1.58） Gy. The difference was statistically significant（P= 0. 039）. IMRT（6.51±7.18） had the lowest mean DMFT than 3D-CRT （9.03±8. 12） and 2DRT（13. 79±9. 96）. The difference was statistically significant（P=0. 001）. The mean DMFT of 254 patients was 8.16±8.20,33.43% of MT in DMFT,17.27% of FT in DMFT. The mean DMFT of upper and lower dentition was not statistically significant （4.24±4.22,3.92±4.47, P = 0. 944）. The mean DMFT of molar was 4.98±4.12, while that of other teeth was 3.18±4.68. The mean DMFT of patients in 1-3 years after radiotherapy（RT） was 5.88±5.10,while that of patients more than 3 years after RT was 10. 87±9.56. The difference was statistically significant（P〈0. 001）. Gender was not a factor in the incidence of dental caries（man 7. 88 ~ 7. 97, woman 8. 86±8. 77, P=0. 541）. CONCLUSIONS To enhance the awareness of d

关 键 词：鼻咽癌 调强放疗 放射性损伤 龋齿 影响因素 

分 类 号：R730.55[医药卫生—肿瘤] R739.63[医药卫生—临床医学]