头颈部恶性肿瘤放射治疗后下颌骨放射性骨坏死发病的影响因素研究  

Clinical Diagnosis and Treatment of Osteonecrosis of the JawsInfluential factors related to osteoradionecrosis of the mandible in oral and maxillofacial cancer patients following radiotherapy

作　　者：韩煜 刘忠龙 原光辉 金善良[2] 李晓光[1] 李烿烿[1] 何悦[1] Han Yu;Liu Zhonglong;Yuan Guanghui;Jin Shanliang;Li Xiaoguang;Li Rongrong;He Yue(Department of Oral&Maxillofacial-Head&Neck Oncology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine&College of Stomatology,Shanghai Jiao Tong University&National Center for Stomatology&National Clinical Research Center for Oral Diseases&Shanghai Key Laboratory of Stomatology,Shanghai 200011,China;Department of Anesthesiology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,200011 [2]上海交通大学医学院附属第九人民医院麻醉科,200011

出　　处：《中华口腔医学杂志》2021年第5期421-427,共7页Chinese Journal of Stomatology

基　　金：国家自然科学基金(81900969)。

摘　　要：目的探索下颌骨放射性骨坏死(osteoradionecrosis,ORN)的发病影响因素,为该疾病的病因学研究及临床预防提供科学依据。方法对2013年1月至2015年12月因口腔颌面部及头颈部恶性肿瘤于上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科完成放疗的患者资料进行回顾性研究,通过单因素分析、最小绝对收缩选择算子(least absolute shrinkage and selection operator,Lasso)回归分析及Logistic回归分析筛选下颌骨ORN发病的主要影响因素。结果研究共纳入757例患者,男性443例,女性314例,年龄(51.8±13.7)岁,下颌骨ORN发生率为12.0%(91/757)。通过单因素分析将33项相关因素筛选至28项,进一步通过Lasso回归分析确定,放疗剂量(OR=1.135,P=0.034,95%CI:1.089~1.232)、肿瘤T分期(OR=2.586,P=0.001,95%CI:1.482~4.512)、下颌骨手术术式(OR=9.101,P<0.001,95%CI:2.796~29.630)、牙周炎(OR=6.089,P<0.001,95%CI:2.708~13.693)、糖尿病(OR=4.467,P=0.002,95%CI:1.705~11.704)、放疗后拔牙(OR=3.228,P=0.001,95%CI:1.640~6.350)、龋齿(OR=2.911,P=0.009,95%CI:1.300~6.516)、根尖周炎(OR=2.726,P=0.016,95%CI:1.209~6.145)、吸烟史(OR=4.438,P=0.002,95%CI:1.702~11.571)、单/双侧放疗(OR=2.225,P=0.028,95%CI:1.090~4.545)共10项因素与下颌骨ORN的发病密切相关。Objective To identify risk factors associated with mandibular osteoradionecrosis(ORN)in oral and maxillofacial cancer patients following radiotherapty and to provide scientific basis for the etiological research and clinical prevention of mandibular ORN.Methods A retrospective study was conducted in patients with oral and maxillofacial-head and neck cancer during the period from January 2013 to December 2015.Influential factors related to mandibular ORN were screened by single factor analysis,Lasso and Logistic regression analysis.Results A total of 757 patients were analyzed,and the total incidence of mandibular ORN was 12.0%(91/757).There were 443 males and 314 females,aged(51.8±13.7)years.Thirty-five related factors were screened to 28 by single factor analysis.It was determined by Lasso regression analysis that,radiation doses(OR=1.135,P=0.034,95%CI:1.089-1.232),T classification(OR=2.586,P=0.001,95%CI:1.482-4.512),mandibular surgery(OR=9.101,P<0.001,95%CI:2.796-29.630),periodontitis(OR=6.089,P<0.001,95%CI:2.708-13.693),diabetes(OR=4.467,P=0.002,95%CI:1.705-11.704),tooth extraction after radiotherapy(OR=3.228,P=0.001,95%CI:1.640-6.350),dental caries(OR=2.911,P=0.009,95%CI:1.300-6.516),periapical periodontitis(OR=2.726,P=0.016,95%CI:1.209-6.145),smoking(OR=4.438,P=0.002,95%CI:1.702-11.571)and unilateral/bilateral radiotherapy(OR=2.225,P=0.028,95%CI:1.090-4.545)were significantly associated with developing mandibular ORN.Conclusions Ten main risk factors for mandibular ORN were identified through the single center,large sample,retrospective analysis,which has a certain value for clinical prevention of mandibular ORN.Prospective,randomized controlled trials and long-term follow-up are still needed.

关 键 词：骨坏死 放射性 下颌骨 口腔颌面-头颈部肿瘤 Lasso回归 

分 类 号：R739.91[医药卫生—肿瘤] R818[医药卫生—临床医学]