龚建忠 韦燕 潘琦津

摘要：目的  评价锌剂防治接受同步放化疗鼻咽癌患者放射性口咽炎（OM）的效果。方法  本研究為单中心、前瞻性、非盲法随机对照临床试验，2014年10月～2017年2月入组我院98例接受同步放化疗Ⅱ～Ⅳa期鼻咽癌患者，随机分为补锌组（n=50）和对照组（n=48）。所有患者采用适型调强放射技术（IMRT）放疗，且至少行1周期同步顺铂（80～100 mg/m2，3周/次）化疗。补锌组从放疗开始至放疗结束后2周给予葡萄糖酸锌片口服，对照组采取空白处理。放疗开始后隔天记录两组患者口咽黏膜的损伤程度及疼痛程度并记录放射性OM出现的时间及放射剂量。结果  补锌组及对照组放射性OM发生率分别为96.00%及 95.83%，差异无统计学意义（P>0.05）;补锌组严重放射性OM发生率为36.00%，低于对照组的60.42%，差异有统计学意义（P<0.05）。补锌组发生放射性OM平均时间为（16.50±5.73）d，大于对照组的（12.73±3.51）d，差异有统计学意义（P<0.05）;补锌组严重OM的平均持续时间为（8.81±3.01）d，短于对照组的（12.12±3.89）d，差异有统计学意义（P<0.05）。补锌组口咽部疼痛较对照组轻，差异有统计学意义（P<0.05）。结论  补锌治疗对减少接受同步放化疗鼻咽癌患者发生严重OM，并缩短其持续时间，推迟发生OM时间，减少口咽部疼痛程度，值得临床进一步研究。

关键词：锌;鼻咽癌;放疗;化疗;放射性口咽炎

Abstract：Objective  To evaluate the effect of zinc on the prevention and treatment of radiation-induced oropharyngeal mucositis（OM） in patients undergoing concurrent chemoradiotherapy for nasopharyngeal carcinoma.Methods  This study was a single-center， prospective， unblinded randomized controlled clinical trial. From October 2014 to February 2017， 98 patients with concurrent chemoradiotherapy with stage II～IVa nasopharyngeal carcinoma were enrolled in our hospital. Zinc group （n=50） and control group （n=48）. All patients received radiotherapy with moderate intensity modulated radiation （IMRT） and synchronized with at least one cycle of cisplatin （80-100 mg/m2，3 weeks/time）. The zinc supplementation group was given orally with zinc gluconate tablets from the start of radiotherapy to 2 weeks after the end of radiotherapy. The control group was treated with a blank. The degree of injury and pain of the oropharyngeal mucosa of the two groups were recorded every other day after the start of radiotherapy and the time and dose of radioactive OM were recorded.Results  The incidence of radioactive OM in the zinc supplementation group and the control group were 96.00% and 95.83%， respectively，the difference was not statistically significant （P>0.05）. However， the incidence of severe radioactive OM in the zinc supplementation group was 36.00%， which was lower than that of the control group 60.42%，the difference was statistically significant （P<0.05）. The average time of radioactive OM in the zinc supplementation group was （16.50±5.73） d， which was greater than that of the control group （12.73±3.51） d， the difference was statistically significant （P<0.05）. The average duration of severe OM in the zinc supplementation group was （8.81±3.01）d was shorter than the control group （12.12±3.89）d，the difference was statistically significant （P<0.05）. The oropharyngeal pain of the zinc supplementation group was less than that of the control group，the difference was statistically significant （P<0.05）.Conclusion  Zinc supplementation is worthy of further clinical study in reducing the incidence of severe OM in patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy， shortening its duration， delaying the onset of OM， and reducing the degree of oropharyngeal pain.

Key words：Zinc;Nasopharyngeal carcinoma;Radiotherapy;Chemotherapy;Radioactive oropharyngeal mucositis

据全球肿瘤统计，2018年全球共约129079例新发鼻咽癌病例，死亡病例约72987例，我国为鼻咽癌高发区，特别是广东、广西等南方地区[1]。2015年中国癌症统计数据表明我国新发鼻咽癌病例约60600例，死亡病例约34100例[2]，新发及死亡例数约占全球1/2，因此，鼻咽癌防治工作在我国尤为迫切和重要。放射治疗在鼻咽癌治疗中占有重要的地位，而适型调强放射治疗（intensity modulated radiation therapy，IMRT）因其优势在于提高瘤体内照射剂量，从达到提高局部控制率，另一方面减少肿瘤周围正常组织的照射，保留了其全部或部分功能，改善患者的生存质量，在鼻咽癌放射治疗中得到了很好的应用[3]。IMRT治疗鼻咽癌最常见的急性期不良反应为放射性口咽炎（oropharyngeal mucositis，OM），其3、4级反应总发生率为27.2%[4]。急性……