Rode M, smid L, Budihna M, Gassperssic D, Rode M, Soba E
Department of Stomatology, University of Ljubljana, Slovenia.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Nov;92(5):509-14. doi: 10.1067/moe.2001.115984.
The purpose of the present study was to investigate the influence of parasympathomimetic pilocarpine and anticholinergic biperiden on salivation, pH value, and calcium, phosphate, and bicarbonate concentrations in saliva in patients irradiated for malignant tumors of the head and neck region.
Sixty-nine patients were randomly assigned into 3 groups. Group A consisted of patients receiving pilocarpine, group B of those who were receiving biperiden during radiotherapy and pilocarpine for 6 weeks after its completion, and group C comprised patients receiving neither of the mentioned drugs. The quantity of secreted unstimulated saliva, its pH value, as well as calcium, phosphate, and bicarbonate concentrations in saliva were measured before the beginning of radiotherapy, after 30 Gy of irradiation, at completed irradiation, and 3, 6, and 12 months after completion of radiotherapy.
Saliva secretion was found to be the least affected in the group of patients receiving biperiden throughout the course of radiotherapy. One year after completion of therapy, the quantity of secreted saliva could only be measured in the patients receiving biperiden during radiotherapy; it amounted to 16% of the average initial quantity of saliva secreted before the beginning of irradiation. In all 3 groups of patients, mean pH value decreased during radiotherapy and started to increase again after completion of irradiation. In group B the decrease in pH value after radiotherapy was statistically significantly smaller than that in group C (P =.01). During and after irradiation, calcium concentration was increased in all 3 groups of patients. Phosphate concentration decreased during radiotherapy in all 3 groups. In group B it started to increase again 3 months after completion of radiotherapy. Bicarbonate concentration showed a slight increase during radiotherapy and started to decrease again after completion of irradiation.
The results of our study indicate that the inhibition of saliva secretion during radiotherapy and its stimulation after completion of treatment can contribute not only to some preservation of the quantity of saliva but also to at least partial preservation of its quality in terms of pH value and calcium, phosphate, and bicarbonate concentrations.
本研究旨在探讨拟副交感神经药物毛果芸香碱和抗胆碱能药物安克痉对接受头颈部恶性肿瘤放疗患者唾液分泌、pH值以及唾液中钙、磷和碳酸氢盐浓度的影响。
69例患者被随机分为3组。A组患者接受毛果芸香碱治疗，B组患者在放疗期间接受安克痉治疗，并在放疗结束后接受6周的毛果芸香碱治疗，C组患者未接受上述任何一种药物治疗。在放疗开始前、照射30 Gy后、放疗结束时以及放疗结束后3、6和12个月，测量未刺激唾液的分泌量、其pH值以及唾液中钙、磷和碳酸氢盐的浓度。
在整个放疗过程中接受安克痉治疗的患者组中，唾液分泌受影响最小。治疗结束1年后，仅在放疗期间接受安克痉治疗的患者中可测量到唾液分泌量；其分泌量相当于照射开始前唾液平均初始分泌量的16%。在所有3组患者中，放疗期间平均pH值下降，放疗结束后又开始上升。B组放疗后pH值的下降在统计学上显著小于C组（P = 0.01）。在照射期间及照射后，所有3组患者的钙浓度均升高。所有3组患者在放疗期间磷浓度均下降。B组在放疗结束后3个月开始再次升高。碳酸氢盐浓度在放疗期间略有升高，放疗结束后又开始下降。
我们的研究结果表明，放疗期间抑制唾液分泌以及治疗结束后刺激唾液分泌，不仅有助于在一定程度上保留唾液量，而且在pH值以及钙、磷和碳酸氢盐浓度方面至少能部分保留唾液质量。
