Jensen Siri Beier, Mouridsen Henning T, Reibel Jesper, Brünner Nils, Nauntofte Birgitte
Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Institute of Odontology, Faculty of Health Sciences, University of Copenhagen, Norre Allé 20, DK-2200 Copenhagen N, Denmark.
Oral Oncol. 2008 Feb;44(2):162-73. doi: 10.1016/j.oraloncology.2007.01.015. Epub 2007 Jun 27.
It is an open question if chemotherapy (CT) per se imposes adverse effects on salivary gland function. The aim of the present study was to investigate effects of CT on salivary function in breast cancer patients during and after adjuvant CT. Forty-five breast cancer patients, eligible for adjuvant CT with CEF or CMF (cyclophosphamide, epirubicin or methotrexate, 5-fluorouracil) were followed before, during, six months and one year after CT. Findings were compared to those in a control group of 31 breast cancer patients not receiving CT. Flow rates and compositions of unstimulated and stimulated whole saliva as well as stimulated parotid saliva (UWS, SWS and SPS) were measured. Feeling of oral dryness and saliva-related complaints were registered. UWS and SWS flow rates decreased during CT (p<0.001 and p<0.01). UWS remained lower six months after, but reached baseline level within one year. SPS flow rate was not significantly affected, suggesting that the decrease in whole saliva production is accounted for by decreased acinar saliva formation by the submandibular glands. Twenty patients (44%) suffered from hyposalivation (UWS < or = 0.1 ml/min and/or SWS < or = 0.5 ml/min) during CT. Xerostomia scores rose during CT and stayed elevated one year after treatment. CT also induced compositional changes by slightly increasing salivary sodium and chloride concentrations as well as decreasing inorganic phosphate concentrations in spite of lower or unchanged flow rates, implying that ductal modification mechanisms are affected. UWS and SWS total protein output and UWS secretory IgA output decreased in response to CT. Thus, the results suggest that acinar and ductal cell functions are affected by adjuvant CT. These adverse drug reactions are temporary, as salivary findings generally returned to baseline values within one year following treatment.
化疗（CT）本身是否会对唾液腺功能产生不良影响仍是一个悬而未决的问题。本研究的目的是调查辅助性CT期间及之后对乳腺癌患者唾液功能的影响。45例符合CEF或CMF（环磷酰胺、表柔比星或甲氨蝶呤、5-氟尿嘧啶）辅助性CT治疗的乳腺癌患者在CT治疗前、治疗期间、治疗后6个月和1年进行随访。研究结果与31例未接受CT治疗的乳腺癌患者对照组进行比较。测量了非刺激性和刺激性全唾液以及刺激性腮腺唾液（UWS、SWS和SPS）的流速和成分。记录口腔干燥感和与唾液相关的不适。CT治疗期间UWS和SWS流速下降（p<0.001和p<0.01）。UWS在治疗后6个月仍较低，但在1年内恢复到基线水平。SPS流速未受到显著影响，这表明全唾液分泌减少是由于下颌下腺腺泡唾液形成减少所致。20例患者（44%）在CT治疗期间出现唾液分泌减少（UWS≤0.1 ml/min和/或SWS≤0.5 ml/min）。口干评分在CT治疗期间升高，并在治疗后1年保持升高。尽管流速降低或不变，但CT仍通过轻微增加唾液钠和氯浓度以及降低无机磷酸盐浓度诱导成分变化，这意味着导管调节机制受到影响。CT治疗后，UWS和SWS总蛋白输出以及UWS分泌型IgA输出下降。因此，结果表明辅助性CT会影响腺泡和导管细胞功能。这些药物不良反应是暂时的，因为唾液检查结果通常在治疗后1年内恢复到基线值。
