Goodson M L, Hamadah O, Thomson P J
Oral and MaxilloFacial Surgery, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4BW, UK.
Br J Oral Maxillofac Surg. 2010 Oct;48(7):507-10. doi: 10.1016/j.bjoms.2009.08.039.
Alcohol is known to be a risk factor for oral precancerous lesions, but evidence has been weakened by subjective estimates of alcohol intake from patients, and confounded by their use of tobacco. Red cell macrocytosis, assessed by calculation of mean corpuscular volume (MCV), may be a useful objective indicator of chronic alcohol intake. The aim of this study was to compare subjective and objective measures of alcohol intake in patients with oral precancerous lesions and assess the use of reported alcohol intake and MCV on assessing the degree of dysplasia at presentation and their role as markers of the behaviour of such lesions by assessing clinical outcome after treatment. Fifty-four new patients were recruited. All were smokers and had histologically confirmed single dysplastic oral precancerous lesions, but had had no previous treatment. Subjective data about their alcohol consumption were recorded, and blood samples taken for the assessment of MCV. All patients had laser excision of their lesions, which were assessed histopathologically for signs of dysplasia. Patients were followed up for 2 years. The significance of differences was assessed using Fisher's exact test. Alcohol intake of more than 28 units/week and MCV of over 100 were associated with increased dysplasia at presentation (p=0.01 and p=0.03, respectively). Thirty-six patients were disease-free at 2 years, but 18 developed further disease, often at new sites. Alcohol intake of more than 28 units/week was significantly associated with an increased risk of further disease (p=0.03), particularly recurrence at the same site (p=0.02).
众所周知，酒精是口腔癌前病变的一个风险因素，但由于患者酒精摄入量的主观估计以及他们吸烟情况的干扰，相关证据受到了削弱。通过计算平均红细胞体积（MCV）评估的红细胞大细胞性，可能是慢性酒精摄入量的一个有用的客观指标。本研究的目的是比较口腔癌前病变患者酒精摄入量的主观和客观测量方法，并通过评估治疗后的临床结果，来评估报告的酒精摄入量和MCV在评估就诊时发育异常程度方面的作用，以及它们作为此类病变行为标志物的作用。招募了54名新患者。所有患者均为吸烟者，且组织学确诊为单一发育异常的口腔癌前病变，但此前均未接受过治疗。记录了他们饮酒情况的主观数据，并采集血样以评估MCV。所有患者均接受了病变的激光切除，并对切除组织进行组织病理学评估以检查发育异常的迹象。对患者进行了2年的随访。使用Fisher精确检验评估差异的显著性。每周饮酒超过28单位以及MCV超过100与就诊时发育异常增加相关（分别为p = 0.01和p = 0.03）。36名患者在2年时无疾病，但18名患者出现了进一步的疾病，通常是在新的部位。每周饮酒超过28单位与疾病进一步发展的风险显著增加相关（p = 0.03），尤其是在同一部位复发（p = 0.02）。
