Bassim C W, Fassil H, Mays J W, Edwards D, Baird K, Steinberg S M, Williams K M, Cowen E W, Mitchell S A, Cole K, Taylor T, Avila D, Zhang D, Pulanic D, Grkovic L, Fowler D, Gress R E, Pavletic S Z
National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, USA.
1] Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA [2] Tufts University School of Dental Medicine, Boston, MA, USA.
Bone Marrow Transplant. 2014 Jan;49(1):116-21. doi: 10.1038/bmt.2013.137. Epub 2013 Sep 2.
Oral chronic GVHD (cGVHD) is a common, late complication of alloSCT that is associated with significant patient morbidity. The NIH Oral Mucosal Score (NIH OMS) was developed to assess oral cGVHD therapeutic response, but has not been fully validated. This study's purpose was to conduct a rigorous construct validity and internal consistency analysis of this score and its components (erythema, lichenoid, ulcers, mucoceles) using established measures of oral pain, oral function, oral-related quality-of-life, nutrition and laboratory parameters in 198 patients with cGVHD. The construct validity of the NIH OMS was supported: a moderate correlation was observed between NIH OMS and mouth pain (rho=0.43), while a weaker correlation was observed with low albumin (rho=-0.26). Total NIH OMS, erythema and lichenoid components were associated with malnutrition, oral pain and impaired oral QOL, while ulcers were only associated with oral pain. No associations were found between mucoceles and any indicator evaluated, including salivary function or xerostomia. Kappa determined between scale components was low overall (all 0.35), supporting a conclusion that each component measures a distinct manifestation of oral cGVHD. This study supports the use of the NIH OMS and its components (erythema, lichenoid and ulcerations) to measure clinician-reported severity of oral cGVHD.
口腔慢性移植物抗宿主病（cGVHD）是异基因造血干细胞移植（alloSCT）常见的晚期并发症，与患者的显著发病情况相关。美国国立卫生研究院口腔黏膜评分（NIH OMS）旨在评估口腔cGVHD的治疗反应，但尚未得到充分验证。本研究的目的是使用既定的口腔疼痛、口腔功能、口腔相关生活质量、营养和实验室参数测量方法，对198例cGVHD患者的该评分及其组成部分（红斑、苔藓样变、溃疡、黏液囊肿）进行严格的结构效度和内部一致性分析。NIH OMS的结构效度得到了支持：观察到NIH OMS与口腔疼痛之间存在中度相关性（rho=0.43），而与低白蛋白之间的相关性较弱（rho=-0.26）。NIH OMS总分、红斑和苔藓样变部分与营养不良、口腔疼痛和口腔生活质量受损相关，而溃疡仅与口腔疼痛相关。未发现黏液囊肿与任何评估指标之间存在关联，包括唾液功能或口干。量表各组成部分之间的kappa值总体较低（均≤0.35），支持了每个组成部分测量口腔cGVHD不同表现的结论。本研究支持使用NIH OMS及其组成部分（红斑、苔藓样变和溃疡）来衡量临床医生报告的口腔cGVHD严重程度。
