The University of Sydney, Sydney Medical School.
Medlab Clinical Ltd., Sydney, New South Wales, Australia.
Curr Opin Clin Nutr Metab Care. 2019 Sep;22(5):365-370. doi: 10.1097/MCO.0000000000000588.
Mucositis is a common and therapy-limiting adverse effect of cancer treatments including radiotherapy, chemotherapy, and immunotherapy. The optimal zinc formulation, dosage, and timing of administration warrant further research as does the efficacious prevention of febrile mucositis that predisposes to febrile neutropenia.
Metaanalyses concluded that zinc sulfate failed to significantly reduce the incidence or severity of chemotherapy-induced oral mucositis, whereas polaprezinc was associated with a significant reduction. Three new trials were published in 2018. The first trial found that zinc sulfate reduced the incidence and severity of chemotherapy-induced oral mucositis. The second reported that polaprezinc reduced oral mucositis in pediatric patients receiving high-dose chemotherapy for hematopoietic stem cell transplantation. The third trial demonstrated efficacy for a zinc lozenge for postoperative sore throat induced by an endotracheal intubation.
Zinc deficits, dietary or induced by cancer, are common in patients with cancer. Febrile mucositis may better describe the condition linking mucositis with febrile neutropenia. Febrile mucositis disrupts treatment and may be life-threatening. A paradigm shift is needed for a more comprehensive understanding of febrile mucositis. Zinc effects on the thymic immunological network and T lymphocytes during chemoradiotherapy regimens also warrant further investigation.
黏膜炎是癌症治疗（包括放疗、化疗和免疫治疗）的常见且具治疗限制的不良反应。锌的最佳制剂、剂量和给药时机仍需要进一步研究，同样需要研究有效的发热性黏膜炎预防方法，因为发热性黏膜炎会导致发热性中性粒细胞减少症。
荟萃分析得出结论，硫酸锌未能显著降低化疗引起的口腔黏膜炎的发生率或严重程度，而聚普瑞锌则与之相关。2018 年发表了三项新试验。第一项试验发现硫酸锌可降低化疗引起的口腔黏膜炎的发生率和严重程度。第二项报告称，聚普瑞锌可降低接受大剂量化疗造血干细胞移植的儿科患者的口腔黏膜炎发生率。第三项试验表明，锌锭对气管插管引起的术后咽喉痛有效。
癌症患者中锌缺乏（饮食或由癌症引起）很常见。发热性黏膜炎可能更好地描述了将黏膜炎与发热性中性粒细胞减少症联系起来的情况。发热性黏膜炎会干扰治疗，甚至可能危及生命。需要对发热性黏膜炎有更全面的了解，需要进行范式转变。在放化疗期间，锌对胸腺免疫网络和 T 淋巴细胞的影响也需要进一步研究。
