口腔黏膜炎
Oral mucositis.
作者信息
Singh Vibha, Singh Akhilesh Kumar
机构信息
Department of Oral and Maxillofacial Surgery, K.G. Medical University, Lucknow, Uttar Pradesh, India.
Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
出版信息
Natl J Maxillofac Surg. 2020 Jul-Dec;11(2):159-168. doi: 10.4103/njms.NJMS_10_20. Epub 2020 Dec 16.
Oral mucositis is one of the most common complications of cancer therapy. It is a nonhematologic complication of cytotoxic chemotherapy and radiotherapy and reduces the quality of life. It is estimated that 40% the cases on standard chemotherapy may develop oral mucositis. Patients receiving radiation, especially in the cases of head and neck cancer, have 30%-60% chances of developing mucositis. Chemotherapy and radiotherapy interfere with the normal turnover of epithelial cells, leading to mucosal injuries. These injuries can also occur due to indirect invasion of Gram negative bacteria and fungi as most of the chemo-therapeutic agents will cause neutropenia and will give a favorable environment for the development of mucositis. The patient-related factors are also responsible for developing mucositis in chemo-induced and radiation-induced mucositis. Poor oral hygiene may also be responsible for bacterial super infection followed by chemotherapy. Mucositis is of two kinds: direct and indirect mucositis. Direct mucositis - The epithelial cells of the oral mucosa undergo rapid turnover in usually 7-14 days due to which these cells are more susceptible to the effect of the cytotoxic therapy which results in oral mucositis. Indirect mucositis - it can develop due to the infection caused by Gram-negative bacteria and fungal infection. There will be a greater risk for oral infection due to neutropenia. The onset of mucositis secondary to mylo-suppression varies depending upon the timing of the neutrophil count associated with chemotherapy agents but they typically develop around 10-21 days after chemotherapy administration.
口腔黏膜炎是癌症治疗最常见的并发症之一。它是细胞毒性化疗和放疗的非血液学并发症,会降低生活质量。据估计,接受标准化疗的患者中有40%可能会发生口腔黏膜炎。接受放疗的患者,尤其是头颈部癌症患者,发生黏膜炎的几率为30%-60%。化疗和放疗会干扰上皮细胞的正常更新,导致黏膜损伤。这些损伤也可能由于革兰氏阴性菌和真菌的间接侵袭而发生,因为大多数化疗药物会导致中性粒细胞减少,从而为黏膜炎的发生提供有利环境。患者相关因素也与化疗诱导和放疗诱导的黏膜炎的发生有关。口腔卫生不良也可能导致化疗后细菌的二重感染。黏膜炎有两种:直接黏膜炎和间接黏膜炎。直接黏膜炎——口腔黏膜的上皮细胞通常在7-14天内快速更新,因此这些细胞更容易受到细胞毒性治疗的影响,从而导致口腔黏膜炎。间接黏膜炎——它可能由于革兰氏阴性菌感染和真菌感染而发生。由于中性粒细胞减少,口腔感染的风险会更高。继发于骨髓抑制的黏膜炎的发作时间取决于与化疗药物相关的中性粒细胞计数时间,但它们通常在化疗给药后10-21天左右出现。
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