放射性碘治疗分化型甲状腺癌患者唾液腺功能障碍的预防：随机对照试验的系统评价。
Prevention of salivary gland dysfunction in patients treated with radioiodine for differentiated thyroid cancer: A systematic review of randomized controlled trials.
机构信息
Division of Endocrinology and Metabolism, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Endocrinology and Metabolism, Faculty of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Nakornnayok, Thailand.
出版信息
Front Endocrinol (Lausanne). 2022 Aug 29;13:960265. doi: 10.3389/fendo.2022.960265. eCollection 2022.
INTRODUCTION
Salivary gland dysfunction (e.g., sialadenitis and xerostomia) is the most common complication of radioactive iodine (RAI) therapy for differentiated thyroid cancer (DTC). Several methods have been used to reduce/prevent this adverse effect. We aimed to systematically review the effectiveness of non-pharmacological and pharmacological interventions in preventing RAI-induced salivary gland dysfunction in patients with DTC.
METHODS
A systematic review was conducted, according to PRISMA guidelines. The protocol was registered (PROSPERO: CRD42022295229). PubMed, Embase, Scopus, and the Cochrane Library electronic databases were searched from inception to November 2021. Inclusion criteria were randomized controlled trials of DTC patients who were older than 18 years and underwent RAI after thyroidectomy in which at least one studied group received an intervention to prevent salivary gland dysfunction.
RESULTS
Twelve studies (a total of 667 participants) were included. Among DTC patients who were treated with RAI, nonpharmacological treatment such as parotid gland massage and aromatherapy ameliorated salivary gland dysfunction. Antioxidants such as vitamin E and selenium demonstrated radioprotective effects on the salivary gland, while other antioxidants did not show radioprotective benefits. Vitamin C showed no significant effects on preventing salivary gland dysfunction. Amifostine had inconsistent outcomes among studies. Among cholinergic agonists, pilocarpine did not demonstrate the radioprotective effect on parotid glands, while bethanechol lowered salivary gland dysfunction. However, the negative results from pilocarpine may be explained by the strong sialorrheic effect of the Cincinnati regimen in both study arms.
CONCLUSION
Among non-pharmacological and pharmacological methods, parotid gland massage, aromatherapy, vitamin E, selenium, amifostine, and bethanechol may have benefits in minimizing RAI-induced salivary gland dysfunction in patients with DTC. The results are limited by a small number of patients and should be confirmed in future larger randomized controlled trials.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295229, PROSPERO, identifier CRD42022295229.
介绍
放射性碘（RAI）治疗分化型甲状腺癌（DTC）后，唾液腺功能障碍（如唾液腺炎和口干）是最常见的并发症。已经使用了多种方法来减少/预防这种不良反应。我们旨在系统地回顾非药物和药物干预措施预防 DTC 患者 RAI 诱导的唾液腺功能障碍的有效性。
方法
根据 PRISMA 指南进行系统综述。该方案已在 PROSPERO 注册（CRD42022295229）。从创建到 2021 年 11 月，检索了 PubMed、Embase、Scopus 和 Cochrane 图书馆电子数据库。纳入标准为接受 RAI 治疗的 DTC 患者的随机对照试验，这些患者年龄大于 18 岁，并在甲状腺切除术后接受 RAI，其中至少一组接受了预防唾液腺功能障碍的干预措施。
结果
纳入了 12 项研究（共 667 名参与者）。在接受 RAI 治疗的 DTC 患者中，腮腺按摩和芳香疗法等非药物治疗可改善唾液腺功能障碍。抗氧化剂如维生素 E 和硒对唾液腺具有放射保护作用，而其他抗氧化剂则没有显示出放射保护作用。维生素 C 对预防唾液腺功能障碍没有显著作用。氨磷汀的研究结果不一致。在胆碱能激动剂中，毛果芸香碱对腮腺没有放射保护作用，而氨甲酰胆碱降低了唾液腺功能障碍。然而，毛果芸香碱的阴性结果可能是由于辛辛那提方案在两个研究组中都具有强烈的唾液分泌作用。
结论
在非药物和药物方法中，腮腺按摩、芳香疗法、维生素 E、硒、氨磷汀和氨甲酰胆碱可能对减少 DTC 患者 RAI 诱导的唾液腺功能障碍有益。由于患者人数较少，结果有限，应在未来更大的随机对照试验中得到证实。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295229，PROSPERO，标识符 CRD42022295229。
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