Woo S B, Sonis S T, Monopoli M M, Sonis A L
Brigham and Women's Hospital, Boston, MA 02115.
Cancer. 1993 Sep 1;72(5):1612-7. doi: 10.1002/1097-0142(19930901)72:5<1612::aid-cncr2820720520>3.0.co;2-q.
Few longitudinal studies have investigated the onset, duration, and resolution of ulcerative mucositis in bone marrow transplant recipients. This study prospectively followed a group of such patients on a daily basis to obtain data on the incidence of ulcerative mucositis, location and duration of lesions, severity with different conditioning regimens, and the relationship of such mucositis to the absolute neutrophil count.
Fifty-nine bone marrow transplant recipients on prophylactic acyclovir were examined daily for 26 days after marrow infusion, and all oral ulcerative lesions were recorded.
Oral ulcers occurred in 76.3% of patients, began at a mean of 5 days after marrow infusion (day + 5), and lasted for a median of 6 days. More than 90% of patients showed complete resolution of ulcers on or before day + 15, and all showed resolution when the absolute neutrophil count was > 500 cells/ml. Persistence of ulcers was noticed in patients who had oral graft-versus-host disease and in some patients who initially developed more severe ulcerations. Ninety-six percent of ulcers were located on nonkeratinized mucosa.
Ulcerative mucositis occurs in about 75% of bone marrow transplant recipients in the absence of herpes simplex virus infection. Most lesions occur on nonkeratinized mucosae which are vulnerable to trauma, especially if such mucosae are rendered atrophic by conditioning regimens. Oral ulcers may persist beyond day + 15 and after recovery of the neutrophil count in patients who initially develop more severe ulcerations or in patients who develop graft-versus-host disease.
很少有纵向研究调查过骨髓移植受者中溃疡性粘膜炎的发病、持续时间和消退情况。本研究对一组此类患者进行了每日随访，以获取有关溃疡性粘膜炎的发病率、病变部位和持续时间、不同预处理方案下的严重程度以及此类粘膜炎与绝对中性粒细胞计数之间关系的数据。
59例接受预防性阿昔洛韦治疗的骨髓移植受者在骨髓输注后26天内每日接受检查，并记录所有口腔溃疡性病变。
76.3%的患者发生口腔溃疡，平均在骨髓输注后5天（+5天）开始，持续时间中位数为6天。超过90%的患者在+15天或之前溃疡完全消退，当绝对中性粒细胞计数>500个细胞/毫升时所有患者溃疡均消退。患有口腔移植物抗宿主病的患者以及一些最初出现更严重溃疡的患者中发现溃疡持续存在。96%的溃疡位于非角化粘膜。
在无单纯疱疹病毒感染的情况下，约75%的骨髓移植受者会发生溃疡性粘膜炎。大多数病变发生在易受创伤的非角化粘膜上，尤其是如果此类粘膜因预处理方案而萎缩。对于最初出现更严重溃疡的患者或发生移植物抗宿主病的患者，口腔溃疡可能在+15天之后以及中性粒细胞计数恢复后仍持续存在。
