冷冻疗法预防头颈癌患者放射性口腔黏膜炎的meta分析

doi:10.3969/j.issn.1674-8115.2022.05.012

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (5): 635-645.doi: 10.3969/j.issn.1674-8115.2022.05.012

冷冻疗法预防头颈癌患者放射性口腔黏膜炎的meta分析

陈卫宏¹^,²(), 侯黎莉¹(), 杨玲¹^,², 毛艳³, 张金凤³

^1.上海交通大学医学院附属第九人民医院护理部，上海 200023
^2.成都中医药大学护理学院，成都 611137
^3.上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011

收稿日期:2022-02-24 接受日期:2022-05-20 出版日期:2022-05-28 发布日期:2022-05-28
通讯作者: 侯黎莉 E-mail:chenweihong1996@163.com;pisces_liz@163.com
作者简介:陈卫宏（1996—），女，护师，硕士生；电子信箱：chenweihong1996@163.com。
基金资助:
长三角科技创新共同体项目(21002411300)

Efficacy of preventive intervention of cryotherapy on radiation-induced oral mucositis in head and neck cancer: a meta-analysis

CHEN Weihong¹^,²(), HOU Lili¹(), YANG Ling¹^,², MAO Yan³, ZHANG Jinfeng³

^1.Department of Nursing, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200023, China
^2.School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
^3.Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China

Received:2022-02-24 Accepted:2022-05-20 Online:2022-05-28 Published:2022-05-28
Contact: HOU Lili E-mail:chenweihong1996@163.com;pisces_liz@163.com
Supported by:
Yangtze River Delta Science and Technology Innovation Community Project(21002411300)

摘要/Abstract

摘要：

目的·系统评价冷冻疗法在头颈癌患者放射治疗（放疗）所致口腔黏膜炎中的应用效果。方法·计算机检索中英文数据库（PubMed、EMbase、Cochrane Library、Web of Science、中国知网、万方、维普、中国生物医学文献数据库）中关于冷冻疗法对头颈癌患者放射性口腔黏膜炎影响的随机对照试验（randomized controlled trial，RCT），检索时间从建库至2022年1月31日。2名研究者独立对所得文献进行筛选、数据提取及质量评价，并运用RevMan 5.4及Stata 16.0软件进行meta分析。结果·共纳入36个RCT。Meta分析结果显示，冷冻疗法组患者放射性口腔黏膜炎总发生率［比值比（odds ratio，OR）=0.30，95%置信区间（confidence interval，CI）0.23~0.39，P=0.000］及严重放射性口腔黏膜炎发生率（OR=0.17，95%CI 0.14~0.21，P=0.000）明显低于对照组患者，差异有统计学意义。结论·冷冻疗法有助于降低头颈癌放疗患者放射性口腔黏膜炎及严重放射性口腔黏膜炎发生率。

关键词: 冷冻疗法, 头颈部肿瘤, 放射性口腔黏膜炎, meta分析, 随机对照试验

Abstract:

Objective·To systematically review the efficacy of cryotherapy in head and neck cancer patients with radiation-induced oral stomatitis.

Methods·PubMed, EMbase, Cochrane Library, Web of Science, CNKI, WanFang, VIP and CBM databases were searched to collect randomized controlled trials (RCTs) of cryotherapy in head and neck cancer patients with ration-induced stomatitis from inception to January 31th, 2022. Literature screening, data extraction, and quality evaluation were performed independently by two researchers. Meta-analysis was then performed by using RevMan 5.4 and Stata 16.0 software.

Results·A total of 36 RCTs were included. The results of meta-analysis showed that compared to control group, cryotherapy group had a lower total incidence of radiation-induced stomatitis [adds ratio (OR)=0.30, 95% confidence interval (CI) 0.23?0.39, P=0.000] and a lower incidence of severe radiation-induced stomatitis (OR=0.17, 95%CI 0.14?0.21, P=0.000).

Conclusion·Cryotherapy may contribute to reducing the incidence of radiation-induced stomatitis and the incidence of severe radiation-induced stomatitis.

Key words: cryotherapy, head and neck neoplasms, radiation-induced oral stomatitis, meta-analysis, randomized controlled trial

中图分类号:

R739.8

陈卫宏, 侯黎莉, 杨玲, 毛艳, 张金凤. 冷冻疗法预防头颈癌患者放射性口腔黏膜炎的meta分析[J]. 上海交通大学学报（医学版）, 2022, 42(5): 635-645.

CHEN Weihong, HOU Lili, YANG Ling, MAO Yan, ZHANG Jinfeng. Efficacy of preventive intervention of cryotherapy on radiation-induced oral mucositis in head and neck cancer: a meta-analysis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(5): 635-645.

图/表 7

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Study	Number of cases		Disease	Intervention		Assessment scale
Study	Exp	Con	Disease	Exp	Con	Assessment scale
GONG^［9］，2010	33	35	Head and neck cancer	RN+holding NS ice in the mouth	RN	RTOG
LI^［10］，2017	50	50	Nasopharyngeal cancer	RN+holding NS ice in the mouth	RN	WHO
XU^［11］，2021	80	80	Nasopharyngeal cancer	RN+holding NS ice in the mouth	RN	RTOG
CHEN^［12］，2012	48	42	Nasopharyngeal and oral cancer	RN+holding NS ice in the mouth+spraying rhEGF	RN+spraying rhEGF	WHO
ZHANG^［13］，2013	60	60	Nasopharyngeal cancer	RN+holding NS ice in the mouth+spraying rhEGF	RN+spraying rhEGF	WHO
GONG^［14］，2011	40	40	Nasopharyngeal cancer	RN+ice compress	RN	RTOG
JI^［15］，2008	31	31	Head and neck cancer	RN+ice compress	RN	RTOG
QU^［16］，2019	44	44	Nasopharyngeal cancer	RN+ice compress+strengthening nursing	RN	WHO
YAN^［17］，2011	66	66	Nasopharyngeal cancer	RN+ice compress+spraying JUS	RN	WHO
CAI^［18］，2021	55	55	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	RTOG
LI^［19］，2010	22	18	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	WHO
MIN^［20］，2014	10	10	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	NCI-CTC
GU^［21］，2020	45	44	Nasopharyngeal cancer	RN+holding green tea ice in the mouth	RN	RTOG
XU^［22］，2019	39	41	Nasopharyngeal cancer	RN+holding green tea ice in the mouth	RN	RTOG
HUANG^［23］，2011	40	40	Nasopharyngeal cancer	RN+holding Kuding tea ice in the mouth	RN	WHO
ZHANG^［24］，2017	25	25	Head and neck cancer	RN+holding Kuding tea ice in the mouth	RN	WHO
ZHANG^［25］，2015	30	30	Nasopharyngeal cancer	RN+holding SB ice in the mouth	RN	WHO
YU^［26］，2011	30	30	Head and neck cancer	RN+holding SB ice in the mouth+aerosol inhalation with deproteinised calf blood extract	RN	WHO
ZHAO^［27］，2015	25	25	Oral cancer	RN+holding milk ice in the mouth	RN	RTOG
WAN^［28］，2011	99	99	Nasopharyngeal cancer	RN+holding milk ice in the mouth+drinking the herbal tea	RN	WHO
HUANG^［29］，2018	50	50	Nasopharyngeal cancer	RN+holding Glycyrrhiza and Wumei ice in the mouth	RN	WHO
JIN^［30］，2019	50	50	Nasopharyngeal cancer	RN+holding Chuanbeipipagao and Yunnanbaiyao ice in the mouth	RN	WHO
LIU^［31］，2010	30	30	Nasopharyngeal cancer	RN+holding Glycyrrhiza ice in the mouth	RN	WHO
LU^［32］，2015	52	48	Nasopharyngeal cancer	RN+holding Biyafen ice in the mouth	RN+mouth-washing with Titai solution	RTOG
TANG^［33］，2018	20	20	Nasopharyngeal cancer	RN+holding carrot ice in the mouth	RN+drinking vitamin solution	RTOG
WANG^［34］，2016	40	40	Nasopharyngeal cancer	RN+holding Smecta ice in the mouth	RN+mouth-washing with warm Smecta solution	RTOG
LIU^［35］，2014	30	30	Oral and maxillofacial cancer	RN+holding ice cream in the mouth	RN	WHO
LU^［36］，2017	20	20	Head and neck cancer	RN+holding the frozen device in the mouth+mouth-washing with vitamin-B12 solution	RN	RTOG
GU^［37］，2016	47	47	Nasopharyngeal cancer	RN+holding sterile distilled water ice in the mouth+mouth-washing with icy saline solution	RN	WHO
HE^［38］，2018	50	50	Nasopharyngeal cancer	RN+mouth-washing with icy aloe solution	RN	WHO
QIN^［39］，2020	40	40	Nasopharyngeal cancer	RN+mouth-washing with icy mixed solution （which contains tea polyphenols， normal saline， lidocaine and dexamethasone）	RN+mouth-washing with NS solution	RTOG
QIN^［40］，2021	60	60	Nasopharyngeal cancer	RN+mouth-washing with icy mixed solution （which contains tea polyphenols， normal saline， lidocaine and dexamethasone）	RN+mouth-washing with sodium bicarbonate solution	RTOG
YANG^［41］，2019	36	36	Nasopharyngeal cancer	RN+mouth-washing with icy water+taking artificial cow-bezoar pills	RN	WHO
XIE^［42］，2019	30	30	Head and neck cancer	RN+mouth-washing with icy solution which contains G-CSF	RN	RTOG
PANG^［43］，2013	25	25	Head and neck cancer	RN+mouth-washing with icy mixed solution which contains thymus protein	RN+mouth-washing with Duobeier solution	WHO
BAI^［44］，2019	33	35	Head and neck cancer	RN+cryogenic aerosol inhalation（4‒8 ℃）	RN+normal aerosol inhalation（18‒24 ℃）	RTOG

Study	Number of cases		Disease	Intervention		Assessment scale
Study	Exp	Con	Disease	Exp	Con	Assessment scale
GONG^［9］，2010	33	35	Head and neck cancer	RN+holding NS ice in the mouth	RN	RTOG
LI^［10］，2017	50	50	Nasopharyngeal cancer	RN+holding NS ice in the mouth	RN	WHO
XU^［11］，2021	80	80	Nasopharyngeal cancer	RN+holding NS ice in the mouth	RN	RTOG
CHEN^［12］，2012	48	42	Nasopharyngeal and oral cancer	RN+holding NS ice in the mouth+spraying rhEGF	RN+spraying rhEGF	WHO
ZHANG^［13］，2013	60	60	Nasopharyngeal cancer	RN+holding NS ice in the mouth+spraying rhEGF	RN+spraying rhEGF	WHO
GONG^［14］，2011	40	40	Nasopharyngeal cancer	RN+ice compress	RN	RTOG
JI^［15］，2008	31	31	Head and neck cancer	RN+ice compress	RN	RTOG
QU^［16］，2019	44	44	Nasopharyngeal cancer	RN+ice compress+strengthening nursing	RN	WHO
YAN^［17］，2011	66	66	Nasopharyngeal cancer	RN+ice compress+spraying JUS	RN	WHO
CAI^［18］，2021	55	55	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	RTOG
LI^［19］，2010	22	18	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	WHO
MIN^［20］，2014	10	10	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	NCI-CTC
GU^［21］，2020	45	44	Nasopharyngeal cancer	RN+holding green tea ice in the mouth	RN	RTOG
XU^［22］，2019	39	41	Nasopharyngeal cancer	RN+holding green tea ice in the mouth	RN	RTOG
HUANG^［23］，2011	40	40	Nasopharyngeal cancer	RN+holding Kuding tea ice in the mouth	RN	WHO
ZHANG^［24］，2017	25	25	Head and neck cancer	RN+holding Kuding tea ice in the mouth	RN	WHO
ZHANG^［25］，2015	30	30	Nasopharyngeal cancer	RN+holding SB ice in the mouth	RN	WHO
YU^［26］，2011	30	30	Head and neck cancer	RN+holding SB ice in the mouth+aerosol inhalation with deproteinised calf blood extract	RN	WHO
ZHAO^［27］，2015	25	25	Oral cancer	RN+holding milk ice in the mouth	RN	RTOG
WAN^［28］，2011	99	99	Nasopharyngeal cancer	RN+holding milk ice in the mouth+drinking the herbal tea	RN	WHO
HUANG^［29］，2018	50	50	Nasopharyngeal cancer	RN+holding Glycyrrhiza and Wumei ice in the mouth	RN	WHO
JIN^［30］，2019	50	50	Nasopharyngeal cancer	RN+holding Chuanbeipipagao and Yunnanbaiyao ice in the mouth	RN	WHO
LIU^［31］，2010	30	30	Nasopharyngeal cancer	RN+holding Glycyrrhiza ice in the mouth	RN	WHO
LU^［32］，2015	52	48	Nasopharyngeal cancer	RN+holding Biyafen ice in the mouth	RN+mouth-washing with Titai solution	RTOG
TANG^［33］，2018	20	20	Nasopharyngeal cancer	RN+holding carrot ice in the mouth	RN+drinking vitamin solution	RTOG
WANG^［34］，2016	40	40	Nasopharyngeal cancer	RN+holding Smecta ice in the mouth	RN+mouth-washing with warm Smecta solution	RTOG
LIU^［35］，2014	30	30	Oral and maxillofacial cancer	RN+holding ice cream in the mouth	RN	WHO
LU^［36］，2017	20	20	Head and neck cancer	RN+holding the frozen device in the mouth+mouth-washing with vitamin-B12 solution	RN	RTOG
GU^［37］，2016	47	47	Nasopharyngeal cancer	RN+holding sterile distilled water ice in the mouth+mouth-washing with icy saline solution	RN	WHO
HE^［38］，2018	50	50	Nasopharyngeal cancer	RN+mouth-washing with icy aloe solution	RN	WHO
QIN^［39］，2020	40	40	Nasopharyngeal cancer	RN+mouth-washing with icy mixed solution （which contains tea polyphenols， normal saline， lidocaine and dexamethasone）	RN+mouth-washing with NS solution	RTOG
QIN^［40］，2021	60	60	Nasopharyngeal cancer	RN+mouth-washing with icy mixed solution （which contains tea polyphenols， normal saline， lidocaine and dexamethasone）	RN+mouth-washing with sodium bicarbonate solution	RTOG
YANG^［41］，2019	36	36	Nasopharyngeal cancer	RN+mouth-washing with icy water+taking artificial cow-bezoar pills	RN	WHO
XIE^［42］，2019	30	30	Head and neck cancer	RN+mouth-washing with icy solution which contains G-CSF	RN	RTOG
PANG^［43］，2013	25	25	Head and neck cancer	RN+mouth-washing with icy mixed solution which contains thymus protein	RN+mouth-washing with Duobeier solution	WHO
BAI^［44］，2019	33	35	Head and neck cancer	RN+cryogenic aerosol inhalation（4‒8 ℃）	RN+normal aerosol inhalation（18‒24 ℃）	RTOG

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冷冻疗法预防头颈癌患者放射性口腔黏膜炎的meta分析

Efficacy of preventive intervention of cryotherapy on radiation-induced oral mucositis in head and neck cancer: a meta-analysis

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