頭頸部癌症病患接受放射線治療後之口腔生理變化研究

Oral Physiological Changes in Head and Neck Cancer Patients Receiving Radiation Therapy

薛育姍(Yu-Shan Hsueh)

指導教授 ： 吳麗珍 ； 何聖佑

長榮大學/健康科學學院/護理學研究所/碩士(2007年)

https://doi.org/10.6833/CJCU.2007.00076

摘要

自西元1982年迄今，台灣地區首要的死亡原因為惡性腫瘤，於西元2006年，頭頸癌排行於癌症死亡原因的第6位。許多頭頸癌病患接受局部的放射線治療（放療）後常見的副作用為口乾、味覺改變、口腔黏膜發炎、齲齒、甚至吞嚥或咀嚼困難，這些不適的副作用對病患的生活品質產生極大的影響。
本研究為縱斷性研究，主要為探討頭頸癌病患接受放療前後之口腔環境的變化。研究期間為2006年8月至2007年5月，研究對象為台南市某兩家醫院放射線腫瘤科門診持續取樣30位個案，年滿18歲、經臨床檢查以及病理切片報告證實為頭頸部區域的惡性腫瘤，且為首次接受頭頸部放射線治療。由研究者以口腔黏膜改變評估量表評估每位患者於放療前、接受放療滿二週、滿四週、放療療程結束週及療程結束後滿一個月，各階段的口腔黏膜改變的嚴重程度；並收集各階段患者唾液檢體進行分析，包括每分鐘唾液分泌量、唾液酸鹼值（pH值）、唾液電解質以及腫瘤壞死因子-α（Tumor necrosis factor-alpha；TNF-α）的濃度變化。研究結果顯示，隨著放療的進行，唾液分泌量會呈現顯著性減少，到放療療程結束後滿一個月，唾液分泌量仍無回復的情形（F=15.6, p=0.001）。口腔黏膜改變評估量表分數會呈現顯著性增加，到放療療程結束後滿一個月，口腔黏膜改變評估量表分數則會恢復至接受放療後第二週的情形，但口乾及味覺改變並未恢復至正常（F=91.69, p＜0.001）。唾液中TNF-α濃度的表現上，會隨著放療的進行，唾液中TNF-α濃度呈現顯著性差異（χ2=18.12, p=0.001）。口腔黏膜改變評估量表分數與唾液分泌量呈現負相關（r= -0.41, p＜0.001），顯示當唾液分泌量減少時，口腔黏膜發炎程度也越嚴重；且口腔黏膜改變評估量表分數與唾液中TNF-α的濃度呈現正相關（r=0.31, p＜0.001），表示口腔黏膜發炎程度越嚴重，唾液中TNF-α的濃度也會升高。研究顯示各階段唾液中電解質及唾液pH值會受唾液分泌量而改變，當唾液分泌量低時，唾液中Na+、K+、Cl-、Ca2+、Mg2+的濃度會隨之增加（p＜0.05），而HPO42-的濃度變化則不顯著，唾液pH值也會隨著唾液分泌量的減少而降低，呈酸性。藉此研究分析使醫護人員對於頭頸部癌症病患接受放療後口腔生理環境的變化情形，提供未來口腔治療及照護的參考。

關鍵字

頭頸癌 ； 唾液 ； 口腔黏膜炎 ； 放療 ； 腫瘤壞死因子（TNF-α）

並列摘要

Cancer has been the leading cause of death in Taiwan since 1982. In 2006, head and neck cancers were the 6th leading cause of death in cancers. Most of the head and neck cancer patients receive radiation therapy and as a result often suffer from side effects such as mouth dryness, parageusia, oral mucositis, dental caries, swallowing or chewing difficulties. These side effects can have a great impact on the patients’ quality of life, and severe symptoms may last for several years.
The purpose of this longitudinal study was to assess physiological changes in the oral cavity environment during and after radiotherapy (RT) in head and neck cancer patients. Thirty head and neck cancer patients who were 18 years and older and had not yet received RT in this regions, were recruited from two cancer clinics from August 2006 to May 2007. The investigator assessed the oral mucus membrane of each subject and collected saliva at 5 time points：prior to RT, 2 weeks and 4weeks after the beginning of RT, the week of completing RT, and one month after completing RT. To oral condition, each saliva sample was analyzed for saliva rate (ml/min), pH levels, levels of electrolytes (sodium, potassium, chloride, calcium, phosphorus, and magnesium) and concentration of tumor necrosis factor-α (TNF-α).
The result showed that during the RT period, salivary secretion decreased continuously and got to its lowest point during the week of completing the RT. One month after completing RT, the salivary secretion remained at the lowest point (F=15.6, p=0.001). Patients’ oral health had similar change as salivary secretion; the mucous condition and oral function deteriorated continuously. However, one month after completing RT, patients’ oral health returned to the level of the 2 weeks after RT (F=91.69, p＜0.001). The salivary TNF-α was also changed significantly (χ2=18.12, p=0.001). The condition of oral health correlated negatively with salivary secretion (r= -0.41, p＜0.001), and positively correlated with salivary TNF-α concentrations (r=0.31, p＜0.001). The salivary secretion was found positively correlated with saliva pH levels (r=0.52, p＜0.001) and negatively correlated with concentrations of sodium (r= -0.3, p＜0.001), potassium (r= -0.19, p＜0.05), chloride (r= -0.45, p＜0.001), calcium (r= -0.57, p＜0.001), and magnesium (r= -0.53, p＜0.001) ; while phosphorus was not significantly correlated with salivary secretion.
This study showed a strong evidence of side effects of RT on oral physiological environment and oral health. The results of the study may help health care providers develop strategies to maintain head and neck patients’ oral health during and after radiation therapy; thus to improve the patients’ quality of life.

並列關鍵字

Head and neck cancers ； TNF-α ； radiotherapy (RT) ； saliva secrete ； oral mucositis

參考文獻

任益民、林玉清、王宜斌、許文林、吳錦榕、黃經民等人（1998）．不同方式放射線照射法對鼻咽癌病人唾液腺功能之影響．放射治療與腫瘤學，5，65-71。

楊翠雲、高紀惠（1996）．頭頸部放射線治療患者的口腔黏膜護理方案．長庚護理，7（2），76-81。

郭士禎（2002）．毛果芸香鹼對血液透析患者口乾、口渴和透析間體重增加的治療效果．碩士論文，台南：國立成功大學臨床藥學研究所。

Atkinson, J. C., ＆ Wu, A. J. (1994). Salivary gland dysfunction: cause, symptoms, treatment. Journal of the American Dental Association, 125(4), 409-416.

Barasch, A., ＆ Peterson, D. E. (2003). Risk factors ulcerative and mucositis in cancer patients：unanswered questions. Oral oncology, 39(2), 91-100.