放射線治療對於頭頸部癌症患者唾液腺功能的影響

Effects of Radiotherapy on Salivary Gland Function in Patients with Head and Neck Cancers

朱想想(Shine-Shine Ju)

指導教授 ： 陳敏慧

國立臺灣大學/牙醫專業學院/臨床牙醫學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.10205

摘要

頭頸癌的病人在接受放射線治療後，其唾液腺會受到放射線的破壞，造成唾液分泌減少。
本研究旨在探討頭頸部癌症病人在接受放射線治療後，其唾液腺功能的改變，包括了唾液酸鹼值，刺激性唾液分泌流速(salivary flow rate)，以及唾液的緩衝能力(buffering capacity)。其中唾液酸鹼值又包括了腮腺開口處的唾液酸鹼值，頷下腺開口處的唾液酸鹼值，全口靜止唾液酸鹼值(resting or non-stimulated)，刺激唾液酸鹼值。除此之外我們也想研究牙菌斑之酸鹼值對於唾液酸鹼值有無影響。
我們使用GC Saliva-Check Buffer來檢測唾液腺功能，好處是其可以臨床直接測量唾液酸鹼值，flow rate，以及緩衝能力，並且是一完全非侵入性的檢查，病人接受度較高。本研究自西元2010年三月至西元2011年十一月共收集了62位接受放射線治療的頭頸癌病患，其中11位是放射線治療前後重複測量，另外51位則是放射線治療後單次測量。重複測量的部分是放射線治療前記錄一次，放射線治療後每一個月檢測一次，至少12個月。另外我們也收集了正常對照組的共計七位。
重複測量的結果顯示，在放射線治療後第一個月flow rate，唾液的pH值，緩衝能力，以及牙菌斑的pH值皆會驟然下降，大概到放射線治療後第三到六個月會開始回升，但是flow rate無法回復到治療前的水平。單次測量的部分，單變數迴歸分析顯示放射線治療後和唾液腺功能檢測之間的時間間隔是頷下腺開口處的唾液酸鹼值和全口靜止唾液酸鹼值之顯著預測因子。相關係數分析顯示牙菌斑酸鹼值與腮腺開口處以及頷下線開口處的唾液酸鹼值，以及全口靜止唾液酸鹼值是呈線性正相關。放射線治療後的時間長度對於唾液腺功能的影響方面，在放射線治療後一年以內所有檢測項目都是下降，之後靜止唾液的酸鹼值以及牙菌斑酸鹼值是隨著時間回升；而刺激唾液的量測，包括了flow rate，刺激唾液的酸鹼值，以及緩衝能力，是在放射線治療後一到五年上升，可是在放射線治療後五年以上的反而又下降。
頭頸部癌症病人在接受放射線治療前其唾液腺功能與正常人無異。所有唾液腺功能檢測項目在放射線治療後一個月會驟降，之後會慢慢回升，但是flow rate無法回復到治療前的水平。從實驗結果發現牙菌斑酸鹼值與唾液酸鹼值呈線性正相關，但是如果從平均值來看很難看出在放射線治療後是由牙菌斑產生的酸造成唾液pH值的下降。

關鍵字

頭頸癌 ； 放射線治療 ； 唾液分泌流速 ； 唾液酸鹼值 ； 緩衝能力 ； 牙菌斑

並列摘要

Head and neck cancer patients after radiotherapy, their salivary glands will be subject to radiation damage, resulting in reduced secretion of saliva.
This study aimed to explore the head and neck cancer patients after radiotherapy, the changes in salivary gland function, including the saliva pH, the stimulated salivary flow rate, and the saliva buffering capacity. Saliva pH includes the pH of saliva of the parotid gland openings and submandibular gland openings, and the whole resting or non-stimulated saliva pH. In addition, we also want to study whether the dental plaque pH influences the saliva pH or not.
We used the GC Saliva-Check Buffer to check the salivary gland function. The advantage of this product is its clinical direct measurement of the salivary pH, flow rate, and buffering capacity, and this is a completely non-invasive examination method, so patients have a high degree of acceptance of this check. From March 2010 AD to November 2011 AD, a total of 62 head and neck cancer patients receiving radiotherapy were included in this study, 11 of which were taken repeated measurements before and after radiotherapy, and the remaining 51 just had a single measurement after radiotherapy. In the “repeated measurements” group, we measured the salivary gland function before radiotherapy, and once a month after radiotherapy, at least for 12 months. In addition, a total of seven of the normal control group were also included.
The repeated measurement results showed that the first month after radiotherapy, the salivary flow rate, saliva pH, buffering capacity, as well as the dental plaque pH dropped steeply, and began to rise or increase from the 3rd month to the 6th month after radiotherapy, but the flow rate can not return to the pre-treatment levels. In the “single measurement” group, univariate linear regression analysis showed that the time interval between termination of radiotherapy and salivary gland function tests was a significant predictor that affcted both the pH of saliva of the submandibular gland openings and the whole resting saliva pH. The Pearson cor-relation coefficients analysis showed that the plaque pH had a positive linear correlation with the saliva pH of parotid gland openings and submandibular gland openings, as well as with the whole resting saliva pH. Concerning the influence of the length of time after radiotherapy on the salivary gland function after radiotherapy, within one year after radiotherapy, all the salivary functional test items were dropped, and after that the resting saliva pH and the plaque pH began to rise over time; however, after that the stimulated saliva measurements, including the flow rate, stimulatd saliva pH and buffering capacity, rised over time initially, but dropped again from the “1~5-year-after-radiotherapy” group to the “≥ 5-year-after-radiotherapy” group.
Before receiving radiotherapy, there is no difference between the salivary gland function of the head and neck cancer patients and that of normal people. All the salivary functional test items will drop steeply one month after radiotherapy, and after that will rise slowly with time, but the flow rate can not return to the pre-treatment levels. We find that the plaque pH has a positive linear correlation with the saliva pH after radiotherapy from the study result; however, if we see the averge of the plaque pH and the saliva pH, it is difficult to find that the saliva pH decline is caused by the acid produced by dental plaque after radiotherapy.

並列關鍵字

head and neck cancer ； radiotherapy ； salivary flow rate ； saliva pH ； buffering capacity ； dental plaque

參考文獻

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