国际口腔医学杂志

国际口腔医学杂志 ›› 2023, Vol. 50 ›› Issue (1): 43-51.doi: 10.7518/gjkq.2023012

• 口腔微生物专栏 • 上一篇    下一篇

口腔菌群变化影响放射治疗和化学治疗相关性口腔黏膜炎病程的研究进展

杨明燕1(),张帆2,赵蕾1()   

  1. 1.口腔疾病研究国家重点实验室;国家口腔疾病临床医学研究中心;四川大学华西口腔医院牙周病科 成都 610041
    2.四川大学华西医院健康管理中心 成都 610041
  • 收稿日期:2022-06-30 修回日期:2022-09-12 出版日期:2023-01-01 发布日期:2023-01-09
  • 通讯作者: 赵蕾
  • 作者简介:杨明燕，住院医师，硕士，Email：1469691138@qq.com
  • 基金资助:
    四川省干部保健科研课题-普及应用项目(川干研2022-109)

Research progress on oral flora changes affecting the course of radiotherapy and chemotherapy-related oral mucositis

Yang Mingyan1(),Zhang Fan2,Zhao Lei1()   

  1. 1.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.Health Management Center of West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2022-06-30 Revised:2022-09-12 Online:2023-01-01 Published:2023-01-09
  • Contact: Lei Zhao
  • Supported by:
    Sichuan Province Cadre Health Care Scientific Research Project-Popularization and Application Project(2022-109)

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摘要：

头颈部放射治疗和化学治疗（简称放化疗）会引起口腔菌群多样性及群落结构的改变，包括与健康相关共生菌的丰度降低，一些革兰阴性菌增加，以及以白色念珠菌增加为主的真菌群落改变，这些改变可导致口腔黏膜炎（OM）的罹患风险及严重程度增加，尤其与严重OM关系密切。放化疗直接或通过活性氧间接导致DNA损伤，同时促进微生物菌群失调，破坏免疫系统，促进炎症发生；细胞损伤形成溃疡，导致细菌易位和定植，激活核因子-κB、Toll样受体等信号通路，诱导更多促炎细胞因子产生，促进OM发展。目前针对调节口腔菌群改善OM的治疗也是研究热点，可采用益生菌或益生菌混合物防治OM，预防性使用抗真菌剂也可降低口腔念珠菌的数量。本文就近年来头颈部放化疗对口腔菌群变化的影响及其与OM相关性的研究进行综述，以期为放化疗相关OM的防治提供新思路。

关键词: 放射治疗, 化学治疗, 头颈癌, 口腔菌群变化, 口腔黏膜炎

Abstract:

Head and neck radiotherapy and chemotherapy (referred to as chemoradiotherapy) can cause changes in oral microbiota diversity and community structure, including decreased abundance of health-related commensal bacteria, increased abundance of some Gram-negative bacteria, and changes in the fungal community dominated by increase in Candida albicans. These changes can lead to an increase in the risk and severity of oral mucositis (OM). Chemoradiotherapy causes direct or indirect DNA damage through reactive oxygen species, promotes the dysbacteriosis of microbial flora, destroys the immune system, and enhances inflammation. Cell damage forms ulcers, leading to bacterial translocation and colonization. In addition, nuclear factor-κB, Toll-like receptor, and other signaling pathways are activated, thus inducing the expression of pro-inflammatory cytokines and promoting the development of OM. The treatment of OM is currently a research hotspot for oral flora regulation. Probiotics or probiotic mixtures can be used to prevent and treat OM, and the prophylactic use of antifungal agents can reduce the number of oral Candida infections. This paper reviews the effects of head and neck chemoradiotherapy on oral microflora changes and their correlation with OM to provide new ideas for the prevention and treatment of chemotherapy-related OM.

Key words: radiotherapy, chemotherapy, head and neck cancer, changes in oral flora, oral mucositis

中图分类号: 

  • R 780.2

表 1

放疗、化疗相关OM的分级"

分级标准分级临床表现
RTOG[21]急性放射性黏膜炎分级标准1红斑
2斑点反应（<1.5 cm，不连续）
3融合性黏膜炎（>1.5 cm，连续）
4溃疡、坏死、出血
WHO[22]口腔毒性量表0无明显症状
1口腔酸痛，红斑
2口腔红斑、溃疡，可以吃固体
3口腔溃疡，只能进食流质饮食
4不能从口腔摄入营养
NCI—不良事件通用术语标准（5.0版[23]和4.0版[21]）1无症状或轻微症状；无需治疗
2不影响经口摄入的中度疼痛或溃疡；需改变饮食
3严重的疼痛；干扰经口摄入营养
4危及生命的后果；需紧急干预治疗
5死亡
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