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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2014, Vol. 10 ›› Issue (02): 218 -221. doi: 10.3877/cma.j.issn.1673-5250.2014.02.020

Special Issue: ；

Original Article

Situation and Analysis of the Influencing Factors of Oral Mucositis by High Dose Methotrexate Therapy in Children with Acute Lymphoblastic Leukemia

Qin Du1, Biru Luo2()   

  1. 1. Department of Pediatric Hematological Tumor , West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2014-01-19 Revised:2014-03-03 Published:2014-04-01
  • Corresponding author: Biru Luo
  • About author:
    (Corresponding author: Luo Biru, Email: )
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Objective

To explore the situation and the influencing factors of oral mucositis by high dose methotrexate(HD-MTX) therapy in children with acute lymphoblastic leukemia (ALL) and provide scientific evidences to prevent and reduce the incidence of oral mucositis after HD-MTX therapy.

Methods

A total of 200 cases of clinical data after HD-MTX therapy according to CCLG-ALL2008 in West China Second University Hospital, Sichuan University from May 2010 to January 2011 were analyzed retrospectively. The situation and influencing factors of oral mucositis were discussed. The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of West China Second University Hospital. Informed consent was obtained from the parents of each participating patient.

Results

The incidence of oral mucositis was 14.5% (29/200)．The buccal mucosa had highest incidence of 41.4%(12/29)．Degree Ⅱ oral mucositis had highest incidence of 41.4% (12/29)．The study showed that the influencing factor of oral mucositis was the choice of mouthwash[OR = 2.450, 95%CI(1.038-5.784), P = 0.041].

Conclusions

It is important to pay more attention to oral nursing and the choice of mouthwash in children with ALL after HD-MTX.

Key words: Methotrexate, Stomatitis, Precursor cell lymphoblastic leukemia-lymphoma, Child
表1 各研究因素及其赋值方法
Table 1 Study factors and their valuations
研究因素 赋值方法 研究因素 赋值方法
性别 男设定为0，女设定为1 恶心、呕吐 无设定为0，有设定为1
年龄 实测值 尿液pH值 实测值
漱口液 1 ∶ 10的0.050%强力碘稀释液设定为0，1 ∶ 20的0.025%强力碘稀释液设定为1 血WBC 正常设定为0，Ⅰ度设定为1，Ⅱ度设定为2，Ⅲ度设定为3，Ⅳ度设定为4
MTX剂量 2 g/(m2 ? d)设定为0，5 g/(m2 ? d)设定为1 口腔黏膜炎 未发生设定为0，发生设定为1
表2 不同程度口腔黏膜炎发生率及构成比[n（%）]
Table 2 Incidence and constituent ratio of the different severity of oral mucositis[n（%）]
分度 构成比 发生率 分度 构成比 发生率
Ⅰ度 8(27.6) 8(4.0) Ⅲ度 6(20.7) 6(3.0)
Ⅱ度 12(41.4) 12(6.0) Ⅳ度 3( 10.3) 3(1.5)
表3 29例口腔黏膜炎发生部位构成比[n（％）]
Table 3 Constituent ratio of location of 29 oral mucositis cases [n（％）]
发生部位 构成比 发生部位 构成比
颊部 12(41.4) 舌 4( 13.8)
牙龈 6(20.7) 软腭 1 (3.4)
唇 6(20.7) 硬腭 0 (0.0)
表4 影响口腔黏膜炎的多因素logistic回归分析结果
Table 4 Logistic analysis about influencing factors of oral mucositis
影响因素 β S. E. Wald OR(95%CI) P
性别 0.354 0.508 0.484 1.424(0.526~3.854) 0.486
年龄 －0.016 0.056 0.079 0.984(0.882~1.098) 0.778
MTX用量 0.119 0.513 0.054 1.127(0.412~3.080) 0.816
尿pH值 0.690 0.403 2.924 1.993(0.904 ～ 4.392) 0.087
血WBC 0.061 0.185 0.110 1.063(0.740~1.527) 0.740
漱口液的选择 0.896 0.438 4.184 2.450(1.038~5.784) 0.041
恶心、呕吐 0.221 0.425 0.272 1.248(0.543~2.868) 0.602
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