大剂量甲氨蝶呤诱发急性淋巴细胞白血病患儿口腔黏膜炎的发生情况及其影响因素分析

目的：探讨大剂量甲氨蝶呤（HD-MTX）治疗儿童急性淋巴细胞白血病（ALL）后,患儿发生口腔黏膜炎情况及其影响因素,为预防和减少 H D-MT X治疗后口腔黏膜炎的发生提供参考。方法选择2010年5月至2011年1月在四川大学华西第二医院住院并采用 CCLG-ALL2008化疗方案治疗的儿童ALL患儿200例为研究对象（本研究遵循的程序符合国家卫生和计划委员会《涉及人的生物医学研究伦理审查办法（试行）》的规定,并得到四川大学华西第二医院伦理委员会批准,征得受试对象监护人知情同意,并与监护人签署临床研究知情同意书）。记录其年龄、性别、临床分度、漱口液的选择等口腔黏膜炎相关因素情况进行统计学分析。结果本组受试对象中,口腔黏膜炎的发生率为14.5%（29/200）;发生部位以颊部最为常见,占41.4%（12/29）;口腔黏膜炎严重程度以Ⅱ度最多,占41.4%（12/29）;漱口液的选择是发生口腔黏膜炎的影响因素[OR=2.450,95%CI（1.038-5.784）,P=0.041]。结论 HD-MTX 治疗儿童ALL后,应加强对患儿的口腔护理,并重视对漱口液的选择。

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

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.