Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer?
Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer?
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发表时间：
2005-02
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通讯作者：
K. Nakada;Tetsuya Ishibashi;Toshiki Takei;K. Hirata;K. Shinohara;Seiichi Katoh;Sonji Zhao;N. Tamaki;Y. Noguchi;S. Noguchi
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作者：
K. Nakada;Tetsuya Ishibashi;Toshiki Takei;K. Hirata;K. Shinohara;Seiichi Katoh;Sonji Zhao;N. Tamaki;Y. Noguchi;S. Noguchi
唾液腺功能障碍是甲状腺癌大剂量放射性碘治疗的常见副作用之一。本研究的目的是确定早期开始吸吮柠檬糖是否会减少放射性碘治疗后的唾液腺损伤。方法对2组分化型甲状腺癌术后患者采用不同的含柠檬糖方案进行放射性碘治疗，前瞻性纵向观察其唾液腺副作用的发生率。1999年8月至2000年10月，连续116例患者在放射性碘治疗后的第一个5d内，每天白天每2-3 h吸吮1 ~ 2个柠檬糖（A组）。柠檬糖吸吮后1小时内开始摄入放射性碘。从2000年11月至2002年6月，连续139名患者（B组）被要求以类似于A组的方式吮吸柠檬糖。在B组中，柠檬糖直到摄入放射性碘后24 h才开始进食。排除了患有唾液腺疾病、糖尿病、胶原组织疾病或既往有放射性碘治疗或颈部外照射史的患者。因此，A组105例患者和B组125例患者可用于分析。两组之间的平均年龄（55.2岁vs. 58.5岁）、血清游离甲状腺素（1 - 3，5，3 '，5'-四碘甲状腺原氨酸）平均水平（0.40 ng/dL vs. 0.47 ng/dL）和（131）I平均给药剂量（3.96 GBq vs. 3.87 GBq）无统计学差异。唾液副作用的发生在住院期间进行监测，并定期随访的基础上与患者的访谈，视觉模拟量表，和唾液腺造影使用（99 m）Tc-高锝酸盐。当患者表现出持续性（>4个月）口干伴唾液腺造影无功能模式时，确定为口干症。结果A组与B组的涎腺炎发生率分别为63.8%与36.8%（P < 0.001），味觉减退或味觉丧失发生率分别为39.0%与25.6%（P <0.01），口干发生率分别为23.8%与11.2%（P < 0.005）。A组15例（14.3%）发生永久性口干，B组7例（5.6%）发生永久性口干（P < 0.05）。在两组中，双侧腮腺受累最常见，其次是双侧颌下腺受累。结论早期开始吸吮柠檬糖可导致唾液腺损伤显著增加。放射性碘治疗后24小时内不应给予柠檬糖。
UNLABELLED Salivary gland dysfunction is one of the common side effects of high-dose radioiodine therapy for thyroid cancer. The purpose of this study was to determine whether an early start of sucking lemon candy decreases salivary gland injury after radioiodine therapy. METHODS The incidence of the side effects of radioiodine therapy on the salivary glands was prospectively and longitudinally investigated in 2 groups of patients with postsurgical differentiated thyroid cancer with varying regimens for sucking lemon candy. From August 1999 to October 2000, 116 consecutive patients were asked to suck 1 or 2 lemon candies every 2-3 h in the daytime of the first 5 d after radioiodine therapy (group A). Lemon candy sucking was started within 1 h after radioiodine ingestion. From November 2000 to June 2002, 139 consecutive patients (group B) were asked to suck lemon candies in a manner similar to that of group A. In the group B, lemon candies were withheld until 24 h after the ingestion of radioiodine. Patients with salivary gland disorders, diabetes, collagen tissue diseases, or a previous history of radioiodine therapy or external irradiation to the neck were excluded. Thus, 105 patients in group A and 125 patients in group B were available for analysis. There were no statistical differences in the mean age (55.2 y vs. 58.5 y), average levels of serum free thyroxine (l-3,5,3',5'-tetraiodothyronine) (0.40 ng/dL vs. 0.47 ng/dL), and the mean dose of (131)I administered (3.96 GBq vs. 3.87 GBq) between the 2 groups. The onset of salivary side effects was monitored during hospital admission and regular follow-up on the basis of interviews with patients, a visual analog scale, and salivary gland scintigraphy using (99m)Tc-pertechnetate. When a patient showed a persistent (>4 mo) dry mouth associated with a nonfunctioning pattern on salivary gland scintigraphy, a diagnosis of xerostomia was established. RESULTS The incidences of sialoadenitis, hypogeusia or taste loss, and dry mouth with or without repeated sialadenitis in group A versus group B were 63.8% versus 36.8% (P < 0.001), 39.0% versus 25.6% (P < 0.01), and 23.8% versus 11.2% (P < 0.005), respectively. Permanent xerostomia occurred in 15 patients in group A (14.3%) and 7 patients in group B (5.6%) (P < 0.05). In both groups, bilateral involvement of the parotid gland was the most frequently seen and was followed by bilateral involvement of the submandibular gland. CONCLUSION An early start of sucking lemon candy may induce a significant increase in salivary gland damage. Lemon candy should not be given until 24 h after radioiodine therapy.