Résumé
Radiotherapy is the main treatment for patients with head and neck cancer. Radiation-induced oral mucositis (RIOM) is one of the common complications of patients with head and neck cancer during radiotherapy. It is a mucus injury reaction related to dysphagia and oral pain, which will affect the quality of life and prognosis of patients when it becomes severe. Therefore, prevention and treatment of RIOM are of significance for patients. In this article, the pathogenesis, clinical manifestations, treatment and prevention methods of RIOM were summarized, aiming to provide guidance for the treatment of oral mucositis caused by radiotherapy in patients with head and neck cancer.
Résumé
Objective:To investigate the application of serum creatinine to prealbumin ratio (Scr/PA) in the diagnosis of patients with heart failure complicated with renal failure.Methods:This was a case-control study. Patients with chronic heart failure and heart failure complicated with renal failure admitted to Dalian Central Hospital from January 5, 2020 to April 23, 2023 were retrospectively analyzed, and Scr/PA was calculated. The general data and laboratory examination indexes of the two groups were compared. According to the data type, t test, Wilcoxon rank sum test and χ 2 test were used for comparison between the two groups. The risk factors of heart failure complicated with renal failure were analyzed by univariate and multivariate logistic regression analysis, and Spearman correlation analysis was used to analyze the correlation between Scr/PA and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and hemoglobin (HGB). ROC curve was used to determine the predictive value of Scr/PA and NT-proBNP for heart failure complicated with renal failure. Results:Compared with the heart failure group, Triglyceride [1.25 (0.94, 1.81) mmol/L vs. 1.07 (0.76, 1.46) mmol/L, Z=-2.159, P=0.031], D-dimer [2.30 (1.53, 4.67) mg/L vs. 1.63 (0.64, 2.96) mg/L, Z=-2.339, P=0.02],NT-proBNP [18 500 (9 575, 30 000) pg/ml vs. 4 865 (1 600, 9 800) pg/ml, Z=-5.637, P<0.001], Scr/PA [0.233 (0.188, 0.351) mg/mg vs 0.064 (0.044, 0.103) mg/mg, Z=-8.197, P<0.001] were higher in heart failure complicated with renal failure group. While albumin [(33.9±5.2) g/L vs. (36.3±4.3) g/L, t=-2.173, P=0.008], estimated glomerular filtration rate[12.86 (7.88, 17.40) ml/(1 min×1.73 m 2) vs. 65.82 (48.66, 86.32) ml/(1 min×1.73 m 2), Z=-9.794, P<0.001], and HGB [(91±24) g/L vs. (123±23) g/L, t=-7.489, P<0.001] were lower. Univariate logistic regression analysis showed that albumin ( OR=0.900, 95% CI 0.830-0.975, P=0.010), HGB ( OR=0.948, 95% CI 0.930-0.966, P<0.001), Scr/PA ( OR=1.639, 95% CI 1.346-1.957, P<0.001) were associated with heart failure complicated with renal failure. Multivariate logistic regression analysis showed that only Scr/PA was an independent risk factor for heart failure complicated with renal failure. The correlation coefficients of Scr/PA with NT-proBNP and HGB were r=0.578 and r=-0.559, respectively (all P<0.001). The area under the AUC curve of Scr/PA and NT-proBNP for predicting heart failure complicated with renal failure was 0.927 (95% CI: 0.881-0.973, P<0.001) and 0.797 (95% CI: 0.717-0.877, P<0.001), respectively. Conclusions:Scr/PA is an independent risk factor for heart failure complicated with renal failure, and it has a good correlation with NT-proBNP and HGB. Scr/PA is superior to NT-proBNP in predicting heart failure complicated with renal failure.