| Objective:Oral mucositis is a common complication after chemotherapy in children with hematologic malignancies.It not only significantly affects the quality of life of children,leading to pain and insufficient intake,but also may cause secondary systemic infections,reduce the tolerance and compliance of anti-tumor therapy,lead to the delay of chemotherapy,and even affect the anti-tumor efficacy.This study aims to investigate the effect of Recombinant human granulocyte-macrophage colony stimulating factor(rh GM-CSF)on oral mucositis in children after chemotherapy.In order to relieve pain,improve quality of life,reduce the chance of infection,promote disease recovery in children,and provide evidence for the treatment of chemotherapy-related oral mucositis with rh GM-CSF gargle.Methods:Children with leukemia,lymphoma and solid tumor(neuroblastoma,rhabdomy-osarcoma,etc.)who received chemotherapy and developed oral mucositis in the Affiliated Hospital of Qingdao University from July 2021 to February 2023 were selected as the study objects to conduct a retrospective study.The children were divided into two groups according to whether they received gargle with rh MG-CSF or not.Those who received conventional chemotherapy-related oral mucositis were the control group,and those who received conventional chemotherapy-related oral mucositis plus gargle with rh GM-CSF were the observation group.The following data of the children were collected:1.General information:name,gender,age and type of neoplastic diseases of the children.2.Efficacy indexes of chemotherapy-related oral mucositis:Grades of oral mucositis were collected at the beginning of treatment,day 5,day 10 and day 14.Compared with the grade level at the beginning of treatment,effective oral mucositis was cured or reduced by grade≥1,while no change in grade or aggravation was invalid.The healing time of mucositis was collected and recorded.Effective rate=number of effective cases/number of cases in the group×100%.3.Indicators of immune function:absolute count of peripheral blood lymphocyte subsets,immunoglobulin level and neutrophil deficiency rate at the beginning of mucositis treatment.4.New infections:The new infections of the two groups from starting the mucositis treatment to 5 days after oral mucositis healed.Statistical analysis:using SPSS26.0 statistical software for data analysis,measurement data accord with normal distribution with mean add and subtract the standard deviation((?)±s).The t test of two independent samples was used for comparison between groups.Measurement data inconsistent with normal distribution were represented by quartiles,and comparison between groups was conducted by Mann-Whitney U test.The adoption rate of counting data(%)was indicated.The Chi-square test,continuously corrected Chi-square test or Fisher exact probability method were used for comparison between groups.P<0.05indicated statistically significant difference.Results:1.Comparison of general data:A total of 56 children with chemotherapy-related oral mucositis were included in this study,including 26 in the observation group and 30 in the control group.There was no significant difference in age and gender between the two groups(P>0.05).2.Comparison of the efficacy of chemotherapy related oral mucositis:(1)Comparison of the effective rate of oral mucositis between the observation group and the control group:the effective rate of the observation group and the control group on day 5 was 23.1%and20.0%,respectively,with no statistical significance between the two groups(P>0.05);The effective rates on day 10 were 84.6%and 56.7%,respectively,with statistical significance(P<0.05).The effective rates on day 14 were 100%and 93.3%,respectively,with no statistical significance(P>0.05).(2)The healing time of oral mucositis in the observation group and the control group was 8.19±3.287 days and 10.20±4.350 days,respectively.There was no statistical significance between the two groups(P>0.05).3.Comparison of immune function indexes between the observation group and the control group:A total of 42 children in the observation group and the control group completed the detection of the absolute count of regulatory lymphocyte subsets and immunoglobulin,including 19 in the observation group and 23 in the control group.(1)There was no statistical difference in the levels of CD3~+,CD4~+,CD8~+and CD19~+between the two groups(P>0.05),while the level of CD3~+-CD56~+in the control group was higher than that in the observation group,with statistical significance(P<0.05).(2)The Ig M levels in the two groups were 0.39(0.23-0.64)g/L and 0.56(0.34-0.75)g/L,respectively.The Ig G levels of the two groups were 7.72±3.48g/L and 8.53±4.01g/L。And there were no significant differences in Ig M and Ig G levels between the two groups at the beginning of oral mucositis treatment(P>0.05).4.Comparison of the rate of granulocytic deficiency between the observation group and the control group:At the beginning of oral mucositis treatment,there were 16 cases of granulocytic deficiency in the observation group,with a rate of 61.5%,and 12 cases of granulocytic deficiency in the control group,with a rate of 40%.There was no statistical significance in the comparison of the rate of granulocytic deficiency between the two groups(P>0.05).5.Comparison of new infections within the beginning of oral mucositis treatment to 5days after oral mucositis healed between the observation group and the control group:There were 25 cases(44.6%)of new infections between the observation group and the control group,10 cases(38.5%)and 15 cases(50.0%),respectively.There was no statistical significance in the comparison of new infection rate between the two groups(P>0.05).The time of occurrence of new infection was 3.50(1.0-10.50)days in the observation group and 3.00(1.00-10.00)days in the control group,and there was no statistical significance between the two groups(P>0.05).Conclusions:1.The incidence of chemotherapy-related oral mucositis in children with hemato-neoplastic diseases is high,which significantly affects the quality of life.2.Chemotherapy-related oral mucositis requires standardized management,comprehensive treatment including oral hygiene,mucosal protection and nutritional support,combined with gargling of rh GM-CSF,which is beneficial to the recovery of oral mucositis.3.The incidence of secondary systemic infection after chemotherapy-related oral mucositis in children is high,mainly with granulocyte-deficient fever,sepsis,bloodstream infection and other serious infections.4.Gargling with rh GM-CSF combined with conventional comprehensive treatment does not reduce the chance of secondary systemic infection in children with chemotherapy-related oral mucositis. |
