9种口腔护理液对癌症患者口腔黏膜炎预防效果的网状Meta分析
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摘要
目的:用网状Meta分析评价9种口腔护理液预防癌症患者口腔黏膜炎(Oral Mucositis,OM)的应用效果。方法:计算机检索PubMed、Embase、Scopus、The Cochrane Library、Google Scholar、CNKI、维普、CBM和万方等数据库,搜集有关口腔护理液预防OM的随机对照试验(RCT),检索时限均从建库至2018年8月。采用Cochrane手册对纳入RCT进行偏倚风险评估,由2位研究者独立提取及分析数据,采用Stata 15.0软件对所得的数据进行网状Meta分析。结果:共纳入28个RCT,包括1811例患者。网状Meta分析结果显示,9种口腔护理液预防OM效果中,与安慰剂比较,洗必泰、苄达明、蜂蜜和姜黄素分别在降低癌症患者OM发生率上差异有统计学意义(P<0.05);与聚维酮碘比较,蜂蜜和姜黄素能更有效降低OM的发生率,差异具有统计学意义(P<0.05),根据累积排序概率曲线下面积(SUCRA)值的大小对不同口腔护理液进行排序,排序结果从优到劣依次为姜黄素、蜂蜜、苄达明、洗必泰、别嘌呤醇、硫糖铝、GM-CSF、聚维酮碘、芦荟。结论:根据SUCRA排序结果得出姜黄素对癌症患者OM的预防效果优于其他口腔护理液,但本结论仍需更大样本的RCT进一步验证。
Objective: To evaluate the effects of nine mouthwashes on the prevention of oral mucositis(OM) in patients with cancer by network Meta-analysis. Methods: Databases including PubMed, Embase, Scopus, the Cochrane Library,Google Scholar, CNKI, VIP, CBM, and WanFang were searched. Studies were limited to randomized control trials(RCT)about the effects of nine mouthwashes in the prevention of OM up to August 2018. The Cochrane Handbook was used to evaluate the methodological quality. Two authors screened literature and extracted data independently. The network Metaanalysis was performed using Stata 15.0 softwares. Results: A total of 28 RCTs involving 1811 patients were included. The network Meta-analysis results showed that chlorhexidine, benzydamine, honey and curcumin significantly reduce incidence of mucositis compared to placebo(P<0.05), honey and curcumin significantly reduce incidence of mucositis compared to povidone-iodine(P<0.05). According to SUCRA, probability ranking in descending order is curcumin, honey, benzydamine,chlorhexidine, allopurinol, sucralfate, GM-CSF, povidone-iodine, aloe. Conclusion: This Meta-analysis found that curcumin is significantly effective in preventing the incidence of oral mucositis in patients with cancer compared with other mouthwashes. However, more randomized controlled trials with larger sample size are needed for further verification.
Objective: To evaluate the effects of nine mouthwashes on the prevention of oral mucositis(OM) in patients with cancer by network Meta-analysis. Methods: Databases including PubMed, Embase, Scopus, the Cochrane Library,Google Scholar, CNKI, VIP, CBM, and WanFang were searched. Studies were limited to randomized control trials(RCT)about the effects of nine mouthwashes in the prevention of OM up to August 2018. The Cochrane Handbook was used to evaluate the methodological quality. Two authors screened literature and extracted data independently. The network Metaanalysis was performed using Stata 15.0 softwares. Results: A total of 28 RCTs involving 1811 patients were included. The network Meta-analysis results showed that chlorhexidine, benzydamine, honey and curcumin significantly reduce incidence of mucositis compared to placebo(P<0.05), honey and curcumin significantly reduce incidence of mucositis compared to povidone-iodine(P<0.05). According to SUCRA, probability ranking in descending order is curcumin, honey, benzydamine,chlorhexidine, allopurinol, sucralfate, GM-CSF, povidone-iodine, aloe. Conclusion: This Meta-analysis found that curcumin is significantly effective in preventing the incidence of oral mucositis in patients with cancer compared with other mouthwashes. However, more randomized controlled trials with larger sample size are needed for further verification.
引文
[1]Oronsky B,Goyal S,Kim MM,et al.A review of clinical radioprotection and chemoprotection for oral mucositis.Transl Oncol,2018,11(3):771-778.
[2]Lecidamia D,Nyellisonn DL,Isabella R,et al.Factors contributing to the duration of chemotherapy-induced severe oral mucositis in oncopediatric patients.International Journal of Environmental Research and Public Health,2018,15(6):1153.
[3]Maria OM,Eliopoulos N,Muanza T.Radiation-induced oral mucositis.Front Oncol,2017(7):89.
[4]Filicko J,Lazar us H M,Flomenberg N.Mucosal injury in patients undergoing hematopoietic progenitor cell transplantation:new approaches to prophylaxis and treatment.Bone Marrow Transplant,2003,31(1):1-10.
[5]Georgiou M,Patapatiou G,Domoxoudis S,et al.Oral Mucositis:understanding the pathology and management.Hippokratia,2012,16(3):215-216.
[6]Villa A,Sonis ST.Mucositis:pathobiology and management.Curr Opin Oncol,2015,27(3):159-164.
[7]Bressan V,Bagnasco A,Aleo G,et al.The life experience of nutrition impact symptoms during treatment for head and neck cancer patients:a systematic review and meta-synthesis.Support Care Cancer,2017,25(5):1699-1712.
[8]Keefe DM,Schubert MM,Elting LS,et al.Updated clinical practice guidelines for the prevention and treatment of mucositis.Cancer,2007,109(5):820-831.
[9]Garcia-Perdomo HA.Network meta-analysis,a new statistical technique at urologists'disposal to improve decision making.Int Braz J Urol,2018,44(3):422-428.
[10]Chaimani A,Higgins JP,Mavridis D,et al.Graphical tools for network meta-analysis in STATA.PLoS One,2013,8(10):e76654.
[11]Amanat A,Ahmed A,Kazmi A,et al.The effect of honey on radiation-induced oral mucositis in head and neck cancer patients.Indian J Palliat Care,2017,23(3):317-320.
[12]Rao S,Hegde SK,Rao P,et al.Honey mitigates radiation-induced oral mucositis in head and neck cancer patients without affecting the tumor response.Foods,2017,6(9):77.
[13]Jayalekshmi JL,Lakshmi R,Mukerji A.Honey on oral mucositis:a randomized controlled trial.Gulf J Oncolog,2016,1(20):30-37.
[14]Eslami H,Pouralibaba F,Falsafi P,et al.Efficacy of Hypozalix spray and propolis mouthwash for prevention of chemotherapyinduced oral mucositis in leukemic patients:a double-blind randomized clinical trial.J Dent Res Dent Clin Dent Prospects,2016,10(4):226-233.
[15]S a h e b j a m e e M,M a n s o u r i a n A,Hajimirzamohammad M,et al.Comparative ef f ica cy of a oe ve r a a nd be n z yd a m i ne mouthwashes on radiation-induced oral mucositis:a triple-blind,randomised,controlled clinical trial.Oral Health Prev Dent,2015,13(4):309-315.
[16]Hawley P,Hovan A,McGahan CE,et al.Arandomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis.Support Care Cancer,2014,22(3):751-761.
[17]Rao S,Dinkar C,Vaishnav LK,et al.The Indian spice turmeric delays and mitigates radiation-induced oral mucositis in patients undergoing treatment for head and neck cancer:an investigational study.Integr Cancer Ther,2014,13(3):201-210.
[18]Jayachandran S,Balaji N.Evaluating the effectiveness of topical application of natural honey and benzydamine hydrochloride in the management of radiation mucositis.Indian JPalliat Care,2012,18(3):190-195.
[19]Roopashri G,Jayanthi K,Guruprasad R.Efficacy of benzydamine hydrochloride,chlorhexidine,and povidone iodine in the treatment of oral mucositis among patients undergoing radiotherapy in head and neck malignancies:a drug trail.Contemp Clin Dent,2011,2(1):8-12.
[20]Panahi Y,Ala S,Saeedi M,et al.Allopurinol mouth rinse for prophylaxis of fluorouracilinduced mucositis.Eur J Cancer Care(Engl),2010,19(3):308-312.
[21]Khanal B,Baliga M,Uppal N.Effect of topical honey on limitation of radiation-induced oral mucositis:an intervention study.Int J Oral Maxillofac Surg,2010,39(12):1181-1185.
[22]Kazemian A,Kamian S,Aghili M,et al.Benzydamine for prophylaxis of radiation-induced oral mucositis in head and neck cancers:a doubleblind placebo-controlled randomized clinical trial.Eur J Cancer Care(Engl),2009,18(2):174-178.
[23]Sorensen JB,Skovsgaard T,Bork E,et al.Double-blind,placebo-controlled,randomized study of chlorhexidine prophylaxis for5-fluorouracil-based chemotherapy-induced oral mucositis with nonblinded randomized comparison to oral cooling(cryotherapy)in gastrointestinal malignancies.Cancer,2008,112(7):1600-1606.
[24]Cheng KKF,Ka TYJ.A pilot study of chlorhexidine and benzydamine oral rinses for the prevention and treatment of irradiation mucositis in patients with head and neck cancer.Cancer Nurs,2006,29(5):423-430.
[25]Vokurka S,BystrickáE,Koza V,et al.The comparative effects of povidone-iodine and normal saline mouthwashes on oral mucositis in patients after high-dose chemotherapy and APBSCT-results of a randomized multicentre study.Support Care Cancer,2005,13(7):554-558.
[26]Dazzi C,Cariello A,Giovanis P,et al.Prophylaxis with GM-CSF mouthwashes does not reduce frequency and duration of severe oral mucositis in patients with solid tumors undergoing high-dose chemotherapy with autologous peripheral blood stem cell transplantation rescue:a double blind,randomized,placebo-controlled study.Ann Oncol,2003,14(4):559-563.
[27]Costa EM,Fer nandes M Z,Quinder LB,et al.Evaluation of an oral preventive protocol in children with acute lymphoblastic leukemia.Pesqui Odontol Bras,2003,17(2):147-150.
[28]Nottage M,McLachlan SA,Brittain MA,et al.Sucralfate mouthwash for prevention and treatment of 5-fluorouracil-induced mucositis:a randomized,placebo-controlled trial.Support Care Cancer,2003,11(1):41-47.
[29]Castagna L,Benhamou E,Pedraza E,et al.Prevention of mucositis in bone mar row transplantation:a double blind randomised controlled trial of sucralfate.Ann Oncol,2001,12(7):953-955.
[30]Epstein JB,Silverman S,Paggiarino DA,et al.Benzydamine HCl for prophylaxis of radiationinduced oral mucositis:results from a multicenter,randomized,double-blind,placebo-controlled clinical trial.Cancer,2001,92(4):875-885.
[31]Sprinzl GM,Galvan O,de Vries A,et al.Local application of granulocyte-macrophage colony stimulating factor(GM-CSF)for the treatment of oral mucositis.Eur J Cancer,2001,37(16):2003-2009.
[32]Cengiz M,Ozyar E,Oztürk D,et al.Sucralfate in the prevention of radiation-induced oral mucositis.J Clin Gastroenterol,1999,28(1):40-43.
[33]Wagner W,Alfrink M,Haus U,et al.Treatment of irradiation-induced mucositis with growth factors(rhGM-CSF)in patients with head and neck cancer.Anticancer Res,1999,19(1B):799-803.
[34]Adamietz IA,Rahn R,B?ttcher HD,et al.Prophylaxis with povidone-iodine against induction of oral mucositis by radiochemotherapy.Support Care Cancer,1998,6(4):373-377.
[35]Foote RL,Loprinzi CL,Frank AR,et al.Randomized trial of a chlorhexidine mouthwash for alleviation of radiation-induced mucositis.JClin Oncol,1994,12(12):2630-2633.
[36]Ferretti GA,Raybould TP,Brown AT,et al.Chlorhexidine prophylaxis for chemotherapy-and radiotherapy-induced stomatitis:a randomized double-blind trial.Oral Surg Oral Med Oral Pathol,1990,69(3):331-338.
[37]Pfeiffer P,Madsen EL,Hansen O,et al.Effect of prophylactic sucralfate suspension on stomatitis induced by cancer chemotherapy.A randomized,double-blind cross-over study.Acta Oncol,1990,29(2):171-173.
[38]Epstein JB,Stevenson-Moore P,Jackson S,et al.Prevention of oral mucositis in radiation therapy:a controlled study with benzydamine hydrochloride rinse.Int J Radiat Oncol Biol Phys,1989,16(6):1571-1575.
[39]Nemes J,Jeneiá,Márton I.Oral mucositis as the most common complication of childhood cancer therapy.Review of the literature.Orv Hetil,2018,159(13):495-502.
[40]Akbar MU,Rehman K,Zia KM,et al.Critical review on curcumin as a therapeutic agent:from traditional herbal medicine to an ideal therapeutic agent.Crit Rev Eukaryot Gene Expr,2018,28(1):17-24.
[41]Liang HH,Huang CY,Chou CW,et al.Heat shock protein 27 influences the anti-cancer effect of curcumin in colon cancer cells through ROSproduction and autophagy activation.Life Sci,2018,209(9):43-51.
[42]Hatamipour M,Ramezani M,Tabassi SAS,et al.Demethoxycurcumin:a naturally occurring curcumin analogue with antitumor properties.J Cell Physiol,2018,233(12):9247-9260.
[43]Hernández M,Wicz S,Santamaría MH,et al.Curcumin exerts anti-inflammatory and vasoprotective effects through amelioration of NFAT-dependent endothelin-1 production in mice with acute Chagas cardiomyopathy.Mem Inst Oswaldo Cruz,2018,113(9):e180171.
[44]Zhang SS,Gong ZJ,Li WH,et al.Antifibrotic effect of curcumin in TGF-β1-induced myofibroblasts from human oral mucosa.Asian Pac J Cancer Prev,2012,13(1):289-294.
[45]Patil K,Guledgud MV,Kulkarni PK,et al.Use of curcumin mouthrinse in radio-chemotherapy induced oral mucositis patients:a pilot study.J Clin Diagn Res,2015,9(8):ZC59-62.
[46]Francis M,Williams S.Effectiveness of Indian turmeric powder with honey as complementary therapy on oral mucositis:a nursing perspective among cancer patients in Mysore.Nurs J India,2014,105(6):258-260.
[47]Santos Filho EXD,Arantes DAC,Oton Leite AF,et al.Randomized clinical trial of a mucoadhesive formulation containing curcuminoids(Zingiberaceae)and Bidens pilosa Linn(Asteraceae)extract(FITOPROT)for prevention and treatment of oral mucositis-phase Istudy.Chem Biol Interact,2018,291(8):228-236.
[48]Molan PC,Allen KL.The effect of gammairradiation on the antibacterial activity of honey.JPharm Pharmacol,1996,48(11):1206-1209.
[49]Co JL,Mejia MB,Que JC,et al.Effectiveness of honey on radiation-induced oral mucositis,time to mucositis,weight loss,and treatment interruptions among patients with head and neck malignancies:a meta-analysis and systematic review of literature.Head Neck,2016,38(7):1119-1128.
[50]Minden-Birkenmaier BA,Bowlin GL.Honey-based templates in wound healing and tissue engineering.Bioengineering(Basel),2018,5(2):E46.
[51]Rubenstein EB,Peterson DE,Schubert M,et al.Clinical practice guidelines for the prevention and treatment of cancer therapyinduced oral and gastrointestinal mucositis.Cancer,2004,100(9 Suppl):2026-2046.
[52]李萌,邓艾平,王奕.2014年MASCC/ISOO肿瘤治疗继发黏膜炎管理的临床实践指南解读.中华放射肿瘤学杂志,2016,25(12):1388-1391.Li M,Deng AP,Wang Y.Interpretation of the clinical practice guidelines by MASCC/ISOO in 2014 for the management of mucositis secondary to cancer therapy.Chin J Radiat Oncol,2016,25(12):1388-1391.
[2]Lecidamia D,Nyellisonn DL,Isabella R,et al.Factors contributing to the duration of chemotherapy-induced severe oral mucositis in oncopediatric patients.International Journal of Environmental Research and Public Health,2018,15(6):1153.
[3]Maria OM,Eliopoulos N,Muanza T.Radiation-induced oral mucositis.Front Oncol,2017(7):89.
[4]Filicko J,Lazar us H M,Flomenberg N.Mucosal injury in patients undergoing hematopoietic progenitor cell transplantation:new approaches to prophylaxis and treatment.Bone Marrow Transplant,2003,31(1):1-10.
[5]Georgiou M,Patapatiou G,Domoxoudis S,et al.Oral Mucositis:understanding the pathology and management.Hippokratia,2012,16(3):215-216.
[6]Villa A,Sonis ST.Mucositis:pathobiology and management.Curr Opin Oncol,2015,27(3):159-164.
[7]Bressan V,Bagnasco A,Aleo G,et al.The life experience of nutrition impact symptoms during treatment for head and neck cancer patients:a systematic review and meta-synthesis.Support Care Cancer,2017,25(5):1699-1712.
[8]Keefe DM,Schubert MM,Elting LS,et al.Updated clinical practice guidelines for the prevention and treatment of mucositis.Cancer,2007,109(5):820-831.
[9]Garcia-Perdomo HA.Network meta-analysis,a new statistical technique at urologists'disposal to improve decision making.Int Braz J Urol,2018,44(3):422-428.
[10]Chaimani A,Higgins JP,Mavridis D,et al.Graphical tools for network meta-analysis in STATA.PLoS One,2013,8(10):e76654.
[11]Amanat A,Ahmed A,Kazmi A,et al.The effect of honey on radiation-induced oral mucositis in head and neck cancer patients.Indian J Palliat Care,2017,23(3):317-320.
[12]Rao S,Hegde SK,Rao P,et al.Honey mitigates radiation-induced oral mucositis in head and neck cancer patients without affecting the tumor response.Foods,2017,6(9):77.
[13]Jayalekshmi JL,Lakshmi R,Mukerji A.Honey on oral mucositis:a randomized controlled trial.Gulf J Oncolog,2016,1(20):30-37.
[14]Eslami H,Pouralibaba F,Falsafi P,et al.Efficacy of Hypozalix spray and propolis mouthwash for prevention of chemotherapyinduced oral mucositis in leukemic patients:a double-blind randomized clinical trial.J Dent Res Dent Clin Dent Prospects,2016,10(4):226-233.
[15]S a h e b j a m e e M,M a n s o u r i a n A,Hajimirzamohammad M,et al.Comparative ef f ica cy of a oe ve r a a nd be n z yd a m i ne mouthwashes on radiation-induced oral mucositis:a triple-blind,randomised,controlled clinical trial.Oral Health Prev Dent,2015,13(4):309-315.
[16]Hawley P,Hovan A,McGahan CE,et al.Arandomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis.Support Care Cancer,2014,22(3):751-761.
[17]Rao S,Dinkar C,Vaishnav LK,et al.The Indian spice turmeric delays and mitigates radiation-induced oral mucositis in patients undergoing treatment for head and neck cancer:an investigational study.Integr Cancer Ther,2014,13(3):201-210.
[18]Jayachandran S,Balaji N.Evaluating the effectiveness of topical application of natural honey and benzydamine hydrochloride in the management of radiation mucositis.Indian JPalliat Care,2012,18(3):190-195.
[19]Roopashri G,Jayanthi K,Guruprasad R.Efficacy of benzydamine hydrochloride,chlorhexidine,and povidone iodine in the treatment of oral mucositis among patients undergoing radiotherapy in head and neck malignancies:a drug trail.Contemp Clin Dent,2011,2(1):8-12.
[20]Panahi Y,Ala S,Saeedi M,et al.Allopurinol mouth rinse for prophylaxis of fluorouracilinduced mucositis.Eur J Cancer Care(Engl),2010,19(3):308-312.
[21]Khanal B,Baliga M,Uppal N.Effect of topical honey on limitation of radiation-induced oral mucositis:an intervention study.Int J Oral Maxillofac Surg,2010,39(12):1181-1185.
[22]Kazemian A,Kamian S,Aghili M,et al.Benzydamine for prophylaxis of radiation-induced oral mucositis in head and neck cancers:a doubleblind placebo-controlled randomized clinical trial.Eur J Cancer Care(Engl),2009,18(2):174-178.
[23]Sorensen JB,Skovsgaard T,Bork E,et al.Double-blind,placebo-controlled,randomized study of chlorhexidine prophylaxis for5-fluorouracil-based chemotherapy-induced oral mucositis with nonblinded randomized comparison to oral cooling(cryotherapy)in gastrointestinal malignancies.Cancer,2008,112(7):1600-1606.
[24]Cheng KKF,Ka TYJ.A pilot study of chlorhexidine and benzydamine oral rinses for the prevention and treatment of irradiation mucositis in patients with head and neck cancer.Cancer Nurs,2006,29(5):423-430.
[25]Vokurka S,BystrickáE,Koza V,et al.The comparative effects of povidone-iodine and normal saline mouthwashes on oral mucositis in patients after high-dose chemotherapy and APBSCT-results of a randomized multicentre study.Support Care Cancer,2005,13(7):554-558.
[26]Dazzi C,Cariello A,Giovanis P,et al.Prophylaxis with GM-CSF mouthwashes does not reduce frequency and duration of severe oral mucositis in patients with solid tumors undergoing high-dose chemotherapy with autologous peripheral blood stem cell transplantation rescue:a double blind,randomized,placebo-controlled study.Ann Oncol,2003,14(4):559-563.
[27]Costa EM,Fer nandes M Z,Quinder LB,et al.Evaluation of an oral preventive protocol in children with acute lymphoblastic leukemia.Pesqui Odontol Bras,2003,17(2):147-150.
[28]Nottage M,McLachlan SA,Brittain MA,et al.Sucralfate mouthwash for prevention and treatment of 5-fluorouracil-induced mucositis:a randomized,placebo-controlled trial.Support Care Cancer,2003,11(1):41-47.
[29]Castagna L,Benhamou E,Pedraza E,et al.Prevention of mucositis in bone mar row transplantation:a double blind randomised controlled trial of sucralfate.Ann Oncol,2001,12(7):953-955.
[30]Epstein JB,Silverman S,Paggiarino DA,et al.Benzydamine HCl for prophylaxis of radiationinduced oral mucositis:results from a multicenter,randomized,double-blind,placebo-controlled clinical trial.Cancer,2001,92(4):875-885.
[31]Sprinzl GM,Galvan O,de Vries A,et al.Local application of granulocyte-macrophage colony stimulating factor(GM-CSF)for the treatment of oral mucositis.Eur J Cancer,2001,37(16):2003-2009.
[32]Cengiz M,Ozyar E,Oztürk D,et al.Sucralfate in the prevention of radiation-induced oral mucositis.J Clin Gastroenterol,1999,28(1):40-43.
[33]Wagner W,Alfrink M,Haus U,et al.Treatment of irradiation-induced mucositis with growth factors(rhGM-CSF)in patients with head and neck cancer.Anticancer Res,1999,19(1B):799-803.
[34]Adamietz IA,Rahn R,B?ttcher HD,et al.Prophylaxis with povidone-iodine against induction of oral mucositis by radiochemotherapy.Support Care Cancer,1998,6(4):373-377.
[35]Foote RL,Loprinzi CL,Frank AR,et al.Randomized trial of a chlorhexidine mouthwash for alleviation of radiation-induced mucositis.JClin Oncol,1994,12(12):2630-2633.
[36]Ferretti GA,Raybould TP,Brown AT,et al.Chlorhexidine prophylaxis for chemotherapy-and radiotherapy-induced stomatitis:a randomized double-blind trial.Oral Surg Oral Med Oral Pathol,1990,69(3):331-338.
[37]Pfeiffer P,Madsen EL,Hansen O,et al.Effect of prophylactic sucralfate suspension on stomatitis induced by cancer chemotherapy.A randomized,double-blind cross-over study.Acta Oncol,1990,29(2):171-173.
[38]Epstein JB,Stevenson-Moore P,Jackson S,et al.Prevention of oral mucositis in radiation therapy:a controlled study with benzydamine hydrochloride rinse.Int J Radiat Oncol Biol Phys,1989,16(6):1571-1575.
[39]Nemes J,Jeneiá,Márton I.Oral mucositis as the most common complication of childhood cancer therapy.Review of the literature.Orv Hetil,2018,159(13):495-502.
[40]Akbar MU,Rehman K,Zia KM,et al.Critical review on curcumin as a therapeutic agent:from traditional herbal medicine to an ideal therapeutic agent.Crit Rev Eukaryot Gene Expr,2018,28(1):17-24.
[41]Liang HH,Huang CY,Chou CW,et al.Heat shock protein 27 influences the anti-cancer effect of curcumin in colon cancer cells through ROSproduction and autophagy activation.Life Sci,2018,209(9):43-51.
[42]Hatamipour M,Ramezani M,Tabassi SAS,et al.Demethoxycurcumin:a naturally occurring curcumin analogue with antitumor properties.J Cell Physiol,2018,233(12):9247-9260.
[43]Hernández M,Wicz S,Santamaría MH,et al.Curcumin exerts anti-inflammatory and vasoprotective effects through amelioration of NFAT-dependent endothelin-1 production in mice with acute Chagas cardiomyopathy.Mem Inst Oswaldo Cruz,2018,113(9):e180171.
[44]Zhang SS,Gong ZJ,Li WH,et al.Antifibrotic effect of curcumin in TGF-β1-induced myofibroblasts from human oral mucosa.Asian Pac J Cancer Prev,2012,13(1):289-294.
[45]Patil K,Guledgud MV,Kulkarni PK,et al.Use of curcumin mouthrinse in radio-chemotherapy induced oral mucositis patients:a pilot study.J Clin Diagn Res,2015,9(8):ZC59-62.
[46]Francis M,Williams S.Effectiveness of Indian turmeric powder with honey as complementary therapy on oral mucositis:a nursing perspective among cancer patients in Mysore.Nurs J India,2014,105(6):258-260.
[47]Santos Filho EXD,Arantes DAC,Oton Leite AF,et al.Randomized clinical trial of a mucoadhesive formulation containing curcuminoids(Zingiberaceae)and Bidens pilosa Linn(Asteraceae)extract(FITOPROT)for prevention and treatment of oral mucositis-phase Istudy.Chem Biol Interact,2018,291(8):228-236.
[48]Molan PC,Allen KL.The effect of gammairradiation on the antibacterial activity of honey.JPharm Pharmacol,1996,48(11):1206-1209.
[49]Co JL,Mejia MB,Que JC,et al.Effectiveness of honey on radiation-induced oral mucositis,time to mucositis,weight loss,and treatment interruptions among patients with head and neck malignancies:a meta-analysis and systematic review of literature.Head Neck,2016,38(7):1119-1128.
[50]Minden-Birkenmaier BA,Bowlin GL.Honey-based templates in wound healing and tissue engineering.Bioengineering(Basel),2018,5(2):E46.
[51]Rubenstein EB,Peterson DE,Schubert M,et al.Clinical practice guidelines for the prevention and treatment of cancer therapyinduced oral and gastrointestinal mucositis.Cancer,2004,100(9 Suppl):2026-2046.
[52]李萌,邓艾平,王奕.2014年MASCC/ISOO肿瘤治疗继发黏膜炎管理的临床实践指南解读.中华放射肿瘤学杂志,2016,25(12):1388-1391.Li M,Deng AP,Wang Y.Interpretation of the clinical practice guidelines by MASCC/ISOO in 2014 for the management of mucositis secondary to cancer therapy.Chin J Radiat Oncol,2016,25(12):1388-1391.