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对头颈部恶性肿瘤进行放射治疗,不可避免地引起涎腺的放射损伤,严重影响患者生活质量。放射性涎腺损伤的主要临床和功能改变为腺体肿胀,涎液分泌减少,涎液电解质和蛋白质分泌异常等;其主要病理变化是腺泡细胞变性萎缩、导管扩张、间质纤维化以及淋巴细胞浸润等;其机制与p53信号分子通路介导的细胞凋亡、活性氧所致的膜损伤作用、水通道蛋白1和5表达降低、腱糖蛋白-C和胞外基质蛋白表达增加以及血管内皮细胞损伤等因素密切相关;改进放射治疗技术、颌下腺移植转位保护及合理应用细胞保护剂和促涎剂,可以减轻放射性涎腺损伤。本文对涎腺放射损伤的分子机制及其防治进展进行综述。
Head and neck cancer radiotherapy, inevitably cause salivary gland radiation damage, seriously affecting the quality of life of patients. Radiation salivary gland injury main clinical and functional changes to the swelling of the gland, salivary fluid secretion decreased, salivary fluid electrolyte and protein secretion abnormalities; the main pathological changes are acinar cell degeneration and atrophy, duct dilatation, interstitial fibrosis and lymphocytes Infiltration and so on. The mechanism is related to apoptosis induced by p53 signaling pathway, membrane damage induced by reactive oxygen species, decreased expression of aquaporin 1 and 5, increased expression of tendon glycoprotein-C and extracellular matrix proteins and vascular endothelial Cell injury and other factors are closely related; improved radiotherapy techniques, submandibular gland transposition protection and rational use of cytoprotective agents and salivary agents, can reduce radiation salivary gland injury. This article reviews the molecular mechanism of salivary gland radiation damage and its prevention and treatment progress.