长期使用抗菌药物治疗复发性口腔溃疡引起口腔扁平苔藓1例并文献复习  

Oral lichen planus induced by long-term use of antimicrobials for recurrent aphthous ulcer:A case report and literature review

作　　者：李文杰 高旭阳 王悦彤 徐祎琦 张馨 陈珺 LI Wenjie;GAO Xuyang;WANG Yuetong;XU Yiqi;ZHANG Xin;CHEN Jun(Xiangya Stomatological Hospital,Xiangya School of Stomatology,Central South University,Changsha 410008;State Key Laboratory of Powder Metallurgy,Changsha 410083;National Key Laboratory of Science and Technology on High-strength Structural Materials,Changsha 410083;School of Stomatology,Peking University,Beijing 100081,China)

机构地区：[1]中南大学湘雅口腔医学院湘雅口腔医院,长沙410008 [2]粉末冶金国家重点实验室,长沙410083 [3]轻质高强结构材料国家级重点实验室,长沙410083 [4]北京大学口腔医学院,北京100081

出　　处：《中南大学学报（医学版）》2021年第6期666-672,共7页Journal of Central South University ：Medical Science

基　　金：supported by the Natural Science Foundation of Hunan Province for Young Scientists(2019JJ50784,2020JJ5404);the Hunan Health Commission Research Grant(202080,202108011054);the Young Teacher’s Institutional Grant from Xiangya School of Stomatology and Xiangya Stomatological Hospital,Central South University(2018YQ02,2019YQ01);the Open Sharing Fund for the Large-scale Instruments and Equipments of Central South University(CSUZC202107);the College Students’Innovative Entrepreneurial Training Plan Program(S2020150330417),China。

摘　　要：口腔扁平苔藓(oral lichen planus,OLP)的确切病因仍不清楚,但是现有证据表明药物摄入、病毒感染、真菌感染、心理疾病和免疫缺陷与OLP的发病密切相关。现报告1例长期使用抗菌药物治疗复发性口腔溃疡诱发OLP的病例并对相关文献进行回顾性研究,讨论OLP与滥用抗生素之间的相关性,希望对全科口腔医师和药剂师在口腔疾病抗菌药物应用方面有所启示。本病例为一名42岁的男性患者,因口腔内广泛分布的白色网纹1年余来口腔黏膜科就诊,经组织病理检查诊断为OLP。患者每1~2个月发生1次复发性口腔溃疡,每次出现溃疡都会口服或注射抗菌药物,持续5年时间。该患者通过停止使用抗菌药物和局部抗真菌治疗取得满意的疗效。其OLP的加重和缓解与抗菌药物的使用密切相关。结合文献复习,抗菌药物可能通过念珠菌机会性感染促进OLP的发展。考虑到抗菌药物耐药和机会性感染的严重性,牙科医师应根据指南和循证医学开具抗菌药物。合理地使用抗菌药物是所有牙科医师的责任。The precise etiology of oral lichen planus(OLP)is still unclear,but the existing evidence suggests that drug intake,virus infection,fungal infection,psychological disorders,and immunodeficiency are closely associated with the pathogenesis of OLP.We report a case of OLP accompanied with candidiasis induced by long-term use of antimicrobials for recurrent aphthous ulcer(RAU)and update the literature,to discuss the possible association between OLP and misuse of antimicrobials,and to inform general dentists and pharmacists the importance for practice with optimal antimicrobial stewardship.In this case,a 42-year-old man presented to Xiangya Stomatological Hospital with white reticular patterns spreading in the oral cavity for almost 1 year.He was diagnosed with OLP via histopathological examination.He had a 5-year history of RAU which occurred every 1-2 months,and he was given antimicrobials ingested or injected whenever the ulcers came up.Satisfactory treatment results were obtained by stopping the abuse of antimicrobials and local antifungal therapy.Meanwhile,the exacerbation and alleviation of OLP was closely related to the administration of antimicrobials.Combined with literature review,antimicrobial might contribute to the development of OLP by inducing candidiasis,a common side-effect of misuse of antimicrobials.Considering the seriousness of antimicrobial resistance and opportunistic infection,dentists should prescribe antimicrobials judiciously according to guidelines and evidence-based indications.Appropriate prescribing of antimicrobials is a professional responsibility to all dentists.

关 键 词：口腔扁平苔藓 念珠菌感染 抗菌药物滥用 管理工作 

分 类 号：R758.65[医药卫生—皮肤病学与性病学]