合并全身系统性疾病的顽固性复发性阿弗他溃疡患者的诊疗策略  

Diagnosis and treatment strategies for patients with refractory recurrent aphthous ulcer and systemic diseases

作　　者：王文梅[1] 彭巧 王翔[1] 朱雅男[2] WANG Wenmei;PENG Qiao;WANG Xiang;ZHU Yanan(Department of Oral Medicine,Nanjing Stomatological Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China;Department of Endodontics,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China.)

机构地区：[1]南京大学医学院附属口腔医院(南京市口腔医院)口腔黏膜病科,江苏南京210008 [2]南京大学医学院附属口腔医院(南京市口腔医院)牙体牙髓病科,江苏南京210008

出　　处：《口腔疾病防治》2023年第11期761-767,共7页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金(82201055,81870767);江苏省临床医学科技专项(BL2014018);江苏省科教强卫青年医学人才项目(QNRC2016118)。

摘　　要：复发性阿弗他溃疡(recurrent aphthous ulcer,RAU)是最常见的口腔黏膜溃疡类疾病。国内外目前尚无根治的特效方法,尤其是顽固性RAU的治疗更加棘手,显著影响患者的口腔健康水平和生活质量。研究证实,顽固性RAU患者常常合并全身系统性疾病,增加了口腔溃疡治疗难度。而临床中口腔专科医师常常专注于口腔问题的处理,忽略了从全身角度对RAU发病原因及诊治进行评估和决策。为此,本文在基于国内外各种相关文献及笔者团队的临床实践基础上,总结出顽固性RAU可能合并的常见系统性疾病的主要临床表现,包括炎症性肠炎、缺铁性贫血、糖尿病、白塞综合征、莱特尔综合征、斯泼卢综合征、Sutton综合征及艾滋病等。在此基础上,本文阐述了对这类患者的治疗策略,即对系统性疾病的积极治疗联合针对RAU采取的局部或全身用药、局部理疗、中医中药治疗和心理治疗等措施。本文旨在为临床医师对顽固性RAU的诊疗提供更加全面的认知,以期为患者做出个性化的治疗方案,提高顽固性RAU临床疗效。Recurrent aphthous ulcer(RAU)is one of the most common diseases of the oral mucosa.At present,no effective method is available for RAU treatment,especially for refractory RAU,which significantly affects patients’oral health and quality of life.Research shows that combination with systemic diseases greatly increases the difficulty of curing refractory RAU,making conventional oral ulcer treatment harder to perform effectively.This is probably because dentists commonly only focus on handling oral ulcers but neglect to think about the etiology of oral ulcers from a holistic perspective.Thus,we summarized some conditions of refractory RAU accompanied by systemic diseases,including inflammatory bowel disease,iron deficiency anemia,diabetes mellitus,Behçet’s disease,Reiter’s syndrome,sprue syndrome,Sutton syndrome,and acquired immunodeficiency syndrome.We also outlined the treatment principles of these patients.To be specific,on the one hand,dentists should cooperate with the relevant specialists to treat the systemic diseases,while on the other hand they should take measures including topical/general use of medicine,local physical therapy,Traditional Chinese medicine treatment,and psychotherapy for RAU management.This paper aims to provide clinicians with a more comprehensive understanding of the diagnosis and treatment of refractory RAU,in order to make personalized treatment plans for patients and improve the clinical efficacy of refractory RAU.

关 键 词：顽固性复发性阿弗他溃疡 系统性疾病 炎症性肠炎 缺铁性贫血 糖尿病 白塞综合征 莱特尔综合征 斯泼卢综合征 Sutton综合征 艾滋病 

分 类 号：R78[医药卫生—口腔医学]