口腔黏膜下纤维性变治疗的循证医学研究  

Evidence⁃based medicine research for the treatment of oral submucous fibrosis

作　　者：郭锦材 谢辉 GUO Jincai;XIE Hui(Department of Pharmacy,Changsha Stomatological Hospital,Changsha 410006,China;School of Stomatology,Hunan University of Chinese Medicine,Changsha 410006,China;School of Pharmacy,Hunan University of Chi-nese Medicine,Changsha 410208,China;Department of Periodontal and Oral Mucosa,Changsha Stomatological Hospital,Changsha 410006,China)

机构地区：[1]长沙市口腔医院药剂科,湖南长沙410006 [2]湖南中医药大学口腔医学院,湖南长沙410006 [3]湖南中医药大学药学院,湖南长沙410208 [4]长沙市口腔医院牙周黏膜科,湖南长沙410006

出　　处：《口腔疾病防治》2024年第12期907-915,共9页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：湖南省自然科学基金(2024JJ9532,2023JJ60071);湖南省中医药科研计划项目(B2023048);湖南省卫生健康委科研计划项目(202313048136);长沙市自然科学基金(kq2403178,kq2208485);长沙市卫生健康委科研计划项目(KJ⁃B2023087);湖南中医药大学院校联合基金项目(2022XYLH134,2022XYLH120)。

摘　　要：口腔黏膜下纤维性变(oralsubmucousfibrosis,OSF)是一种与咀嚼槟榔等因素密切相关的口腔黏膜潜在恶性疾患。OSF的致病机制不明确,无根治方法,目前临床上治疗方法较多,如类固醇、己酮可可碱、番茄红素、姜黄、丹参、芦荟等药物及激光和手术等治疗方法,为了评价这些治疗方法改善OSF最大张口度、灼痛感、舌灵活度等症状的有效性及安全性,近十年学者们已完成了多项循证医学研究。本文对近十年(2014年7月至2024年6月)PubMed、Embase、WebofScience、TheCochraneLibrary、中国知网、万方、维普七大数据库治疗OSF的系统性评价或Meta分析进行归纳总结,为OSF的临床治疗和研究提供参考。当前的循证医学研究表明,己酮可可碱、透明质酸酶联合类固醇、番茄红素、姜黄素、丹参联合类固醇、芦荟等药物可有效改善OSF患者的最大张口度和烧灼感,且安全性好。透明质酸酶联合类固醇、番茄红素、姜黄素、丹参联合类固醇、芦荟证据等级均为A级,己酮可可碱证据等级为B级。番茄红素比其他药物,改善患者最大张口度的效果更好。芦荟在治疗早期比其他药物,改善烧灼感效果更好。此外,抗氧化剂改善OSF的症状效果佳,应用前景好。激光可改善OSF最大张口度、疼痛等症状,但成本较高,证据等级为C级;手术改善OSF最大张口度效果明显,但创伤大,证据等级为C级。目前循证证据纳入的临床研究数量和样本量较少,未来需更多设计良好、随访期长、结局指标标准化的治疗OSF多中心大样本的随机对照临床试验,再进行循证评价。Oral submucous fibrosis(OSF)is an oral potentially malignant disorader that may be closely related to be⁃tel chewing and other factors.The pathogenic mechanism of OSF is still unclear,and there is no cure for OSF.Current⁃ly,there are many clinical treatments for OSF,such as medications,including steroids,pentoxifylline,lycopene,turmer⁃ic,salvia miltiorrhiza,and aloe vera,lasers,and surgery.In order to evaluate the safety and efficacy of these methods to improve the maximum mouth opening,alleviate the burning sensation,increase tongue flexibility,and other symptoms that accompany OSF,researchers have completed some evidence⁃based studies in recent years.We searched PubMed,Embase,Web of Science,The Cochrane Library,CNKI,Wanfang,and VIP databases for systematic reviews or meta⁃analyses of OSF research and treatment published over the last 10 years(July 2014–July 2024).Current evidence⁃based studies have shown that pentoxifylline,hyaluronidase combined with steroids,lycopene,curcumin,salvia miltior⁃rhiza combined with steroids,and aloe vera are effective in improving maximum mouth opening and alleviating the burn⁃ing sensation in patients with OSF.The evidence levels of hyaluronidase combined with steroids,lycopene,curcumin,salvia miltiorrhiza combined with steroids,and aloe vera were all A,and pentoxifylline was B.Lycopene was more effec⁃tive than other positive drugs in improving maximum mouth opening in patients,and aloe vera was more effective than positive drugs in improving the burning sensation in the early stage of treatment.In addition,antioxidants are good for improving OSF symptoms and have promising application.Lasers can improve maximum mouth opening and alleviate pain and other OSF symptoms,but laser treatment is costly and the level of evidence is C.Surgery is effective in improv⁃ing maximum mouth opening,but it is traumatic and the level of evidence is C.However,the current evidence⁃based da⁃ta are not of high quality,and additional well⁃designed multi⁃center,large⁃samp

关 键 词：口腔黏膜下纤维性变 治疗 循证医学 类固醇 丹参 己酮可可碱 透明质酸酶 番茄红素 姜黄素 芦荟 

分 类 号：R78[医药卫生—口腔医学]