风险期及0期药物相关性颌骨坏死的研究进展  

Research progress on the at-risk category and stage 0 of medication-related osteonecrosis of the jaw

作　　者：杨沐 康非吾[1] 张雪明[1] YANG Mu;KANG Feiwu;ZHANG Xueming(Shanghai Engineering Research Center of Tooth Restoration and Regeneration&Tongji Research Institute of Stomatology&Department of Oral and Maxillofacial Surgery,Shanghai Tongji Stomatological Hospital and Dental School,Tongji University,Shanghai 200072,China)

机构地区：[1]上海市同济口腔医院口腔颌面外科,同济大学口腔医学院,上海牙组织修复与再生工程技术研究中心,同济大学口腔医学研究所,上海200072

出　　处：《口腔颌面外科杂志》2025年第1期53-58,共6页Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(82271013);上海市科委“科技创新行动计划”医学创新研究专项(22Y11903100);同济大学中央高校基本科研业务费专项资金自主原创项目(22120240389)。

摘　　要：药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)是指因恶性肿瘤骨转移、骨质疏松等疾病使用抗骨吸收类药物(anti-resorptive,AR)和抗血管生成类药物(anti-angiogenic,AA)等所致的颌骨代谢紊乱及骨坏死类疾病。美国口腔颌面外科医师协会(American Association of Oral and Maxillofacial Surgeons,AAOMS)根据临床表现将MRONJ分成5期,其中,风险期指口服或静脉注射相关药物的患者,颌面部无任何异常症状;0期指没有发现临床可见的颌骨坏死,但是有非特异性的临床表现、影像学变化和症状。目前,0期MRONJ的诊断和治疗方法尚存在不确定性,如何有效预防风险期和0期患者向确立期的MRONJ转化存在争议。本文通过回顾0期MRONJ的诊断方法与治疗现状,分析针对风险期患者实施口腔有创操作的临床实践与研究成果,指出当前研究领域中存在的争议点与不确定性,旨在为未来的科学研究与临床实践提供参考与启示。Medication-related osteonecrosis of the jaw(MRONJ)is a metabolic disorder and a form of jaw osteonecrosis that arises from the use of bisphosphonates,anti-angiogenic drugs,and other medications in the treatment of conditions such as malignant tumor bone metastasis and osteoporosis.The American Association of Oral and Maxillofacial Surgeons(AAOMS)has categorized MRONJ into five stages based on clinical manifestations.Within this classification,the at-risk category encompasses asymptomatic patients who have received intravenous or oral antiresorptive therapy but show no apparent necrotic bone.Stage 0 refers to patients who exhibit no clinical evidence of necrotic bone yet present with nonspecific symptoms or clinical and radiographic findings.Presently,the diagnosis and treatment of stage 0 MRONJ still exhibit uncertainties.There is controversy regarding the effective prevention of progression from at-risk and stage 0 patients to established MRONJ.This article reviews the diagnostic approaches and current treatment status of stage 0 MRONJ,analyzes the clinical practices and research findings concerning invasive oral procedures for at-risk patients,and highlights the controversies and uncertainties within the current research field.The aim is to provide valuable insights and references for future scientific research and clinical practice.

关 键 词：药物相关性颌骨坏死 骨改良药物 口腔并发症 诊断 预防 治疗 

分 类 号：R782[医药卫生—口腔医学]