血清甲状腺抗体对口腔扁平苔藓治疗方案选择意义的初步探讨  

Preliminary study on the significance of serum thyroid antibody in the selection of treatment for oral lichen planus

作　　者：刘传霞 陈方曼 张珊珊 唐帆 章尚君 钱韵 陈谦明 Liu Chuanxia;Chen Fangman;Zhang Shanshan;Tang Fan;Zhang Shangjun;Qian Yun;Chen Qianming(Department of Oral Medicine,Stomatology Hospital,School of Stomatology,Zhejiang University School of Medicine&Clinical Research Center for Oral Diseases of Zhejiang Province&Key Laboratory of Oral Biomedical Research of Zhejiang Province&Cancer Center of Zhejiang University&Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province,Hangzhou 310005,China;Department of Clinical Laboratory,Stomatology Hospital,School of Stomatology,Zhejiang University School of Medicine&Clinical Research Center for Oral Diseases of Zhejiang Province&Key Laboratory of Oral Biomedical Research of Zhejiang Province&Cancer Center of Zhejiang University&Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province,Hangzhou 310005,China)

机构地区：[1]浙江大学医学院附属口腔医院口腔内科中心·浙江大学口腔医学院,浙江省口腔疾病临床医学研究中心,浙江省口腔生物医学研究重点实验室,浙江大学癌症研究院,口腔生物材料与器械浙江省工程研究中心,杭州310005 [2]浙江大学医学院附属口腔医院检验科·浙江大学口腔医学院,浙江省口腔疾病临床医学研究中心,浙江省口腔生物医学研究重点实验室,浙江大学癌症研究院,口腔生物材料与器械浙江省工程研究中心,杭州310005

出　　处：《中华口腔医学杂志》2025年第3期223-231,共9页Chinese Journal of Stomatology

基　　金：浙江省卫生健康重大科技计划项目(WKJ-ZJ-2212);国家自然科学基金(82330029);浙江省科技计划项目(2024C03193);浙江省教育厅一般科研项目(Y202353386)。

摘　　要：目的初步探讨口腔扁平苔藓(OLP)伴甲状腺抗体阳性患者不同治疗方案的疗效及其与甲状腺抗体滴度的相关性,以期为伴甲状腺抗体阳性的OLP患者提供更有针对性的诊疗方案。方法纳入2020年2月至2024年6月于浙江大学医学院附属口腔医院口腔内科中心因OLP就诊,且做过甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TGAb)血清检测的患者。记录人口学资料及临床信息,收集患者TPOAb及TGAb的定性状况及其定量滴度。将TPOAb和(或)TGAb阳性患者纳入抗体阳性组,TPOAb及TGAb均阴性患者纳入抗体阴性组。根据治疗方案分为局部治疗组、局部治疗联合口服免疫抑制剂组、局部治疗联合口服免疫增强剂组。分别于治疗后2周、1个月比较抗体阳性组与抗体阴性组不同治疗方案的临床疗效,并分析不同临床疗效与年龄、性别、甲状腺抗体滴度的相关性。结果本研究共纳入116例OLP患者,其中抗体阳性组患者38例(32.8%),抗体阴性组患者78例(67.2%)。与治疗前相比,局部治疗以及局部治疗联合口服免疫抑制治疗后2周、1个月,抗体阴性组患者的改良OLP评分和疼痛程度显著改善(均P<0.01),而抗体阳性组患者虽有缓解趋势,但治疗前后相比差异均无统计学意义(均P>0.05)。局部治疗联合口服免疫增强剂者,治疗后2周和1个月抗体阳性组和抗体阴性组患者改良OLP评分和疼痛程度与治疗前相比差异均有统计学意义(P<0.01),且两组间疗效差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,OLP在局部治疗组、局部治疗联合口服免疫抑制剂组、局部治疗联合口服免疫增强剂组的疗效与年龄、性别、TPOAb滴度、TGAb滴度均无显著相关性(P>0.05)。结论甲状腺抗体TPOAb、TGAb可作为OLP治疗方案选择的参考因素;OLP伴甲状腺抗体阳性患者,可优先选择局部治疗联合口服免疫增强剂的治疗方案。ObjectiveTo investigate the efficacy of different treatment of oral lichen planus(OLP)patients with thyroid antibody positive and its correlation with thyroid antibody,providing more targeted treatment for OLP patients with thyroid antibody positive.MethodsPatients who were admitted to Department of Oral Medicine,Stomatology Hospital,School of Stomatology,Zhejiang University School of Medicine for OLP with serum thyroid peroxidase antibody(TPOAb)and thyroglobulin antibody(TGAb)from February 2020 to June 2024 were included.Demographic and clinical data were recorded,and qualitative status and quantitative titers of TPOAb/TGAb were collected.TPOAb and/or TGAb positive patients were included into the thyroid antibody positive group,while patients with both TPOAb and TGAb negative were included into the thyroid antibody negative group.According to the treatment methods,they were divided into topical treatment group,topical treatment combined with oral immunosuppressant group,and topical treatment combined with oral immunoenhancer group.After 2 weeks and 1 month of treatment,the clinical efficacy of thyroid antibody positive group and negative group in OLP patients under different treatment methods were compared,and the correlations of different clinical efficacy with age,sex and thyroid antibody titer were analyzed.ResultsA total of 116 OLP patients were included in this study,of which 38(32.8%)were thyroid antibody positive and 78(67.2%)were thyroid antibody negative.Compared with untreated,the modified OLP score and pain degree in thyroid antibody negative group were significantly improved after 2 weeks and 1 month of topical treatment and topical treatment combined with oral immunosuppression(P<0.01).Although the thyroid antibody positive group also showed a remission trend,there was no statistical significance before and after treatment(P>0.05).For topical treatment combined with oral immunoenhancer,the modified OLP score and pain degree in both groups of antibody positive and negative were statistically signific

关 键 词：扁平苔藓 口腔 甲状腺炎 桥本甲状腺炎 甲状腺过氧化物酶抗体 甲状腺球蛋白抗体 临床疗效 

分 类 号：R781.5[医药卫生—口腔医学]