放化疗性口腔黏膜炎模型建立及防治现状

与癌症治疗相关的口腔黏膜炎被认为是最重要的放化疗急性并发症。一般来说,头颈部癌症放疗或放化疗引起的口腔黏膜炎发病率较高,也较为严重;单纯化疗引起的口腔黏膜炎发病率较低,程度较轻。严重的口腔黏膜炎造成病人疼痛、吞咽困难、继发感染、营养障碍,影响癌症的治疗,给病人造成了极大的痛苦。本文对国内外口腔黏膜炎动物模型建立情况和新近的各种防治方法进行综述。     

放化疗性口腔黏膜炎动物模型研究进展

由放疗和(或)化疗诱发的口腔黏膜炎症,可能导致患者疼痛、说话吞咽困难、局部和全身感染风险增高,甚至中断抗癌治疗,严重影响患者生活质量。放化疗性口腔黏膜炎的发病机制复杂而且防治较为困难,而动物模型在探究放化疗性口腔黏膜炎的发病机制以及探索更好的防治方法中发挥了重要作用,本文就以现有的放化疗性口腔黏膜炎动物模型的复制及评估方法予以综述。文献复习结果表明,国内外采用小鼠、大鼠、金仓鼠等动物来复制动物模型;放疗诱发的口腔黏膜炎的诱导方法有仅采用X射线设备对动物进行局部单剂量照射或局部分割照射,或照射时辅助使用化疗药物5 氟尿嘧啶或顺铂,也可以采用137铯作为放射源进行局部照射;单纯使用化疗药物5 氟尿嘧啶诱发的口腔黏膜炎一般症状较轻,因此多采用5 氟尿嘧啶联合机械刺激或乙酸进行诱导;评估放化疗性口腔黏膜炎的方法主要为大体样本观察及组织病理学观察。     

放化疗性口腔黏膜炎相关生物标志物研究进展

放化疗性口腔黏膜炎是肿瘤患者进行放疗和(或)化疗时常见的口腔局部并发症,严重降低患者的生活质量,甚至影响抗肿瘤治疗.生物标志物是在疾病发生前或过程中在不同生物学水平上出现的信号指标.全面了解口腔黏膜炎相关生物标志物有助于早期识别口腔黏膜炎高风险患者及筛选易发展成为严重口腔黏膜炎的患者,从而指导针对口腔黏膜炎的防治.本文...     

口腔乳杆菌作为口腔益生菌的研究进展

人类口腔内的细菌种类繁多,益生菌是其中不可或缺的组成部分。作为益生菌重要成员的乳杆菌对口腔疾病,尤其是牙周组织疾病具有一定的影响。笔者就近年来有关口腔乳杆菌与口腔常见牙周组织相关疾病的研究作一系统性回顾和展望。     

Toll样受体在放化疗诱导的消化道黏膜炎中的作用

黏膜炎是肿瘤患者进行放化疗时常见的消化道并发症,包括口腔黏膜炎和胃肠道黏膜炎,临床表现为口腔溃疡、呕吐、腹泻和疼痛等症状,严重降低患者的生活质量,甚至影响抗癌治疗。Toll样受体(Toll?like receptor,TLR)是参与天然免疫的重要受体,通过介导微生物与宿主之间的作用参与放化疗诱导黏膜炎的发生发展。文本针对现有TLR与黏膜炎相关研究予以综述。文献复习结果表明,不同TLR在放化疗诱导的黏膜炎中作用不同:TLR2是放化疗诱导的黏膜炎发生中炎性级联反应的重要受体;TLR4的激活能增加胃肠道黏膜炎症反应以及导致口腔上皮溃疡形成;TLR5激动剂能够降低放疗诱导的黏膜炎损伤程度;拮抗或敲除TLR9可减轻放化疗诱导的胃肠道黏膜炎。然而,目前尚未有TLR相关激动剂或抑制剂应用于临床,未来需要更多的研究对不同TLR在黏膜炎中的作用进行探讨,为放化疗性黏膜炎的精准防治提供参考。     

口腔菌群变化影响放射治疗和化学治疗相关性口腔黏膜炎病程的研究进展

头颈部放射治疗和化学治疗（简称放化疗）会引起口腔菌群多样性及群落结构的改变,包括与健康相关共生菌的丰度降低,一些革兰阴性菌增加,以及以白色念珠菌增加为主的真菌群落改变,这些改变可导致口腔黏膜炎（OM）的罹患风险及严重程度增加,尤其与严重OM关系密切。放化疗直接或通过活性氧间接导致DNA损伤,同时促进微生物菌群失调,破坏免疫系统,促进炎症发生;细胞损伤形成溃疡,导致细菌易位和定植,激活核因子-κB、Toll样受体等信号通路,诱导更多促炎细胞因子产生,促进OM发展。目前针对调节口腔菌群改善OM的治疗也是研究热点,可采用益生菌或益生菌混合物防治OM,预防性使用抗真菌剂也可降低口腔念珠菌的数量。本文就近年来头颈部放化疗对口腔菌群变化的影响及其与OM相关性的研究进行综述,以期为放化疗相关OM的防治提供新思路。     

放化疗后口腔黏膜炎的研究进展

口腔黏膜炎（oral mucositis,OM）是癌症放化疗中最常见的一种口腔毒性反应,临床表现为轻度不适、红斑、痛性红斑、水肿和溃疡。OM不但影响患者的生存质量,而且影响患者对治疗计划的依从性,严重时可导致治疗计划中断。本文对放化疗后OM发生的病理机制和治疗的最新进展做如下综述。     

肿瘤放化疗性口腔黏膜炎的防与治

口腔黏膜炎是肿瘤放射治疗和（或）化学治疗过程中最常见的并发症之一,以疼痛性黏膜广泛充血、糜烂、溃疡形成为特征,严重影响患者生存质量甚至延误肿瘤治疗进程。因此,放化疗性口腔黏膜炎的预防与治疗必须贯穿于肿瘤治疗的全过程,包括全面的口腔卫生宣教、积极的治疗前口腔处置和物理预防、及时促进愈合和感染防控介入、必要的饮食调整与营养...     

放射治疗和化学治疗诱发性口腔黏膜炎的防治

口腔黏膜炎(OM)是接受放射治疗和化学治疗的头颈部肿瘤患者常见的不良反应和剂量限制因素之一,OM的黏膜破损会给患者带来难以忍受的疼痛,影响机体的营养摄入,还可使感染通过黏膜破损扩散到全身,进而影响肿瘤治疗计划。目前虽然防治方式多样,但临床上还未有疗效确切的防治方法被大家公认,本文将对近年来针对防治OM的研究进展进行综述。     

Microbiota and their role in the pathogenesis of oral mucositis

Oral mucositis in patients undergoing cancer therapy is a significant problem. Its prevalence ranges between 20 and 100%, depending on treatment type and protocols and patient‐based variables. Mucositis is self‐limiting when uncomplicated by infection. Unfortunately, the incidence of developing a local or systemic infection during the course of the treatment is very high. At this stage, it is unclear which role oral microbiota play in the onset, duration, and severity of oral mucositis. Nevertheless, there is growing interest in this underexplored topic, and new studies are being undertaken to unravel their impact on the pathogenesis of mucositis.     

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口腔内已知细菌种类多达700余种,多种微生物属于益生菌(probiotics)。近年研究发现,益生菌能够竞争性抑制口腔致病菌黏附和定植、中和致病毒素,还可能通过调节机体免疫反应维持口腔中的菌落平衡,从而对龋病、牙周病等的防治发挥积极的作用。特别是益生菌对龋病预防作用取得了更多证据支持,同时口腔益生菌也得到一定商业化开发应用。本文就口腔益生菌的防龋作用与应用做一回顾和展望。     

Impact of muscle volume loss on acute oral mucositis in patients undergoing concurrent chemoradiotherapy after oral cancer resection

This study evaluated the association between skeletal muscle mass depletion and severe oral mucositis in patients undergoing concurrent chemoradiotherapy after oral cancer resection. Skeletal muscle mass was evaluated in 60 patients using the skeletal muscle index, which was based on skeletal muscle cross-sectional area (on computed tomography) at the level of the third lumbar vertebra. In accordance with the grading criteria of the Radiation Therapy Oncology Group, patients with a grade ≥3 were defined as having severe oral mucositis. Multivariate logistic regression analysis was used to evaluate independent risk factors for severe oral mucositis. Eleven patients (18.3%) were diagnosed with low skeletal muscle mass. Severe oral mucositis occurred in 17 (28.3%) patients, and the mean skeletal muscle index was 42.8 cm²/m². A low skeletal muscle mass (hazard ratio 18.1; P = 0.001) and a chemotherapy regimen consisting of 5-fluorouracil and cisplatin (versus cisplatin only) (hazard ratio 5.5; P = 0.015) were independent risk factors for severe oral mucositis. Future prospective studies are warranted to identify effective pre- and perioperative exercises and nutrition programmes to increase low skeletal muscle mass and reduce the incidence of severe oral mucositis in patients undergoing concurrent chemoradiotherapy after oral cancer resection.     

Bacteriotherapy and probiotics' role on oral health

Oral infections constitute some of the most common and costly forms of infections in humans. The concept of microbial ecological change as a mechanism for preventing dental disease is an important one while altered microbial ecology may lead to dental disease. New methods such as probiotic approaches (i.e. whole bacteria replacement therapy) to eliminate pathogenic members of the microbiota can be investigated. Bacteriotherapy is an alternative and promising way to combat infections by using harmless bacteria to displace pathogenic microorganisms. Probiotics are one of these new agents which are widely used for their therapeutic action. Limited research is available showing that some probiotic cultures may help dental improvement. Present paper focuses on possible oral benefits of probiotics.     

个体化口腔卫生指导对种植体周围黏膜炎治疗效果的影响

目的:探讨个体化口腔卫生指导对种植体周围黏膜炎的临床疗效的影响。方法:将36名种植体周围黏膜炎患者随机分为实验组和对照组。对照组用碳纤维工作头对种植体周围进行刮治,不作口腔卫生指导;实验组用同样方法刮治后进行个体化口腔卫生指导。分别于术后第1,3,6周记录改良菌斑指数(mPLI)、改良龈沟出血指数(mSBI)、探诊深度(PD)以评价口腔卫生指导的效果。结果:在第1周,两组病例各指标差异无统计学意义(P>0.05)。到第3,6周,实验组与对照组相比mPLI及mSBI改善效果明显,两组PD稳定。结论:个体化口腔卫生指导可以有效提高种植体周围黏膜炎的治疗效果。     

Comparative assessment of the therapeutic effects of the topical and systemic forms of Hypericum perforatum extract on induced oral mucositis in golden hamsters

Oral mucositis is a common and irritating complication of chemotherapy and radiotherapy for malignancies. Current treatments have failed to achieve complete remission of this complication. The St. John's wort plant (Hypericum perforatum) has long been known for its anti-inflammatory and antibacterial effects. The current study was designed to investigate the therapeutic efficacy of the topical and systemic administration of H. perforatum extract on oral mucositis. Oral mucositis was induced in 72 male golden hamsters by administration of 5-fluorouracil (60 mg/kg), on days 0, 5, and 10 of the study. The cheek pouch was scratched with a sterile needle on days 1 and 2. On days 12–17, H. perforatum extract topical gel 10%, oral H. perforatum extract (300 mg/kg), and gel base groups were treated and then compared with a control group. Weights and blood samples were evaluated, biopsies from buccal lesions were examined histopathologically, and tissue malondialdehyde (MDA) was measured. Both of the H. perforatum extract treatment groups saw a significant relief in oral mucositis compared to the control and base gel groups; the systemic form was superior to the topical form. H. perforatum extract, administered orally or topically, expedited the healing of chemotherapy-induced oral mucositis in hamsters.     

二甲双胍在口腔疾病治疗中的应用研究进展

二甲双胍是目前治疗糖尿病的一线药物,除降血糖作用外,其还被发现有促成牙本质分化、促成骨分化、抗肿瘤、抗炎等作用。已有研究表明二甲双胍可以促进根尖周病变组织愈合,其机制可能与二甲双胍激活腺苷酸活化蛋白激酶促进成骨分化与诱导牙髓细胞分化有关。应用二甲双胍辅助治疗的牙周炎患者探诊深度、附着丧失水平以及探诊出血指数等临床指标明显改善,其可能是通过促进牙周膜干细胞的增殖、迁移和成骨分化发挥防治牙周炎的作用。二甲双胍已被证实可抑制肿瘤细胞生长增殖等,在防治口腔肿瘤如口腔鳞状细胞癌中有重要作用。然而,目前大部分的研究仍处于体外和动物试验阶段,二甲双胍防治口腔疾病的具体分子作用机制尚未阐明;临床试验停留在对临床指标的评价方面,需进一步开展大规模、长期、多中心、随机对照的临床试验。