口腔黏膜下纤维性变的病因、致病机理、诊断与治疗

doi:10.12016/j.issn.2096-1456.2021.04.001

摘要/Abstract

摘要：

口腔黏膜下纤维性变是一种能形成瘢痕、组织纤维化的慢性疾病。流行病学研究显示,咀嚼槟榔是导致口腔黏膜下纤维性变的危险因素。在中国的口腔黏膜下纤维性变患者均有咀嚼槟榔的习惯。研究证实,嚼槟榔、吸烤烟和饮白酒可增加口腔黏膜下纤维性变的风险。口腔黏膜下纤维性变被广泛认为是一种口腔癌前病变,病理表现为慢性炎症、结缔组织内广泛的胶原纤维沉积、上皮固有层或其下结缔组织内的局部炎症改变。口腔黏膜下纤维性变的癌变发生率为7%~30%。口腔黏膜下纤维性变的治疗主要采用曲安奈德和丹参酮注射液行黏膜下局部注射,对改善患者的张口度及口腔黏膜的烧灼痛效果良好,其治疗总有效率可达93%。本文就口腔黏膜下纤维性变的病因、致病机理、诊断与治疗进行阐述,以供同道们临床参考之用。

关键词: 口腔黏膜下纤维性变, 口腔癌前病变, 口腔潜在恶性病变, 口腔黏膜病, 张口受限, 治疗干预, 曲安奈德注射液, 丹参酮注射液

Abstract:

Oral submucous fibrosis (OSF) is a chronic disease that produces scars, tissue fibrosis, and precancerous lesions. Epidemiological studies have shown that chewing betel nut is the most significant risk factor for OSF. Many studies have also indicated that habits such as chewing and smoking tobacco and drinking alcohol increase the risk of OSF, which is widely recognized as an oral precancerous lesion or a potentially malignant oral disorder. Pathological characteristics include chronic inflammation, excessive collagen deposition in the connective tissues below the oral mucous epithelium and local inflammation in the lamina propria or deep connective tissues. OSF patients have a 7%~30% chance of developing oral cancer. Submucosal local injection of triamcinolone and tanshinone was mainly used for the treatment of oral submucosal fibrosis. This treatment improves mouth opening and alleviates the burning sensation in OSF, and the treatment efficacy was as high as 93%. The article will discuss the occurrence, development, diagnosis and treatment of oral submucous fibrosis for clinical management by the medical community.

Key words: oral submucous fibrosis, oral precancerous lesion, oral potentially malignant disorders, oral mucous disease, limited mouth opening, therapeutic interventions, triamcinolone acetonide, tanshinone

中图分类号:

翦新春,高兴. 口腔黏膜下纤维性变的病因、致病机理、诊断与治疗[J]. 口腔疾病防治, 2021, 29(4): 217-225.

JIAN Xinchun,GAO Xing. Etiology, pathogenesis, diagnosis and treatment of oral submucous fibrosis[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(4): 217-225.

图/表 2

图1 口腔黏膜下纤维性变癌变为口腔癌

Figure 1 The transformation of OSF into oral cancer a: cancer in the right soft palate; b: cancer in the left buccal region; c: cancer in the left corner of the mouth; OSF: oral submucous fibrosis

图2 口腔黏膜下纤维性变癌变的可能事件解析

Figure 2 Possible events in the malignant transformation of oral submucous fibrosis TGF-β: transforming growth factor; VEGF: vascular endothelial growth factor; EMT: epithelial-mesenchymal transition; PDGF: platelet derived growth factor; b-FGF: basic fibroblast growth factor; HIF-1α: hypoxia-inducible factor-1α; iNOS: inducible nitric oxide synthase; ROS: reactive oxygen species; IL: interleukin; GRO-α: growth regulation oncogene α

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