口腔黏膜瘙痒症

瘙痒是发生在皮肤及黏膜的特殊感觉，是由化学物质刺激游离神经末梢产生神经冲动传向中枢形式的。口腔黏膜瘙痒症可由局部的病灶刺激、性激素变化、营养缺乏、精神因素等造成，也可由系统性疾病和药物引起。本文详细阐述口腔黏膜瘙痒症的发生机制和临床表现，提出了几种可能的治疗方法。     

口腔黏膜瘙痒症16例临床分析

目的探讨口腔黏膜原因不明性瘙痒症的治疗方法。方法采用地塞米松针剂5 mg加庆大霉素8万U超声雾化吸入法,每日1次,每次20 min,5次为1疗程。结果14例患者中12例痊愈,2例有效。结论地塞米松超声雾化吸入法用于治疗不明原因的口腔黏膜瘙痒症有效、可行。     

与糖尿病相关的口腔黏膜病变

糖尿病是一组由于胰岛素绝对或相对不足及胰升糖素绝对或相对过多所引起的以糖代谢障碍为主，并有脂肪和蛋白质代谢紊乱的全身性疾病。糖尿病患者可伴发多种口腔疾病，尤其是口腔黏膜病变，本文拟对与糖尿病相关的口腔黏膜病变的发病率，病因，临床表现等进行综述，提醒广大临床医师在诊治口腔黏膜病的同时，重视糖尿病的存在与伴随。治疗或预防糖尿病对降低口腔黏膜病发病率，减轻口腔黏膜病病损有重要意义。     

正畸治疗并发口腔黏膜溃疡的原因分析及防治

目的：分析口腔正畸治疗中并发口腔黏膜溃疡的相关因素，为尽可能减少口腔溃疡发生率和防治提供依据。方法：通过对1486例口腔正畸病例进行回顾分析。分析口腔溃疡与系统性疾病的关系，了解口腔黏膜溃疡发生的时间、部位以及与正畸材料的关系。结果：口腔溃疡的发生率可高达83．51％。患有系统性疾病者溃疡发生率96．4％。口腔黏膜溃疡发生的部位，以尖牙、第一磨牙颊面管或带环处最易引起。结论：对口腔正畸患者要告知口腔溃疡的发病情况并作适当处理，对顺利完成正畸治疗是必要的。     

口腔黏膜人乳头瘤病毒感染的研究现状

人乳头瘤病毒(HPV)在人类广泛传播,与许多人类常见病有关,已证实HPV感染是导致宫颈癌的主要病因。随着分子生物学技术的发展,已在多种口腔黏膜病损中检测出不同型别的HPV感染,越来越多研究表明HPV可能是引起多种口腔病损的致病因素。HPV在口腔黏膜的感染情况及其引起的口腔黏膜病损日益受到关注。本文对HPV的生物学特性、口腔黏膜HPV感染的途径、检测方法、HPV相关口腔黏膜损害及其可能的致病机制等进行综述。     

雌激素与口腔黏膜健康与疾病的关系

雌激素是一种重要的女性激素,在口腔黏膜和唾液腺存在雌激素受体表达。机体内雌激素水平的变化可引起口腔黏膜的变化,是多种口腔黏膜疾病的可能病因之一。本文就雌激素与口腔黏膜健康与疾病的关系作一综述。     

口腔黏膜白斑癌变的相关危险因素分析

目的 通过对409例口腔黏膜白斑患者的回顾性综合分析,探讨口腔黏膜白斑癌变的相关危险因素.方法 首先进行单因素检验,观察性别、年龄、病程、系统疾病、吸烟、饮酒、病变部位、临床类型、病变数量、病变范围、症状与口腔黏膜白斑组织病理的关系,筛选与口腔黏膜白斑组织病理相关的变量,进入多元Logistic回归分析模型,计算这些因素的相对危险度(OR值)及95%可信区间.结果 409例口腔黏膜白斑中52例(包括9例重度异常增生)发生了癌变,癌变率为12.7%.其中,性别、年龄、临床分型、病变部位和症状被选入多元Logistic回归分析模型.多元Logistic回归分析结果表明:与单纯增生相比,发生轻中度异常增生的危险性,女性口腔黏膜白斑患者是男性的2.40倍,颗粒型口腔黏膜白斑是均质型的2.81倍,危险区是非危险区的1.98倍,伴有症状的口腔黏膜白斑是无症状的1.84倍.发生重度异常增生及癌变的危险性,女性患者是男性患者的3.11倍,颗粒型、溃疡型、疣状型口腔黏膜白斑分别是均质型的4.50、5.63、4.09倍,危险区是非危险区的2.79倍,伴有症状的口腔黏膜白斑是无症状的4.38倍.结论 口腔黏膜白斑癌变与性别、年龄、临床类型、病变部位及症状等相关.     

口腔黏膜下纤维性变发病机制的研究进展

口腔黏膜下纤维性变 (OSF)的发病机理尚不清楚 ,近年来研究发现 :口腔黏膜角朊细胞、多种细胞因子、铜、细胞免疫等因素与OSF的发生密切相关 ,本文就这些因素在OSF发生发展过程中的可能作用作一综述。     

口腔扁平苔藓会传染吗？

口腔扁平苔藓（OLP）是一种可能与多种致病因素有关的口腔黏膜慢性炎性疾病，研究发现OLP的发生发展可能与细菌、病毒、真菌等感染因素有关，因此，有关OLP是否会传染的问题受到临床医师及患者的关注。本文分析总结了可能与OLP密切相关的感染因素，提出OLP可能会传染的观点。     

口腔黏膜癌变过程中血清生化标志物的研究进展

口腔黏膜癌变是指口腔黏膜从正常状态经口腔潜在恶性疾患阶段发展为口腔鳞状细胞癌,直至远处转移的多步骤、多阶段、多基因改变的过程。该过程涉及多种血清生化标志物的变化,这些动态变化对于病情的进展具有重要的提示作用,对临床有着深远的意义。本文将与口腔黏膜癌变过程相关的血清生物标志物的研究现状作一综述。     

Permeability of lichen planus lesions and healthy buccal mucosa to water.

The resurgence of interest in the oral mucosa as a route for drug delivery requires a thorough understanding of the permeability of this tissue in health and disease. Previous work has indicated that non-keratinized oral mucosa is more permeable than its keratinized counterpart. It has been suggested that pathological hyperkeratotic mucosa, which was previously non-keratinized, would be more permeable than healthy tissue. Equivocal results obtained from animal studies in which chemical or mechanical irritation was used to induce a hyperplastic and hyperkeratotic epithelium, prompted us to conduct a study on the comparison of the permeability to water of lichen planus lesions and healthy buccal mucosa. Buccal mucosa was obtained from six patients with previously confirmed lichen planus and from six clinically healthy patients. Thawed biopsies from each specimen were mounted in flow-through diffusion cells and their permeability to tritiated water determined using a continuous flow-through perfusion system. Specimens were examined histologically before and after permeability experiments. No statistically significant differences between mean steady state flux values (10-20 h) for lichen planus tissue and healthy buccal mucosa were found. These results warrant further studies with other oral conditions associated with hyperkeratosis to establish whether the nature and course of the condition are determinants for the retention or loss of the epithelium's permeability characteristics.     

Diversity of gammadelta T cells in patients with Behcet's disease is indicative of polyclonal activation

OBJECTIVE: Behcet's disease (BD) is a multisystemic disease, with vasculitic lesions in the oral and genital mucosa, eyes, joints, skin and brain. We have previously found that gammadelta T cells are increased in peripheral blood of BD patients. The aim of this study was to investigate the extent of gammadelta T cells in oral biopsies from BD patients with special emphasis on the restriction of Vgamma and Vdelta usage. PATIENTS AND METHODS: Expression of Vgamma and Vdelta chains on peripheral blood gammadelta T cells from 31 BD patients and 19 healthy controls was analysed by flow cytometry and the expression of Vgamma and Vdelta chains in nine ulcerated and eight non-ulcerated oral mucosa from BD patients and non-ulcerated oral mucosa from three healthy controls was analysed by immunohistochemistry. RESULTS: Vgamma9 and Vdelta2 were the predominant chains expressed in peripheral blood of BD patients, although other Vgamma and Vdelta chains were also expressed. The presence of gammadelta T cells was only observed in the ulcerated oral mucosa but not in the non-ulcerated mucosa from the BD patients, and not in the non-ulcerated mucosa from the healthy controls. These gammadelta T cells showed no preferential expression of any of the Vgamma or Vdelta chains. CONCLUSION: These data suggest a polyclonal rather than oligoclonal activation of the gammadelta T cells. This may indicate that during repeated inflammation of the oral mucosa, the gammadelta T cells are responding to a wide variety of antigenic stimuli with consequent expansion of gammadelta T cells expressing various Vgamma and Vdelta chains and that different antigenic stimuli or responses may be responsible for the clinical heterogeneity of the disease.     

Neoplastic transformation of oral lichen planus. II: association with risk co-factors

The possible malignant transformation of oral lichen planus is still controversial. It is not clear if this is in fact due to the premalignant nature of oral lichen planus or to the presence of some risk-factors in patients with this pathology. The risk co-factors that may he involved in this malignant transformation are numerous. Some authors suggested a correlation between oral lichen planus and HCV or HGV, or with the presence of some oncogenic viruses (EBV, HSV, HPV). Cases of this malignant transformation on oral and genital mucosa with lichen are reported, hut none on the skin lesions. The aim of this study is to investigate, through the literature, these correlations that may have a role in the malignant transformation of oral lichen planus.     

孕激素及受体的检测在女性口腔扁平苔藓患者中的意义

为了探索口腔粘膜扁平台藓的病因与防治方法，本研究应用放射免疫技术及ＡＢＣ方法对１５例与月经周期相关的女性口腔扁平苔藓患者分别检测黄体期血清孕酮的含量及口腔膜损害中的孕激素受体，并对血清孕酮含量低于正常的女性口腔扁平苔藓患者给予孕酮治疗。结果显示：在１５例女性口腔扁平苔藓患者中，孕酮与正常组相比具有高度显著性差异（Ｐ〈０．０１）；其中孕激素受体阳性为１１例，在１０例血清孕酮低于正常组且孕激素受体阳性     

造血干细胞移植预处理诱发口腔黏膜炎模型的建立

目的探讨建立造血干细胞移植预处理诱发口腔黏膜炎大鼠模型的可行性。方法采用马利兰和环磷酰胺预处理方案结合左颊黏膜搔刮建立大鼠口腔黏膜炎模型。设立模型组和对照组，从自然过程、口腔黏膜炎指数、血象、骨髓象、病理检查等指标动态观察口腔黏膜炎的发生、发展过程。结果模型组大鼠于第7天开始出现口腔黏膜炎表现，发生率为80．00％；口腔黏膜炎指数在第11天达到峰值（2．04±1.80），4级以上口腔黏膜炎占39．29％（11／28）；第18～21天病损基本恢复，期间大鼠体重持续下降，白细胞计数于第10天下降至最低点，骨髓增生度低下。结论成功建立了造血干细胞移植预处理诱发口腔黏膜炎的大鼠模型。     

免疫方法建立复发性口腔溃疡动物模型

目的 :利用试验家兔口腔黏膜蛋白注射方法 ,建立复发性口腔溃疡动物模型 ,为研究人类RAU的发病机制及治疗提供理论基础。方法 :应用从试验家兔提取的口腔黏膜蛋白及沉淀物 ,分别作为抗原免疫家兔。将上述抗原注入家兔脊柱二侧皮内 ,2周注射一次 ,观察家兔口腔溃疡的发病情况及愈合情况。检测试验家兔血清中抗口腔黏膜抗体并做溃疡的组织病理学检查。结果 :以口腔黏膜蛋白作为抗原的实验家兔都发生了RAU ,血清中抗口腔黏膜抗体阳性。以口腔黏膜蛋白作为抗原组与以沉淀物作为抗原组引发实验家兔RAU有显著统计学差异(p <0 .0 1)。结论 :利用兔口腔黏膜蛋白作为抗原 ,可引起实验家兔发生RAU ,其临床表现及组织学检查均与人类RAU相似 ,表明此动物模型可作为研究人类RAU的模型。也提示了人类RAU的发生可能与自身免疫有关。     

Angina bullosa hemorrhagica of the soft palate: a clinical study of 16 cases

Angina bullosa hemorrhagica (ABH) is an oral mucosal blood blister that develops without blood dyscrasia or vesiculobullous disorder. Although a minor mucosal trauma has been suggested as a triggering factor for ABH, its etiopathogenesis, especially the causative role of systemic conditions, is largely unknown. We investigated the presence or absence of local factors as well as systemic background disease in 16 patients with ABH arising in the soft palate. All the lesions were solitary, and 75% of them (n = 12) appeared during the ingestion of hard or crispy food. With regard to underlying systemic conditions, hypertension was the most common (n = 6), and asthma, insomnia, diabetes mellitus, rheumatoid arthritis, gastrointestinal disorder and hyperuricemia were also recorded (n = 1 each). Five patients had no significant background disease. There were no recalcitrant or recurrent cases. In conclusion, the present study has revealed that scratching of the oral mucosa during eating plays an important role in the formation of ABH. Hypertension appears to be the most frequent background condition, but its pathogenic relationship with ABH remains speculative, as hypertension is fairly common in adults.     

Effectiveness of autofluorescence to identify suspicious oral lesions—a prospective,blinded clinical trial

Regular screening through white light inspection of the entire oral mucosa is the most important examination method to identify precancerous lesions and early oral carcinoma. Additionally, the physiologic autofluorescence of the oral mucosa has been described as a novel screening method for the detection of mucosal lesions that are not visible by white light. This study aimed to evaluate the sensitivity and specificity of the autofluorescence examination. Seventy-eight patients were examined in this study. All of them suffered from suspicious oral mucosal lesions. Two different investigation methods were applied: the standard examination by white light and an examination by a novel light source of 400 nm that evoked a green light emission (>500 nm) in normal mucosa. It was proposed that malignant oral mucosal lesions show different autofluorescence characteristics than the green autofluorescence of healthy mucosa. Red autofluorescence indicated SCC with a sensitivity of 20% and a specificity of 98%. The results showed that dysplasia and carcinoma could be identified with a sensitivity of 96% and a specificity of 18% by using the autofluorescence method. The sensitivity decreased according to the grade of mucosal keratosis and was influenced by the localisation of the lesion. In conclusion, benign as well as malignant oral lesions could not be distinguished by a diminished autofluorescence signal. A red autofluorescence signal, however, could indicate cancerous processes of the oral mucosa.     

口腔癌术后放疗患者口腔菌群的变化

目的　了解口腔鳞癌术后放疗对患者口腔菌群的影响,为临床防治继发感染提供实验依据。方法　32例 口腔鳞癌术后患者,于放疗前后分别在照射野的中心区域与对侧黏膜采集唾液标本,进行细菌的分离培养鉴定,测 量可培养细菌的检出率、检出量和构成比。结果　与放疗前相比,放疗后照射侧和非照射侧的链球菌属、白色念珠 菌和绿脓杆菌检出增加;而照射侧的放线菌属和奈瑟菌属检出减少(P<0·05)。结论　口腔癌术后放疗可影响口 腔的微生态平衡,是导致口腔癌术后放疗患者发生感染的重要原因之一。     

Oral complaints in patients with acute myeloid leukemia treated with allogeneic hematopoietic stem cell transplantation

Background Acute myeloid leukemia belongs to proliferative diseases of the hematopoietic system. It is currently the leading indication for allogeneic hematopoietic stem cell transplantation. This study was designed to determine the most common subjective oral mucosa complaints in patients with acute myeloid leukemia after allogeneic hematopoietic cell transplantation, in relation to the type of conditioning used.Material and Methods Eighty patients diagnosed with acute myeloid leukemia were assigned to two groups depending on the intensity of the conditioning regimen before transplantation: myeloablative and reduced-intensity chemotherapy. The oral symptoms were evaluated based on an authorial questionnaire designed for this analysis. The following oral mucosa subjective complaints were included: pain, paraesthesia, burning mouth sensation, taste disorders, excessive salivation, halitosis, and dryness of the oral mucosa.Results The most commonly reported subjective oral complaint in the examined patients was xerostomia, which was found in 92% of patients during the second visit, followed by spontaneous pain in the mouth (55%), burning (36%), and dysgeusia (20%). It occurred significantly more frequently in patients who underwent myeloablative conditioning. Moreover, it was observed that the frequency of complaints increased considerably after the transplantation, reaching a peak intensity during the second week following the procedure.Conclusions Oral complaints significantly decrease the patients'' quality of life during the transplantation and may lead to premature termination of the treatment. As the number of transplantations in patients with acute myeloid leukemia increases, further investigations of oral complaints and symptoms induced by the disease itself and by the therapeutic approaches are required. Key words:Acute myeloid leukemia, oral pathology, xerostomia, myeloablative conditioning, reduced-intensity conditioning.