口腔黏膜下纤维性变治疗的研究进展

口腔黏膜下纤维性变 (OSF)是一种慢性、隐匿性 ,具有癌变可能的疾病。OSF的发生与咀嚼槟榔习惯有关 ,其发病机理尚不清楚 ,OSF的治疗方法很多 ,但疗效不够理想 ,本文将近年来OSF治疗进展作一综述     

口腔黏膜下纤维性变的治疗研究进展

本文回顾了近些年国内外临床上治疗口腔黏膜下纤维性变的方法,总结出目前口腔黏膜下纤维性变仍然缺乏特效治疗手段的结论。该病应在患者戒除咀嚼槟榔习惯的前提下,根据病情采用多种治疗方法进行综合治疗。     

口腔黏膜下纤维性变癌变防治策略研究进展

口腔黏膜下纤维性变（OSF）是一种癌前病变,其恶性进展与多种内、外因素有关,包括咀嚼槟榔、饮食习惯和不良口腔环境等,尤其与咀嚼槟榔关系最为密切。我国湖南、海南等地居民有咀嚼槟榔的习惯,导致OSF和口腔癌高发,且呈逐年上升趋势。尽管目前口腔癌的治疗方法有所发展,但其5年生存率依然较低。因此,要提高OSF癌变患者的生存率和生活质量,应力争做到早发现、早诊断和早治疗。本文就目前OSF癌变防治策略研究进展相关问题进行综述。     

槟榔碱在口腔黏膜纤维性变及癌变发病机制中的作用

口腔黏膜下纤维性变(oral submucous fibrosis,OSF)是一种慢性、隐匿性、具有癌变可能的炎性疾病.咀嚼槟榔习惯与OSF的发生密切相关,本文对槟榔碱在OSF及癌变发病机制中的作用作一综述.     

口腔黏膜下纤维性变易感基因的研究进展

咀嚼槟榔是引起口腔黏膜下纤维性变（OSF）的决定性因素,但并非所有咀嚼槟榔者都会发生OSF,并且该类疾病不发生于未咀嚼槟榔的人群中。近年来,国内外关于OSF易感基因的研究已取得了长足进展,本文就有关OSF易感基因的研究做一综述。     

中国大陆地区口腔黏膜下纤维性变研究的过去、现在与未来

口腔黏膜下纤维性变（oral submucous fibrosis．OSF）是一种慢性、隐匿性、与咀嚼槟榔有关的口腔黏膜疾病．主要临床症状为进食刺激性食物时口腔黏膜有烧灼痛、软腭区起水疱、硬腭部小黏液腺导管阻塞而出现小点状突起、口腔及咽部干燥感、软腭及悬雍垂纤维化致腭咽闭合不全时说话带有轻微的鼻音。临床检查时可见部分或全部口腔黏膜苍白．张口度逐渐变小以致张口困难；软腭部出现横行的纤维条索．伴有舌腭弓及咽腭弓的变短，悬雍垂皱缩（图1）：双侧颊部黏膜苍白伴有纵行的纤维条索．尤以翼下颌韧带前方区域最为明显。     

口腔黏膜下纤维性变癌变的发生机制研究进展

口腔黏膜下纤维性变(oral submucous fibrosis, OSF)是口腔鳞状细胞癌(oral squamous cell carcinoma, OSCC)的主要癌前病变之一,其癌变过程复杂,癌变机制尚不明确。本文从咀嚼槟榔与OSF恶性进展、低氧与血管生成、上皮-间质转化和表观遗传调控等方面,对OSF癌变机制的最新研究进展作一综述。     

咀嚼槟榔种类与口腔黏膜疾病的流行病学调查分析

目的 研究海南省海口地区嚼食干鲜槟榔嗜好的不同对口腔黏膜疾病发病和癌变的影响。方法 将1 722例有咀嚼槟榔嗜好的人员按嚼食槟榔嗜好不同,分为嚼食鲜槟榔和嚼食干槟榔两组。采用问卷调查、临床检查和定期复诊的方法,收集临床资料,确定罹患口腔黏膜下纤维性变（OSF）、口腔白斑（OLK）、口腔扁平苔藓（OLP）3种口腔黏膜疾病的年龄、人数、发病时间以及是否癌变等,并对数据进行统计学分析。结果 1）在1 722例咀嚼槟榔人群中,嚼食干槟榔组（704例）与嚼食鲜槟榔组（1 018例）黏膜病的患病率无明显差异（P>0.05）,但患病高峰年龄提前（P<0.01）。2）咀嚼干槟榔组5年内所致OSF、OLK和OLP的发病率及口腔黏膜疾病的总发病率均明显高于咀嚼新鲜槟榔组（P<0.01）。3）嚼食干槟榔组口腔黏膜疾病癌变率高于嚼食鲜槟榔组（P<0.01）。结论 嚼食干槟榔比嚼食鲜槟榔的致病性和致癌性更强,干槟榔中过多的有害成分在口腔黏膜疾病的发生和癌变过程中起着重要的协同促进作用。     

湖南省娄底市城区中小学生嚼槟榔情况调查

目的 调查湖南省娄底市城区中小学生槟榔咀嚼情况及口腔黏膜下纤维性变(oral submucous fibrosis,OSF)发病情况,以了解咀嚼槟榔在未成年人中的流行情况.方法 按照全国第三次口腔健康流行病学调查的要求,采用二阶段随机抽样的方法抽取湖南省娄底市6所学校的研究样本,共计4087名学生.采用问卷调查的方式调查咀嚼槟榔的情况,进行口腔检查并观察OSF的发病情况.结果 4087名被抽查学生共完成问卷4019份,问卷完成率为98.3%;4019名中小学生中有498人咀嚼槟榔,咀嚼槟榔率为12.4%;男性咀嚼槟榔率为21.1%(437/2073),女性为3.1%(61/1946),男性咀嚼槟榔率显著高于女性(P＜0.05);小学生咀嚼槟榔率为6.4%(126/1983),初中生为14.9%(143/959),高中生为21.3%(229/1077),三组相比差异有统计学意义(P＜0.001);小学生咀嚼的槟榔主要来源于父母(61/126,48.4%),中学生主要来源于朋友(初中生:88/143,61.5%;高中生:165/229,72.1%);4019名学生中共发现5例OSF患者,OSF患病率为0.12%,均为高中男生.结论 湖南省娄底市城区中小学生有咀嚼槟榔习惯且有OSF患者;咀嚼槟榔率男性高于女性;咀嚼槟榔与年级相关,年级越高咀嚼槟榔率越高;小学生槟榔主要来源于父母,中学生槟榔主要来源于朋友.     

口腔黏膜下纤维性变恶变机制的研究进展

口腔黏膜下纤维性变(oral submucous fibrosis,OSF)是一种慢性、进行性、与咀嚼槟榔有关的口腔黏膜疾病,主要表现为口腔黏膜苍白、进食刺激性食物时口腔黏膜烧灼疼痛、张口受限、软腭区水疱等.OSF具有恶变倾向,其恶变率为7％～13％.因此,WHO将其列入口腔潜在恶性疾患的范畴.OSF的恶变机制尚未完全清楚,目前多认为是多因素共同作用的结果,包括遗传易感性、细胞周期改变、上皮相关蛋白改变、缺氧、血管生成、细胞衰老、上皮-间充质转化等.本文对OSF恶变机制进行归纳总结,旨在为了解该病恶变规律及临床早期防治提供参考.     

��ǻ�Ĥ����ά�Ա��²������о���չ

口腔黏膜下纤维性变(oral submucous fibrosis,OSF)是一种慢性、隐匿性且具有癌变倾向的疾病,主要发生于印度、巴基斯坦等东南亚国家以及我国湖南、台湾两省。OSF病因不明,咀嚼槟榔是其最主要的致病因素,且咀嚼槟榔的频率越高、年限越长,越易患OSF。所有OSF患者都有咀嚼槟榔史,咀嚼槟榔还与口腔白斑、口腔癌发病高度相关。此外,OSF的发生还与遗传因素、免疫反应、胶原相关性基因,营养缺乏等有关。本文就OSF致病因素做一简单介绍。     

Epidemiological survey of oral submucous fibrosis in Xiangtan City, Hunan Province, China

Abstract Oral submucous fibrosis is a high risk precancerous condition and is suggested to be caused by areca nut chewing. Areca nut chewing is popular in Hunan Province of China, and is more concentrated in Xiangtan City. Two and nine cases of oral submucous fibrosis (OSF) were first noticed in 1984 and 1985 respectively, and an epidemiologic survey was subsequently performed in 1986. The epidemiologic method of cluster sampling was used. The Yuhu District, one of the five urban districts of the Xiangtan City with a population of 100 000 was selected as a whole body in the survey. 57 independent units of various professions were randomly selected as group samples and more than 70% of subjects in each unit were examined. Definite fibrous band on palpation was used as a main diagnostic criterion for OSF. A total of 11 046 individuals were examined; among them were 3 907 areca nut chewers (35.37%) and 7 139 non-chewers (64.63%). 335 cases of OSF were found, comprising a prevalence rate of 3.03%. The disease involved mainly the middle third of the oral cavity. All of the OSF cases were areca nut chewers. No case had been found in non-chewers. Four cases of oral carcinoma were found on the basis of OSF, the malignant transformation rate was 1.19%. The high prevalence of OSF may be due to areca nut chewing plus extensive and heavy use of hot pepper in Xiangtan people. The result supports the role of the areca nut as an etiologic factor in the development of OSF. The low malignant transformation rate of 1.19% compared with the 7.6% in an Indian report may be because Xiangtan people chew areca nut without tobacco.     

Oral precancerous disorders associated with areca quid chewing, smoking, and alcohol drinking in southern Taiwan

OBJECTIVE: To investigate the prevalence and the associated risk factors of oral precancerous disorders in southern Taiwan. METHODS: We conducted a cross-sectional community survey interviewing 1075 adult subjects, 15 years of age and over, gathered from randomly selected 591 households, and spanning five villages in southern Taiwan. The study protocol included a visual oral soft tissue examination and a questionnaire-based interview. The chi-square test was used to test the differences in prevalence of oral precancerous lesions and conditions by different "life styles" relating to current risk habits of current areca quid chewing, smoking, and alcohol drinking. To control for possible confounding, a logistic regression model was used to estimate the Odds Ratios (OR) for leukoplakia and oral submucous fibrosis (OSF). RESULTS: 136 precancerous lesions and conditions were detected among 1075 subjects (12.7%). The analysis of the spectrum of oral precancerous disorders detected, leukoplakia (n = 80), OSF (n = 17) and verrucous lesions (n = 9), demonstrated an association with gender (P < 0.001). There were statistically significant associations among leukoplakia (P < 0.01), OSF (P < 0.0001), and verrucous lesions (P < 0.0001) and the life style of current areca quid chewing, smoking, and alcohol drinking. The synergistic effect of smoking and areca quid chewing habit on leukoplakia and OSF was demonstrated. CONCLUSION: This study reinforces the association of current areca quid chewing without tobacco, cigarette smoking, and alcohol drinking to leukoplakia, OSF, and verrucous lesions in Taiwan.     

Development of an in vivo mouse model to study oral submucous fibrosis

BACKGROUND: Epidemiological data have shown an association of areca nut chewing with oral submucous fibrosis (OSF). Experimental evidence to confirm this has been limited. Fibrosis-promoting activity of areca nut was tested in an animal model. METHOD: Buccal mucosa of a group of 20 female BALB/c strain mice, 10-12 weeks of age, was treated twice daily 6 days per week with topical application of aqueous areca nut extracts for 300-600 days. A control group (n = 20) was treated with 50 mM NaCl. The influence of areca nut on the oral epithelium and connective tissue was recorded semiquantitatively by light microscopy. RESULTS: The areca nut-treated oral epithelium showed progressive changes in epithelial thickness leading to atrophy, increased cellularity of fibroblasts, fibrosis of connective tissue, focal infiltration of inflammatory cells and muscle atrophy. On killing after 600 days of treatment, the scores on cellularity, inflammation and muscle atrophy were significantly different to the control group (P = 0.03). CONCLUSION: The study provides further evidence that areca nut contributes to the development of OSF in treated animals. The model has the potential to test synergism of areca nut with other carcinogens and any therapeutic interventions.     

Distribution of procollagen type III, collagen type VI and tenascin in oral submucous fibrosis (OSF)

The distribution of procollagen type III, collagen type VI and tenascin was studied in biopsy specimens from the buccal mucosa of 19 Indian women with confirmed oral submucous fibrosis (OSF) using the immunogold-silver staining technique. Immunohistochemistry revealed a loss of stainable procollagen type III and collagen type VI in the fibrotic zones of oral submucous fibrosis compared to normal oral mucosa. Tenascin was noted only very faintly at the subepithelial basement membrane. The present study showed that procollagen type III and collagen type VI in OSF were expressed in a specific pattern which allows a clear differentiation between fibrotic areas and adjacent apparently normal connective tissue stroma. Loss of procollagen type III, and therefore a probable predominance of collagen type I in collagen fiber bundles, and an almost complete loss of collagen type VI might explain the stiffness of the oral mucosa in patients with OSF. The immunohistochemical findings provided evidence that the process of fibrosis starts in the deeper subepithelial connective tissue stroma and not close to the subepithelial basement membrane. Further studies are required to determine whether OSF is due to increased or altered synthesis and deposition of extracellular matrix proteins, altered fibrolysis or both.     

口腔黏膜下纤维性变组织中Smad2/3蛋白的表达研究

目的：检测Smad2／3蛋白在13腔黏膜下纤维性变（OSF）组织中的表达及分布,探讨其在OSF发病机制中的作用。方法：采用免疫组化SABC法,用Smad2／3兔抗人多克隆抗体检测20例OSF病变组织及10例正常13腔黏膜组织中的Smad2／3蛋白的表达及分布。结果：Smad2／3在OSF病变组织中为中等强度表达,在正常口腔黏膜组织中为强阳性表达,具有显著性差异（P〈0．05）。结论：Smad2／3蛋白在OSF病变组织中中等强度表达,在OSF发病机制中有重要作用。     

Multiple logistic regression analysis of risk factors for carcinogenesis of oral submucous fibrosis in mainland China

Oral submucous fibrosis (OSF), a chronic progressive disorder, is regarded as the premalignant lesion of oral squamous cell carcinoma (OSCC). Its distribution is associated with chewing betel quid (BQ). The objective of the present study was to investigate risk factors for the carcinogenesis of OSF in mainland China. A case-control study was performed in 42 patients with OSCC that originated from OSF and 40 OSF controls. Epidemiological data and information related to risk factors were collected using a short structured questionnaire. Odd ratios (OR) and 95% confidence intervals (CI) were derived from logistic regression analysis. In multivariate analysis, only age, duration of BQ chewing, duration of cigarette smoking, and OSF accompanied by oral leukoplakia or oral lichen planus were associated with significantly increased risk for the malignant transformation of OSF. These findings contribute to current knowledge on the prevention of carcinogenesis of OSF in mainland China.     

Comparing dose–response measurements of oral habits on oral leukoplakia and oral submucous fibrosis from a community screening program

J Oral Pathol Med (2010) 39 : 306–312 Background: Many studies have reported that the interaction and dose–response effects of betel quid chewing, tobacco smoking and alcohol drinking habits are important risk factors for oral cancer and precancerous lesions or conditions. These results are useful for comparing statistics, but may not be informative for personal disease‐related information. Methods: This study used data from a community screening program to evaluate the dose–response effects of daily frequency and duration from oral habits in Taiwan. The receiver operating characteristic (ROC) curves were further used to compare exposure measurements on indicating the occurrence of lesions/conditions. Results: Our results showed that the highest prevalence was found in leukoplakia (11.1%) and followed by oral submucous fibrosis (OSF, 4.4%). Betel quid chewing habit was found to have dose–response effects on leukoplakia and OSF, cigarette smoking habit only has the dose–response effect on leukoplakia, and alcohol drinking was not associated with both oral precancers. The daily frequency of chewing habit is a better indicator than other dose–response measurements for the occurrence of precancers. In addition, the cut‐off points of two to five counts per day have about 60–82% of sensitivities and 79–88% of specificities. Conclusions: The cut‐off points from ROC curves can provide an informative message to people with oral habits and their chances of developing diseases. High daily frequency of chewing can lead to excessive irritation to oral mucosa. Although the tobacco is never added to chewing quid in Taiwan, intensive irritation may play an important role in developing oral precancers in Taiwan.     

Role of areca nut in the causation of oral submucous fibrosis: a case-control study in Pakistan

A case-control study on chewing and smoking habits and oral submucous fibrosis (OSF) was undertaken in Karachi in 1989/90. Cases were patients detected with fibrous bands and leathery mucosa and hospital-based controls were matched by age and sex. Information on habits was collected by personal interview of 157 cases and 157 controls. Despite overall female preponderance, a substantial number of young men were enlisted. The male/female risks were found to be similar. Immigrants from India to Pakistan (Mohajir) had a similar risk status to local Punjabis. No differences between risks were found when comparing the three age categories. 21.21-40, 41-60 yr. Among the cases, an increased risk was observed for areca nut chewing. This habit when practised alone appeared to have the highest risk (RR 154), followed by pan with or without tobacco (RR 64. 32 respectively). Logistic regression and discriminant analysis showed that daily consumption rates appeared to be more important with respect to risk than lifetime duration of habit. Tobacco habits were more prevalent amongst those 15 cases who presented with concurrent carcinoma and OSF: We conclude that areca nut chewing has a causal relationship with OSF: additional tobacco insult may be necessary for subsequent carcinoma development.     

OSF并存OLP34例回顾性分析

目的：总结口腔黏膜下纤维性变（OSF）并存口腔扁平苔藓（OLP）的临床特征,提高对该病的诊断和治疗水平。方法：对34例OSF并存OLP患者的临床资料进行回顾性分析。结果：34例OSF并存OLP患者表现为青壮年男性居多,均有进食刺激性食物和咀嚼槟榔史,29例（85.29%）有吸烟史,27例（79.41%）有饮酒史,28例（82.35%）OSF的病理分期为早期,6例（17.65%）为中期,发病部位以颊部和舌部为主,所有患者均无糜烂和张口受限,治疗后疼痛症状缓解,但白色条纹或斑点始终未消退,已消失的丝状乳头、菌状乳头亦未见恢复。结论：OSF并存OLP并非两种疾病的简单叠加,而是具有其特异性的表现,必要时可行两个典型部位活检进行诊断,治疗中及治疗后须戒烟、戒槟榔。