150例口腔黏膜白斑的回顾分析

目的：研究口腔黏膜白斑癌变和发病部位及临床表现的关系。方法：对15年来诊治的150例临床和组织学确诊为口腔白斑的病例进行回顾性分析。结果：龈、舌、颊等部位为白斑高发区，其中有14例白斑癌变，癌变率为9．33％。结论：口腔白斑以颗粒型、溃疡型、疣状型癌变率较高。癌变高发部位为舌部，舌部又以舌侧缘（包括舌腹和舌缘）的癌变率为著。     

口腔粘膜白斑癌变的分析

作者对经临床和组织学确诊的235例口腔粘膜白斑患者进行l～16年追踪随访,有32例白斑恶变,癌变率为13.6％。其中男性18例,占男性白斑数的11.8％;女性14例,占女性白斑数的16.9％。癌变组平均年龄为53.4岁。白斑类型以颗粒型和疣状型恶变率较高。癌变损害部位以舌部白斑恶变率最高占75％,尤以舌缘、舌腹损害为多。白斑出现疼痛,局部充血红斑,损害迅速扩大、糜烂、增殖质硬等,都可能为恶变的征兆。本组32例,术后随访到20例,有2例复发,术后中位生存期为8.5年。预后较好。     

白斑癌变危险因素与口腔白斑病分期体系的关系

目的：通过对209例口腔白斑患者癌变危险因素与LSCP分期分级关系的综合分析，探讨LSCP分期分级方法的临床意义。方法：首先进行单因素卡方检验，观察性别、病史、吸烟、饮酒，病损数、部位、大小、临床类型及病理分型与LSCP分期体系的关系。筛选对LSCP分期有意义的变量选入多元Logistic回归分析模型。其次对这些因素在LSCP分期中患Ⅳ期白斑相对于Ⅰ、Ⅱ、Ⅲ期白斑的危险性进行分析，并观察各因素对LSCP分期分级的影响。结果：性别、部位、损害类型及病理分型被选入多元Logistic回归分析模型。多元Logistic回归分析表明，女性患者白斑的危险性是男性的2．49倍，舌部及口底白斑危险性高于其他部位，疣 状白斑的危险性是均质型白斑的10．00倍，中度异常增生白斑的危险性是单纯增生或轻度异常增生性白斑的276．48倍，重度异常增生是单纯增生或轻度异常增生性白斑的499．55倍。重度异常增生白斑对LSCP分期的贡献最大。结论：LSCP分期体系可以全面描述白斑的499．55倍，重度异常增生白斑对LSCP分期的贡献最大。结论：LSCP分期体系可以全面描述口腔白斑的特点，有助于对病损癌变危险性综合评估，可以指导临床追踪观察和协助选择最佳治疗方案。     

口腔黏膜白斑与念珠菌感染的临床分析

目的：研究口腔白斑念珠菌感染的临床和病理学特征。方法：利用过碘酸雪夫染色诊断念珠菌感染,回顾性分析448例白斑患者的活检组织中念珠菌感染率,并分析年龄、性别、白斑病损部位、白斑上皮异常增生等因素与感染的关系。结果：白斑组织中念珠菌的感染率14．1％。念珠菌性白斑比普通型白斑的上皮异常增生发生率更高（57．1％vs．33．8％）。回归分析显示＞60岁的老年患者、舌部白斑和上皮异常增生是念珠菌易感因素。结论：念珠菌感染和上皮异常增生密切相关。伴有上皮异常增生的舌部白斑的老年患者更易感染念珠菌。     

目标miRNAs在口腔白斑癌变患者唾液中的表达研究

目的：寻找能够准确评估口腔白斑癌变风险的生物标志物指导临床工作。方法：随机收集未经治疗的口腔癌患者、稳定白斑、癌变白斑患者各20例,收集唾液标本,采用RT－qPCR探讨癌变口腔白斑患者唾液miRNA的变化。结果：癌变白斑患者唾液中miR－339－5p、miR－144、miR－－521－3p、miR－429和miR－181a与病变组织中的表达情况一致（P＜0．10）。结论：miRNA表达改变的唾液检测有望成为一种理想的、无创的早期检测癌变口腔白斑的新方法。     

白斑癌变相关基因的表达谱研究

目的 运用cDNA微阵列技术研究口腔白斑组织和口腔鳞癌组织的基因表达谱的变化，为探讨口腔白斑癌变基因提供初步筛选资料。方法 对临床切除的5例口腔白斑和口腔癌组织进行总RNA抽提，逆转录制备探针，纯化后与含有4124个基因的微阵列杂交，杂交后的信号经扫描仪检测和计算机分析后筛选出与白斑癌变相关的基因。结果 对口腔白斑和口腔癌基因表达谱进行分析，发现存在30个差异表达的基因，它们可能与白斑癌变有关。结论 采用cDNA微阵列技术能成功检测出两种不同组织中多个基因的差异表达，为研究白斑癌变机制提供有价值的筛选资料。     

口腔白斑癌变率与癌变时间及其影响因素的回顾分析

目的:回顾1978年—2009年就诊于上海交通大学医学院附属第九人民医院口腔黏膜病专科门诊的口腔白斑病例,统计口腔白斑癌变率和癌变时间的基线资料,同时评价影响口腔白斑癌变的相关因素。方法:使用SAS6.12软件包对合适的病例资料进行生存分析(寿命表法和乘积极限法)和Cox回归,分析和描述口腔白斑的癌变率和影响因素。结果:576例口腔白斑中,男350例,女226例,66例癌变,男女各33例,总癌变率为11.46%。适合生存分析和Cox回归的病例共267例,根据病程计算1年癌变率(寿命表法、乘积极限法)为(0.40±0.40)%、(0.86±0.61)%,2年癌变率上升至(2.84±1.15)%、(2.93±1.18)%,5年癌变率达(11.28±2.70)%、(11.31±2.71)%。在多因素分析得出的Cox回归模型中,部位和年龄是影响口腔白斑癌变的主要因素。结论:口腔白斑的癌变率与随访时间有关,影响癌变的主要因素是发病部位和年龄。     

绞股蓝总甙对鼠舌白斑癌变过程中琥珀酸脱氢酶表达影响的研究

目的：探讨中药绞股蓝总甙（Gypenosides,GP）对实验性口腔白斑癌变过程的阻断作用及其对琥珀酸脱氢酶（Succinate dehydrogenaseS,DH）的影响。方法：Wistar大鼠70只,随机分为癌变模型组（n=25）、中药干预组（n=30）、正常对照组（n=5）和中药对照组（n=10）。以4NQO饮水喂养诱导大鼠舌白斑癌变,中药绞股蓝总甙水溶液灌胃干预癌变过程,取9、13、20、24、32周舌背黏膜标本进行组织病理学观察,用实时荧光定量PCR法检测SDH基因表达水平。结果：中药干预组舌背黏膜异常增生发生率明显低于癌变模型组,SDH表达明显高于癌变模型组（P〈0.01或P〈0.05）,尤其在20、24周时。结论：绞股蓝总甙对实验性口腔白斑癌变有阻断作用,通过影响SDH表达以修复三羧酸循环可能是其抗癌机制之一。     

口服白斑患者口腔粘膜脱落细胞微核细胞率的研究

本研究采用Ｆｅｕｇｌｅｎ染色方法，对我院就诊的１２７口服白斑患者和鳞癌患者的口腔脱落粘膜细胞微核细胞进行了检测，同时检测了１００例正常健康人作对照。研究结果表明，口腔白斑患者脱落粘膜细胞微核细胞率明显于正常人，且随着病变程度的加重微核细胞率也增高，各组之间有显著差异，证明该指标可反映口腔白斑的病变程度，可作为癌变早期的观察指标和反映口腔白斑癌变危性大小的标志物。     

P16在口腔白斑和鳞癌组织中的表达及其意义

目的探讨P16在口腔白斑癌变过程中的变化及其意义。方法免疫组化polymer法检测P16蛋白在口腔白斑和鳞癌组织中的表达情况。结果 P16蛋白在10例正常口腔黏膜组织、16例单纯增生性白斑、10例异常增生性白斑及30例口腔鳞癌组织中表达逐步下降,在正常口腔黏膜组织和单纯增生性白斑中表达强于异常增生性白斑组织和鳞癌组织（P〈0.05）,在异常增生性白斑中表达亦强于鳞癌组织（P〈0.05）。结论 P16蛋白表达下降可以作为口腔白斑癌变的指征之一。     

表皮生长因子受体与口腔白斑癌变关系的初步研究

目的通过检测口腔白斑表皮生长因子受体(epidermal growth factor receptor,EGFR)的表达水平,探讨EGFR与口腔白斑癌变潜力的相关性。方法口腔白斑患者根据手术切除后有无存在癌变分成癌变组和未癌变组,癌变组19例,未癌变组31例,免疫组织化学SP法检测两组白斑标本EGFR的表达水平。结果癌变组的口腔白斑与未癌变组EGFR阳性率分别为73.6%和41.9%,癌变组EGFR阳性率明显高于未癌变组,二者差异有显著性意义。结论EGFR表达水平与口腔白斑癌变存在相关性,EGFR可以作为判断口腔白斑癌变潜力的指标之一。     

口腔白斑癌变与吸烟关系的初步探讨

目的：初步探讨口腔白斑的重度上皮异常增生及癌变与吸烟的关系。方法：通过对口腔白斑患者中吸烟者与不吸烟者的临床分型、组织病理变化和吸烟者吸烟情况等临床资料进行综合分析、比较。结果：吸烟者白斑的重度上皮异常增生和癌变发生率明显高于不吸烟者。并且随着吸烟包年数的增加,吸烟者的重度上皮异常增生和癌变发生率也增高,结论：口腔白斑的癌变与吸烟有着一定的联系。     

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目的研究鸟氨酸脱羧酶（ODC）与口腔白斑的发生、发展乃至癌变潜能的关系。方法选取2009—2010年大连医科大学附属第一医院口腔科收治且经病理确诊的口腔白斑患者22例,以其病变黏膜组织为研究对象,同时以11例正常口腔黏膜、22例口腔扁平苔藓组织和22例口腔鳞癌组织为对照。采用免疫组化法检测ODC在各种组织中的表达,并对阳性率进行比较分析。结果在口腔正常黏膜、扁平苔藓、白斑和鳞癌组织中ODC的阳性率依次增加;ODC在口腔扁平苔藓中的阳性率高于正常黏膜,但差异无统计学意义（P〉0.05）,ODC在口腔白斑中的阳性率与正常黏膜和扁平苔藓的差异均有统计学意义（P〈0.05）,口腔鳞癌组织中ODC的阳性率显著高于其余组（P〈0.05）。结论 ODC表达程度可用于判断口腔白斑的恶变倾向及口腔鳞癌的恶性程度。     

Recurrence patterns of oral leukoplakia after curative surgical resection: important factors that predict the risk of recurrence and malignancy

J Oral Pathol Med (2012) 41 : 682–688 Background: Oral leukoplakia can be treated using a variety of treatment procedures; however, the lesions recur in many cases irrespective of the treatment procedure used. The rate of recurrence was from 7.7% to 38.1%. This study aims to identify the important factors that can lower the risk of recurrence of oral leukoplakia treated by curative surgical resection. Methods: The clinical records of 52 patients with oral leukoplakia (53 lesions) who underwent curative surgical resection between 2004 and 2009 were retrospectively analyzed for the rate of recurrence, clinical outcome, epithelial dysplasia, lesion location, and resection margins. Results: The recurrence rate following curative surgical resection was 15.1%, with the most common site being the gingiva. Malignant transformation occurred in a single patient (1.9%). Minimal resection margins (<3 mm) were observed in many patients with recurrent disease, and recurrence was more likely in cases with positive margins (epithelial abnormalities at the resection margins) than in those with negative margins. There was no significant association between recurrence and the degree of epithelial dysplasia. Conclusions: Our data suggest that surgical resection of oral leukoplakia is curative only if all areas of epithelial abnormalities are identified and resected. Moreover, an adequate resection margin may reduce the risk of recurrence.     

中老年人口腔黏膜白斑的回顾性分析

目的 通过对部分临床诊断为白斑的中老年病人的临床表现和相关因素做回顾性分析，为今后更好的正确诊断和预防提供参考。方法 收集118例临床诊断为白斑的中老年病例临床及病理资料，总结其发生发展的相关因素。结果 临床白斑发生部位以颊部最常见(60％)，其次为唇部(24％)、腭部(9％)、舌部(6％)、牙龈和牙槽嵴部(0．8％)。类型以均质型占绝大多数(87％)，非均质型的溃疡型、颗粒型、疣状型总体呈少数(合计仅占13％)。局部刺激因素的长期存在对白斑恶变有一定影响。结论 对临床可疑白斑的诊断力求准确，应对白斑和其他一般的白色角化加以区别，建议在观察一定时期后常规进行病理学检查以确诊。对中老年人一定要加强对不良习惯和局部刺激因素的纠正，以预防少数白斑的恶变。     

The prevalence of oral leukoplakia in 138 patients with oral squamous cell carcinoma

OBJECTIVES: To determine the relationship between oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), and to evaluate possible differences between those carcinomas with and without associated leukoplakia. MATERIAL AND METHODS: A total of 138 patients were studied at the Stomatology Service of the University General Hospital, Valencia, Spain. These patients were divided into two groups: group 1, patients with oral cancer and leukoplakia, and group 2, patients with OSCC but with no associated premalignant lesions. The relationship between this precancerous lesion and the OSCC was evaluated, as well as the possible clinical and histological differences between the tumours of the two groups. RESULTS: Leukoplakia was detected in 27 (19.56%) patients with OSCC. No differences were found between the two groups regarding age and tumour location. However, statistically significant differences were observed with respect to the form, tumour stage and the presence of adenopathies in the cancers with and without leukoplakia; in that the tumours associated with leukoplakia were diagnosed as being at a more initial stage. CONCLUSIONS: Those patients with OL associated with oral cancer presented with tumours at a less advanced stage than those where no associated leukoplakia existed.     

灯盏细辛抗白斑癌变的功效及其血管生成机制的实验研究

目的评价灯盏细辛的抗癌变效果并动态观察其对癌血管生成的影响。方法用Salley法诱导金黄地鼠颊囊白斑癌变,以灯盏细辛干预,采用墨汁灌注图像分析、微血管树脂铸形、α-SMA免疫组化染色及组织病理对照等多种方法联合动态观察其变化规律。结果灯盏细辛组较模型组白斑癌变率下降1倍,正常细胞率是模型组的近4倍。α-SMA值明显高于模型组(P<0.001)。血管面积与血管密度比值两组间相比P>0.05,但树脂微血管铸形显示形态和空间构筑近似于空白对照组。结论灯盏细辛有确切的防止白斑癌变的功效。该药对白斑癌变过程中的血管增生和扩张无明显影响,但对血管构形、空间配置和血管壁的完整性有保护作用,可能是活血化瘀类中药发挥抗癌功效的“良性血管生成”基础。     

Concomitant leukoplakia in patients with oral squamous cell carcinoma

OBJECTIVE: There is an ongoing debate on the prevalence of premalignant lesions, in particular leukoplakia, at the time of diagnosis of an oral squamous cell carcinoma (OSCC). The aim of the present study was to determine the presence of concomitant leukoplakia in 100 patients with OSCC, and to evaluate possible differences in clinical and histopathological parameters of the OSCC between those with or without concomitant leukoplakia.PATIENTS AND METHODS: One hundred consecutive patients, 61 men and 39 women, with a histologically proven OSCC were screened on the presence of leukoplakia. Four groups were distinguished: (I) leukoplakia adjacent to the OSCC, (II) combination of leukoplakia adjacent to the OSCC, and leukoplakia at another oral site, (III) leukoplakia present at another oral site, but not adjacent to the OSCC, and (IV) no leukoplakia present.RESULTS: In 47 (47%) patients with OSCC the presence of concomitant leukoplakia was observed. Thirty-six (36%) patients had a leukoplakia adjacent to the OSCC (groups I and II), of which eight (8%) patients (group II) also had a leukoplakia present at another oral site. Eleven (11%) patients (group III) had no leukoplakia adjacent to the OSCC, but a leukoplakia present at another oral site. Fifty-three (53%) patients (group IV) with OSCC had no concomitant leukoplakia present. No differences were noted between men and women, nor was there any preference for an oral subsite with regard to the carcinoma. There were no statistically significant differences in clinical and histopathological presentation of OSCC's between those with or without concomitant leukoplakia.CONCLUSION: Almost 50% of oral squamous cell carcinomas are presumably associated with or preceded by leukoplakia. Early detection and active management of patients with oral leukoplakia may prevent the true development of a number of oral squamous cell carcinomas.