Nd:YAG激光联合曲安奈德治疗口腔黏膜下纤维化的临床研究

  目的  采用Nd:YAG激光联合曲安奈德治疗口腔黏膜下纤维化患者，观察治疗后纤维化组织的修复、愈合及病情进展情况。  方法  选取2018年6月—2019年10月于杭州师范大学附属医院口腔科就诊的80例口腔黏膜下纤维化患者，采用随机数字表法分为观察组与对照组，每组40例。对照组患者使用曲安奈德注射液治疗，观察组在此基础上使用Nd:YAG激光治疗，2组均持续治疗9周。2组患者治疗前后采用视觉模拟评分法(VAS)评分进行评价，并测量张口程度和口腔黏膜病损面积；采用酶联免疫吸附法(ELISA)测定血清血管内皮生长因子(VEGF)、血小板反应蛋白(TSP)、基质金属蛋白酶-2(MMP-2)水平及血清IL-6、TNF-α水平。  结果  治疗后，对照组口腔黏膜病损面积为(1.47±0.62)cm2，观察组为(0.86±0.23)cm2，观察组口腔黏膜病损面积小于对照组(P < 0.05)；2组患者血清VEGF均升高，观察组高于对照组[(0.75±0.19)pg/mL vs.(0.61±0.23)pg/mL, P < 0.05]，而血清TSP、MMP-2、IL-6和TNF-α水平均降低，观察组低于对照组(均P < 0.05)。  结论  Nd: YAG激光联合曲安奈德可有效缓解口腔黏膜下纤维化患者口腔灼痛，抑制纤维化发展，并促进纤维化组织的修复与愈合，控制病情进一步发展。 

Clinical study of Nd:YAG laser combined with triamcinolone acetonide in the treatment of oral submucosal fibrosis

Objective To investigate the repair and healing of fibrotic tissue and the progress of the disease in patients with oral submucosal fibrosis after treatment with Nd:YAG laser combined with triamcinolone acetonide.Methods A total of 80 patients with submucosal oral fibrosis admitted to Affiliated Hospital of Hangzhou Normal University from June 2018 to October 2019 were selected,and random numbers were used.No significant difference was observed in VAS scores between the two groups after treatment(P>0.05).The area of oral mucosal lesions in the treatment group was smaller than that in the control group.According to table method,the patients were divided into treatment and control groups with 40 cases in each group.The control group was treated with triamcinolone acetonide injection,and the treatment group was treated with Nd:YAG laser on this basis.Both groups were treated continuously for 9 weeks.VAS score,mouth opening degree and oral mucosal lesion area,serum levels of VEGF,TSP,MMP-2,and serum levels of IL-6 and TNF-αwere compared between the two groups before and after treatment.Results After treatment,the oral mucosal lesion area was(1.47±0.62)cm² in the control group and(0.86±0.23)cm² in the experimental group.The oral mucosal lesion area in the experimental group was lower than that in the control group(P<0.05).Serum VEGF increased in both groups,and the treatment group was higher than the control group[(0.75±0.19)pg/mL vs.(0.61±0.23)pg/mL,P<0.05],whereas serum TSP,MMP-2,IL-6,and TNF-αdecreased,and the treatment group was lower than the control group(all P<0.05).Conclusion Nd:YAG laser combined with triamcinolone acetonide can effectively relieve the burning pain in the mouth of patients with oral submucosal fibrosis,inhibit the development of fibrosis,promote the repair and healing of fibrotic tissue,and control the development of the disease.