口腔扁平苔藓与精神因素的相关性研究

The Correlation Reach of OLP and Mental Factor

扁平苔藓(oral lichen planus,OLP)是一种口腔黏膜慢性炎症性疾病,属癌前病变,其发病机制尚不明确,一般认为与免疫、精神心理因素、应激等有关。其中周期性或长期心理压力与扁平苔藓的发生和恶化密切相关。众多研究表明,OLP患者往往伴有焦虑抑郁等情绪障碍,情绪障碍可通过改变T细胞亚群的迁移性能,及引起循环血液中5羟色胺,去甲肾上腺素,CD4和CD8等含量升高,从而影响神经内分泌及免疫系统。也有研究报导,负性生活事件刺激作为应激源,使机体长期处于紧张状态,导致机体出现下丘脑-垂体-肾上腺皮质轴(HPA轴)兴奋为主的神经内分泌反应,促使持久的神经内分泌紊乱,导致OLP的发生。另外,人格因素也影响到了患者对压力的感知和应对。一些研究证明神经质与黏膜病相关,神经质人格对各种刺激反应强烈,容易产生焦虑、紧张、易怒、抑郁等情绪,并影响到皮质醇的含量和HPA轴的调节。单胺类神经递质如5-HT,NE通过相应的受体作用于神经内分泌免疫调节网络,对中枢系统起调节作用。经检测扁平苔藓患者血液中5-HT,NE的含量发现OLP组显著高于对照组,提示在发病过程中5-HT,NE起到一定作用。由于5-HT,NE是控制情绪的主要物质,情感障碍的核心递质。因此情绪及社会心理因素可能是OLP发病的危险因素之一。

Oral lichen planus（OLP）is a chronic inflammatory disease of the oral mucosa,precancerous lesions,the mechanism is unclear.It is generally considered to be concerned with immune,mental factor,stress and so on.The cyclical or long-term psychological stress is closely related to the genesis and deterioration of OLP.Numerous studies have shown that OLP patients often accompanied by anxiety,depression and other mood disorders,which changed the migration of T cell subgroup and increased the content of 5-HT,NE,CD4 and CD8,then lead to the disorder of Neuroendocrine and immune system.Other studies showed negative life events stimulating as a source of stress,make the body tension for a long time,which cause the hypothalamus- pituitary- adrenal cortex axis（HPA axis）stimulation,then result in OLP.Besides,personality factors also influence the perception of stress.Some research suggested that neuroticism is associated with mucosal disease,neurotic personality has a strong response to various stimuli,caused a series of negative emotions,then affect the content of cortisol.5-HT and NE modulate Neuroendocrine and immune system via corresponding receptors then affect the central nervous system.The contents of 5-HT and NE in serum of OLP patients are obvious higher than normal people,suggesting that they may contribute to the development of OLP.As 5-HT and NE are the important factors controlling emotions,therefore,emotional and social psychological factors may be one of the risk factors resulting in OLP.