药物相关性颌骨坏死的研究进展

Research progress on medication-related osteonecrosis of the jaw

随着抗骨吸收和抗血管生成药物的不断使用,药物相关性颌骨坏死作为一种较严重的不良反应受到广泛关注。药物相关性颌骨坏死属于多因素影响的疾病,危险因素众多,在一般人群中的年发病率大致为每年1×10-5。目前存在多种假说解释有关机制。双膦酸盐和狄诺塞麦能抑制破骨细胞的分化及功能,促进破骨细胞凋亡,使骨吸收及骨重建减少。双膦酸盐的抗血管生成作用降低了颌骨区域血供,同时抑制了机体的免疫功能。口腔局部的菌群还会进一步加重组织损伤和减少血管生成。除此之外,双膦酸盐对口腔黏膜细胞的直接作用和颌骨的解剖结构都对骨坏死的发展有一定的作用。患者的治疗措施因患病情况存在差异,但均以减轻痛苦、控制软硬组织感染、延缓或停止骨坏死进程为主。本文就药物相关性颌骨坏死的危险因素、相关机制、分期以及预防治疗策略作一综述。

Given the use of anti-resorptive and antiangiogenic drugs, medication-related osteonecrosis of the jaw （MRONJ） has gained wide attention as a severe side effect. MRONJ is a multifactorial disease with a number of risk factors. The population incidence of BRONJ is approximately 1×10^-5 per year. Many hypotheses are proposed to explain the mechanism. Bisphosphonates and denosumab inhibit osteoclast differentiation and function and increase apoptosis, which lead to decreased bone resorption and remodeling. Bisphosphonates reduce the blood supply to the jaw area and has immuno-suppressive effects. Oral local flora can also aggravate the damage of tissues and reduce angiogenesis. The direct effect of bisphosphonates on oral mucosa cells and the anatomy of the jaw have a role on the development of osteonecrosis. According to sickness status, treatment methods are different but are focused on reducing pain, treating soft and hard tissue infections, and delaying or stopping the process of osteonecrosis. This article reviewed the risk factors, relevant mechanisms, and prevention and treatment strategies.