口腔扁平苔藓治疗现状分析

The present situation in treatment for oral lichen planus

口腔扁平苔藓(oral lichen planus,OLP)因其病因复杂,当前仍然缺乏有效的根治方法。有效控制该病病情、预防其复发是OLP临床治疗的首要目的。现有的研究证据支持糖皮质激素可作为治疗本病的首选药物,但临床上仍然存在部分病例治疗效果欠佳的现象,这主要与药物抵抗性以及不可耐受等因素有关。因此国内外学者一直在探索新的治疗药物与方法,以期达到更有效且安全的治疗效果。局部应用他克莫司、吡美莫司以及维甲酸与糖皮质激素类药物的联合应用,对糖皮质激素药物抵抗性的病例可作为一线替代疗法。全身性使用糖皮质激素、免疫抑制剂如氨甲喋呤、麦考酚酯、氨苯砜等药物应该限于病变广泛、难治性病例,或者病损累及口腔以外的部位。手术治疗、冷冻治疗可应用于独立的、范围较局限的病损。由于以往临床随机对照研究存在样本量小、治疗周期短、临床追踪不足、缺乏可靠的调查量表以及统一的疗效评估标准等局限性,因而今后工作应注重以下几点:(1)开展大样本临床随机对照研究,为评估各治疗方式疗效提供可靠度更高的研究依据;(2)治疗评估的周期应尽可能延长;(3)追踪研究周期应足够长,以便于评估复发率;(4)治疗效果的评估方式与标准应统一。

Oral lichen planus(OLP),a common and chronic disorder,has no effective treatment or cure because its etiology is complicated and has until now remained unclear.Therefore,effectively controlling the activity of the disease and preventing its recurrence are two primary purposes of clinical treatment for OLP.The available evidence supports the notion that topical steroids are the preferred drug for treating this disease.However,some cases have poor clinical curative responses to steroids or other medicines,mainly because of drug resistance and other factors.Therefore,schol-ars have explored new drugs and methods with the aim of achieving more effective and safe treatment effects.The current research evidence indicates that glucocorticoid remains the front-line drug for OLP treatment.Topical tacrolimus,pimecrolimus and retinoic acid combined with glucocorticoid can be used as alternative therapies,especially in cases with glucocorticoid drug resistance.The systemic application of glucocorticoid or immunosuppressive agents,such as methotrexate,mycophenolate mofetil,and sulfoxide,should be limited to extensive,refractory cases or those with lesions involving regions outside the oral cavity.Surgery and cryotherapy can be applied in a specific,limited range of lesions.Some previous randomized controlled clinical studies have had limitations,including a small sample size,short treatment and clinical follow-up periods,a lack of reliable questionnaires and differences in evaluation standards.Therefore,future studies should include the following:randomized controlled clinical studies with large sample sizes that offer reliable evidence of a curative effect;assessments of treatment outcomes should be extended as long as possible;the follow-up period should be long enough to assess the recurrence rate;and the methods and standards used to evaluate treatment effects should be standardized.