直流电药物离子导入曲安奈德治疗口腔黏膜下纤维性变的临床研究

Clinical study of the treatment effects of direct current iontophoresis of triamcinolone acetonide on oral submucous fibrosis

目的探讨直流电药物离子导入曲安奈德(triamcinolone acetonide,TA)治疗口腔黏膜下纤维性变(oral submucous fibrosis, OSF)的临床效果。方法 51名OSF患者被随机分为两组,A组患者接受黏膜下注射TA(20 mg/侧,n=25),B组患者使用直流电药物离子导入TA(20 mg/侧,n=26)共8周,治疗结束后12周进行随访。测量患者治疗前后上下颌前牙间最大开口距离。视觉模拟评分法(VAS)评估两种治疗方式的疼痛。口腔健康影响程度量表中文版(OHIP-14)评价患者治疗效果。结果 B组患者在接受治疗的第8周开口度增加值为(3.76±0.88)mm,高于A组(3.25±0.77)mm,差异有统计学意义(P<0.05)。A组患者在治疗结束后12周开口度增加值为(2.61±0.62) mm,B组为(2.53±0.52)mm,差异无统计学意义(P>0.05)。在接受治疗的第1周时,A组患者VAS评分为7.88±0.80,显著高于B组2.47±0.64(P <0.001)。在接受治疗的第8周时,A组患者VAS评分为7.29±0.53,仍显著高于B组1.77±0.48(P <0.001)。两组患者在治疗后VAS评分均有减少,差别具有统计学意义(P <0.001)。在接受治疗前,A组患者OHIP14评分为31.44±2.55,B组为32.04±2.20,差异无统计学意义(P>0.05)。在治疗结束后12周时,A组患者OHIP14评分为13.52±3.31,B组为12.04±2.84,差异无统计学意义(P>0.05)。两组患者在治疗后OHIP14评分均有明显减少,差别具有统计学意义(P <0.001)。结论直流电药物离子导入TA可以作为治疗OSF的有效手段之一。

Objective To observe the clinical effects of direct current iontophoresis(DCI) of triamcinolone acetonide(TA) on treatment of oral submucous fibrosis. Methods Fifty-one patients were randomly divided in group A(n=25), which underwent local submucous injection with TA(20 mg for each side) once a week for 8 weeks, and group B(n=26), which underwent local TA administration by DCI(20 mg for each side) for 8 weeks, follow-up was performed 12 weeks after treatment. The distances between the upper and lower central incisors were recorded. The visual analogue scale(VAS) was used to evaluate the pain caused by the two treatments. The Oral Health Impact Profile(OHIP)-14 was used to assess the entire effect of treatments. Results At 8 weeks of treatment, the mouth opening was increased by 3.25 ± 0.77 mm in group A and 3.76 ± 0.88 mm in group B(P < 0.05). At 20 weeks after treatment, the mouth opening was increased by 2.61 ± 0.62 mm in group A and 2.53 ± 0.52 mm in group B(P > 0.05). After the first treatment, the VAS score of group A was 7.88 ± 0.80, and the VAS score of group B was 2.47 ± 0.64, resulting in a statistically significant difference(P < 0.001). After the last treatment, the VAS score was 7.29 ± 0.53 in group A and 1.77± 0.48 in group B, resulting in a statistically significant difference(P < 0.001). The VAS scores of the two groups were decreased after treatment, and the difference between groups was statistically significant(P < 0.001). The OHIP-14 score of patients in group A before treatment was 31.44 ± 2.55, while that in group B was 32.04 ± 2.20(P > 0.05). At20 weeks after treatment, the score in group A was 13.52 ± 3.31 and that in group was 12.04 ± 2.84(P > 0.05). The OHIP-14 scores of the two groups were significantly decreased before and after treatment, and the difference between groups was statistically significant(P < 0.001). Conclusion The results suggest that local TA administration by DCI might be a promising method for treatment in the early and middle disease periods in OSF patients.