口腔苔藓样药物反应的研究进展

Research progress on oral lichenoid drug reactions

口腔苔藓样药物反应(oral lichenoid drug reactions,OLDR)是特殊体质者使用特定药物后引起的口腔黏膜炎性反应,属于口腔苔藓样损害(oral lichenoid lesions,OLL)这一病种,其临床表现和病理表现与其他种类的OLL相比不存在明显的特异性,可能诱发OLDR的药物种类繁多,包括了降压药、非甾体抗炎药、降糖药、抗焦虑/精神类药物、生物制剂等,治疗方案除局部或全身使用糖皮质激素以外,停用可疑药物是最有效的治疗措施,大多数患者的黏膜溃疡、糜烂能得到较大缓解,但可能仍有白纹残留。虽然OLDR已在文献报道和临床工作中得到广泛关注,但由于缺乏系统的认识,对于OLDR的诊断并没有公认的标准,也缺乏规范化的诊疗流程,且相关药物与口腔苔藓样病变之间的因果关系仍然存在疑问。针对以上问题,笔者检索了近20年国内外药物相关口腔扁平苔藓和苔藓样损害的文献,其中绝大多数为病例报告,仅有少量病例对照研究。本文从相关概念、可疑药物、临床及病理表现、治疗预后4个方面介绍了其研究现状,希望能为相关苔藓样损害的预防、诊断和临床治疗提供理论参考。文献综述显示了该疾病在病因、发病机制、临床诊疗、治疗预后等方面仍有大量问题尚不明确,仍需进一步开展临床及基础研究予以深入探索。

Oral lichenoid drug reactions(OLDRs)are inflammatory reactions of the oral mucosa caused by the use of specific drugs in sensitive individuals and are classified as oral lichenoid lesions(OLLs).Its clinical and pathological manifestations do not have significant specificity compared to other types of OLL.Various types of drugs have been reported to induce OLDR,including antihypertensive drugs,nonsteroidal anti-inflammatory drugs,hypoglycemic drugs,antipsychotics,and immunosuppressants,among other drugs.Apart from local or systemic administrate glucocorticoids,the most effective treatment measure is to stop using suspicious drugs.Most patients can achieve significant relief from mucosal ulcers and erosion,but white lines may still remain.OLDR has been widely reported in the literature.However,due to a lack of systematic understanding,we do not have a recognized standard for the diagnosis and treatment of this disease.There are still doubts about the causal relationship between related drugs and oral lichen-like lesions.In response to the abovementioned problems,we searched the literature on drug-related oral lichen planus and lichen-like le-sions at home and abroad over the past 20 years,most of which were case reports and only a few of which were case-control studies.This article describes the current research status of lichenoid lesions from four perspectives:concepts,suspicious drugs,clinical and pathological manifestations,and treatment prognosis.We hope to provide a theoretical reference for the prevention,diagnosis,and clinical treatment of related lichenoid lesions.A literature review demonstrated that there are still many unclear issues related to the etiology,pathogenesis,clinical diagnosis and treatment,treatment prognosis,and other aspects of this disease,and further clinical and basic research is needed for in-depth exploration.