富血小板血浆凝胶联合复方倍他米松治疗糜烂型口腔扁平苔藓效果研究

Study on the efficacy of platelet-rich plasma gel combined with compound betamethasone in the treatment of erosive oral lichen planus

目的研究富血小板血浆(platelet-rich plasma,PRP)凝胶联合复方倍他米松对糜烂型口腔扁平苔藓(oral lichen planus,OLP)的临床疗效。方法选取2020年9月至2023年9月于徐州市中心医院就诊的糜烂型OLP患者80例,采用随机数字表法分为研究组(40例)和对照组(40例)。研究组采用复方倍他米松联合PRP凝胶治疗,对照组采用复方倍他米松治疗,比较2组患者治疗前及治疗4、8周后的病损面积和疼痛视觉模拟量表(visual analogue scale,VAS)评分,治疗前及治疗8周后的白细胞介素-17(interleukin 17,IL-17)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)表达量及CD4+T细胞与CD8+T细胞比值(CD4/CD8),治疗8周后的临床疗效,以及治疗过程中的不良反应发生情况。结果治疗前2组病损面积、VAS评分、IL-17和TNF-α表达量及CD4/CD8的差异均无统计学意义(均P>0.05)。治疗4、8周后,研究组病损面积分别为(2.40±0.84)、(1.37±0.61)cm^(2),小于相同治疗时间的对照组[(2.93±0.85)、(2.33±0.91)cm^(2)],且均较治疗前明显缩小;研究组VAS评分分别为(2.50±0.65)、(1.74±0.57)分,小于相同治疗时间的对照组[(3.00±0.68)、(2.47±0.85)分],且均较治疗前明显下降,差异均有统计学意义(均P<0.05)。治疗8周后,研究组治疗显效29例(72.5%)、有效9例(22.5%)、无效2例(5.0%),对照组治疗显效20例(50.0%)、有效12例(30.0%)、无效8例(20.0%),2组差异有统计学意义(Z=2.266,P=0.023);研究组IL-17、TNF-α表达量低于对照组,CD4/CD8高于对照组,差异均有统计学意义(均P<0.05)。治疗过程中2组均未出现较为严重的不良反应,研究组不良反应发生率为10%(4/40),对照组为15%(6/40),2组差异无统计学意义(χ^(2)=0.114,P=0.735)。结论在为期8周的临床治疗中,PRP凝胶联合复方倍他米松相较于仅使用复方倍他米松对糜烂型OLP的治疗效果更好,值得临床推广与深入研究。

Objective To investigate the clinical efficacy of platelet-rich plasma(PRP)gel combined with compound betamethasone on erosive oral lichen planus(OLP).Methods A total of 80 patients with erosive OLP who were admitted to Xuzhou Central Hospital from September 2020 to September 2023 were enrolled and divided into the study group(40 cases)and the control group(40 cases)according to the random number table method.The study group was treated with compound betamethasone combined with PRP gel,and the control group was treated with compound betamethasone,the lesion area and pain visual analogue scale(VAS)before treatment and after 4 and 8 weeks of treatment,interleukin 17(IL-17),tumor necrosis factor-α(TNF-α)and the ratio of CD4+T cells to CD8+T cells(CD4/CD8)before and after 8 weeks of treatment,the clinical efficacy after 8 weeks of treatment,and the occurrence of adverse reactions during treatment were recorded.Results There were no significant differences in lesion area,VAS score,IL-17 and TNF-αexpressions,and CD4/CD8 between the two groups before treatment(all P>0.05).After 4 and 8 weeks of treatment,the lesion area in the study group were(2.40±0.84)cm^(2)and(1.37±0.61)cm^(2),respectively,which were smaller than that of the control group with the same treatment time[(2.93±0.85)cm^(2)and(2.33±0.91)cm^(2)],both were significantly smaller than those before treatment;the VAS scores in the study group were(2.50±0.65)and(1.74±0.57),respectively,which were smaller than that of the control group with the same treatment time[(3.00±0.68)and(2.47±0.85)],both were significantly lower than those before treatment,the differences were statistically significant(all P<0.05).After 8 weeks of treatment,in the study group,29 cases(72.5%)had significant effective treatment,9 cases(22.5%)had effective treatment,and 2 cases(5.0%)had ineffective treatment,while 20 cases(50.0%)had significant effective treatment,12 cases(30.0%)had effective treatment and 8 cases(20.0%)had ineffective treatment in the control group,there was a statistically significant difference between the two groups(Z=2.266,P=0.023).The expressions of IL-17 and TNF-αin the study group were lower than those in the control group,the CD4/CD8 levels were higher than those in the control group,the differences were statistically significant(all P<0.05).There were no serious adverse reactions in the two groups during the treatment,the incidence of adverse reactions was 10%(4/40)in the study group and 15%(6/40)in the control group,there was no statistically significant difference between the two groups(χ^(2)=0.114,P=0.735).Conclusion In the 8-week clinical treatment,PRP gel combined with compound betamethasone has a better therapeutic effect on erosive OLP than compound betamethasone is used alone,which is worthy of clinical promotion and in-depth research.