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中华口腔医学研究杂志(电子版) ›› 2017, Vol. 11 ›› Issue (04) : 218 -224. doi: 10.3877/cma.j.issn.1674-1366.2017.04.005

所属专题: 文献

临床研究

己酮可可碱和维生素E联合治疗放射性颌骨骨坏死的Meta分析
肖维维1, 陈媛丽1, 宗春琳1, 宋林1, 田磊1,()   
  1. 1. 710032 西安,军事口腔医学国家重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,第四军医大学口腔医院颌面外科
  • 收稿日期:2017-06-05 出版日期:2017-08-01
  • 通信作者: 田磊

Meta analysis for the efficacy of pentoxifylline and vitamin E in treatment of osteoradionecrosis of jaw

Weiwei Xiao1, Yuanli Chen1, Chunlin Zong1, Lin Song1, Lei Tian1,()   

  1. 1. State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, The Fourth Military Medical University, Xi′an 710032, China
  • Received:2017-06-05 Published:2017-08-01
  • Corresponding author: Lei Tian
  • About author:
    Correspondence: Tian Lei, Email:
引用本文:

肖维维, 陈媛丽, 宗春琳, 宋林, 田磊. 己酮可可碱和维生素E联合治疗放射性颌骨骨坏死的Meta分析[J]. 中华口腔医学研究杂志(电子版), 2017, 11(04): 218-224.

Weiwei Xiao, Yuanli Chen, Chunlin Zong, Lin Song, Lei Tian. Meta analysis for the efficacy of pentoxifylline and vitamin E in treatment of osteoradionecrosis of jaw[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2017, 11(04): 218-224.

目的

通过Meta分析研究己酮可可碱和维生素E联合治疗放射性颌骨骨坏死的有效性。

方法

运用计算机检索PubMed(1980—2017.02)、EMbase(1980—2017.02)、Cochrane图书馆(2017年第2期)、中国生物医学文献数据库(1980—2017.02)中关于己酮可可碱和维生素E联合治疗放射性颌骨骨坏死随机对照试验,将检索时限定为1980年1月至2017年2月。经过对检索到的论文进行客观的质量评价后,应用Cochrane协作网提供的Reman 5.3软件系统进行Meta分析。

结果

经过分析,在有效文献中,应用己酮可可碱和维生素E对放射性颌骨坏死进行治疗,其治愈率较对照组明显增高,差异有统计学意义(OR= 8.25,95% CI:1.84~ 36.94,P<0.05),不良反应报道少,安全性高。

结论

经过对相关文献的Meta分析,采用己酮可可碱和维生素E联合治疗放射性颌骨骨坏死有明显的临床疗效,该研究对临床具有指导意义,但仍需进行更直接有效的临床研究。

Objective

To study the efficacy of pentoxifylline and vitamin E in treatment of osteoradionecrosis of jaw by Meta analysis.

Methods

Pubmed (1980-2017.02) , EMbase (1980-2017.02) , Cochrane library (2017.02) , the Chinese biomedical literature database (1980-2017.02) were retrieved about the randomized controlled trials of pentoxifylline and vitamin E in treatment of osteoradionecrosis of jaw, and the time extent was from January 1980 to February 2017. After objective evaluation of the retrieved paper quality, Cochrane collaboration with Rev Man 5.3 software system was applied to accomplish this Meta analysis.

Results

Five out of thirty eight paper were fully analyzed, the cured rate of treating osteoradionecrosis of jaw by pentoxifylline and vitamin E group was significantly higher than control group, and the difference was statistically significant (OR= 8.25, 95% CI: 1.84~ 36.94, P<0.05) .

Conclusions

Meta analysis shows the clinical effect of pentoxifylline and vitamin E in treatment of osteoradionecrosis of jaw is significant, but the direct and effective clinical evidence is still needed to be collected.

表1 纳入研究文献的基本情况
图1 文献筛选过程
表2 纳入文献的质量评价(分)
图2 己酮可可碱和维生素E治疗与其他疗法对比(OR= 8.25,95% CI:1.84~ 36.94,P<0.05)
图3 己酮可可碱和维生素E与抗生素的疗效比较(OR= 8.22,95% CI:1.32~ 51.27,P<0.05)
图4 己酮可可碱和维生素E与高压氧的疗效比较(OR= 20.06,95% CI:1.74~ 230.78,P<0.05)
图5 己酮可可碱和维生素E与局部手术的疗效比较(OR= 9.27,95% CI:1.36~ 63.10,P<0.05)
图6 己酮可可碱和维生素E治疗与其他疗法对比森林图(修剪之后;OR= 2.46,95% CI:1.39~ 4.34,P<0.05)
图7 己酮可可碱和维生素E治疗与其他疗法对比漏斗图(修剪之后)
[1]
McLeod NM, Pratt CA, Mellor TK,et al. Pentoxifylline and tocopherol in the management of patients with osteoradionecrosis,the Portsmouth experience[J]. Br J Oral Maxillofac Surg,2012,50(1):41-44.
[2]
Vissink A, Burlage FR, Spijkervet FK,et al. Prevention and treatment of the consequences of head and neck radiotherapy[J]. Crit Rev Oral Biol Med,2003,14(3):213-225.
[3]
Balogh JM, Sutherland SE. Osteoradionecrosis of the mandible:a review[J]. J Otolaryngol,1989,18(5):245-250.
[4]
Delanian S, Lefaix JL. Radionécrose de l′os mature:connaissance physiopathologique récente motrice d′une thérapeutique médicale innovante[J]. Cancer/Radiother,2002,6(1):1-9.
[5]
Cochran WG. The combination of estimates from different experiments[J]. Biometrics,1954,10(1):101-129.
[6]
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis[J]. Stat Med,2002,21(11):1539-1558.
[7]
DerSimonian R, Laird N. Meta-analysis in clinical trials[J]. Control Clin Trials,1986,7(3):177-188.
[8]
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease[J]. J Natl Cancer Inst,1959,22(4):719-748.
[9]
D′Souza J, Lowe D, Rogers SN. Changing trends and the role of medical management on the outcome of patients treated for osteoradionecrosis of the mandible:experience from a regional head and neck unit[J]. Br J Oral Maxillofac Surg,2014,52(4):356-362.
[10]
Robard L, Louis MY, Blanchard D,et al. Medical treatment of osteoradionecrosis of the mandible by PENTOCLO:preliminary results[J]. Eur Ann Otorhinolaryngol Head Neck Dis,2014,131(6):333-338.
[11]
Delanian S, Depondt J, Lefaix JL. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol:a phaseⅡ trial[J]. Head Neck,2005,27(2):114-123.
[12]
Delanian S, Chatel C, Porcher R,et al. Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination(PENTOCLO):a phaseⅡ trial[J]. Int J Radiat Oncol Biol Phys,2011,80(3):832-839.
[13]
Patel V, Gadiwalla Y, Sassoon I,et al. Use of pentoxifylline and tocopherol in the management of osteoradionecrosis[J]. Br J Oral Maxillofac Surg,2016,54(3):342-345.
[14]
O′Dell K, Sinha U. Osteoradionecrosis[J]. Oral Maxillofac Surg Clin North Am,2011,23(3):455-464.
[15]
Meyer OT, Dannenberg AM Jr. Radiation,infection,and macrophage function.Ⅱ. Effect of whole body radiation on the number of pulmonary alveolar macrophages and their levels of hydrolytic enzymes[J]. J Reticuloendothel Soc,1970,7(1):79-90.
[16]
Marx RE. A new concept in the treatment of osteoradionecrosis[J]. J Oral Maxillofac Surg,1983,41(6):351-357.
[17]
Annane D, Depondt J, Aubert P,et al. Hyperbaric oxygen therapy for radionecrosis of the jaw:a randomized,placebo-controlled,double-blind trial from the ORN96 study group[J]. J Clin Oncol,2004,22(24):4893-4900.
[18]
何悦,刘忠龙,代天国,等.放射性下颌骨坏死的BS临床分类及治疗策略[J].中国肿瘤临床,2015,42(16):817-826.
[19]
Shaw RJ, Dhanda J. Hyperbaric oxygen in the management of late radiation injury to the head and neck. PartⅠ:treatment[J]. Br J Oral Maxillofac Surg,2011,49(1):2-8.
[20]
Shaw RJ, Butterworth C. Hyperbaric oxygen in the management of late radiation injury to the head and neck. PartⅡ:prevention[J]. Br J Oral Maxillofac Surg,2011,49(1):9-13.
[21]
Madrid C, Abarca M, Bouferrache K. Osteoradionecrosis:an update[J]. Oral Oncology,2010,46(6):471-474.
[22]
Lyons A, Ghazali N. Osteoradionecrosis of the jaws:current understanding of its pathophysiology and treatment[J]. Br J Oral Maxillofac Surg,2008,46(8):653-660.
[23]
何悦,代天国,孙坚,等.血管化骨组织瓣在下颌骨放射性骨坏死临床治疗中的应用研究[J].中国肿瘤临床,2015,42(16):827-833.
[24]
Delanian S. Striking regression of radiation-induced fibrosis by a combination of pentoxifylline and tocopherol[J]. Br J Radiol,1998,71(848):892-894.
[25]
Delanian S, Ballamekias S, Lefaix JL. Striking regression of chronic radiotherapy damage in a clinical trial of combined pentoxifylline and tocopherol[J]. J Clin Oncol,1999,17(10):3283-3290.
[26]
Kaya V, Yazkan R, Yıldırım M,et al. The relation of radiation-induced pulmonary fibrosis with stress and the efficiency of antioxidant treatment:an experimental study[J]. Med Sci Monit,2014(20):290-296.
[27]
Okunieff P, Augustine E, Hicks JE,et al. Pentoxifylline in the treatment of radiation-induced fibrosis[J]. J Clin Oncol,2004,22(11):2207-2213.
[28]
Delanian S, Lefaix JL. The radiation-induced fibroatrophic process:therapeutic perspective via the antioxidant pathway[J]. Radiother Oncol,2004,73(2):119-131.
[29]
Delanian S, Porcher R, Balla-Mekias S,et al. Randomized,placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis[J]. J Clin Oncol,2003,21(13):2545-2550.
[30]
宗春琳,郭宇轩,窦庚,等.兔下颌骨放射性骨坏死模型的建立及评估[J].中国口腔颌面外科杂志,2014,12(6):481-486.
[31]
付洪海,周咏,张志愿,等. TGF-β1过表达介导的放疗诱导成纤维细胞向肌成纤维细胞分化的体外研究[J].中国口腔颌面外科杂志,2012,10(4):266-270.
[32]
Zong C, Cai B, Wen X,et al. The role of myofibroblasts in the development of osteoradionecrosis in a newly established rabbit model[J]. J Craniomaxillofac Surg,2016,44(6):725-733.
[33]
Chen Y, Zong C, Guo Y,et al. Hydrogen-rich saline may be an effective and specific novel treatment for osteoradionecrosis of the jaw[J]. Ther Clin Risk Manag,2015(11):1581-1585.
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