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放射性口腔黏膜炎及其致病机制的研究进展
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Abstract:
放射性口腔黏膜炎是头颈部放射治疗中最常见且难以避免的并发症，不仅导致患者口腔疼痛和进食困难，甚至可能中断放射治疗。临床上多以消炎、镇痛、抗感染等方式对症处理放射性口腔粘膜炎，有效的防治策略仍较少。目前关于放射性口腔黏膜炎致病机制的新研究较多，还需进一步系统性梳理。综合分析表明，过量的电离辐射会对正常细胞造成损伤，主要表现为细胞DNA双链断裂、大量活性氧以及相关炎症因子的释放。辐照剂量在机体内不断地累积，且受损的口腔黏膜组织、细胞难以及时、准确地修复，共同导致了放射性口腔黏膜炎的发生发展，而NF-kB、Wnt/β-catenin等信号通路在此过程中被高度激活，此外新的研究发现Keap1-Nrf2信号通路以及衰老细胞的存在也会影响放射性口腔黏膜炎的进程。本文重点阐述了辐射损伤机制及放射性口腔粘膜炎的相关信号通路，这为后续研究放射性口腔黏膜炎致病机制及治疗方案提供了一定的新思路。
Radiation-induced oral mucositis is the most common and unavoidable complication in head and neck radiotherapy. It not only causes oral pain and difficulty in eating for patients, but may even interrupt radiotherapy. Clinically, radiation-induced oral mucositis is mostly treated symptomatically with anti-inflammatory, analgesic and anti-infection methods, but effective prevention and treatment strategies are still relatively few. At present, there are many new studies on the pathogenic mechanism of radiation-induced oral mucositis, and further systematic sorting is still needed. Comprehensive analysis indicates that excessive ionizing radiation can cause damage to normal cells, mainly manifested as double-strand breaks in cell DNA, the release of a large amount of reactive oxygen species, and related inflammatory factors. The continuous accumulation of irradiation dose in the body and the difficulty in timely and accurate repair of damaged oral mucosal tissues and cells jointly lead to the occurrence and development of radiation-induced oral mucositis. During this process, signaling pathways such as NF-kB and Wnt/β-catenin are highly activated. In addition, new research has found that the Keap1-Nrf 2 signaling pathway and the presence of senescent cells can also affect the progression of radiation-induced oral mucositis. This article focuses on elaborating the mechanism of radiation damage and the related signaling pathways of radiation-induced oral mucositis, which provides certain new ideas for the subsequent research on the pathogenic mechanism and treatment plan of radiation-induced oral mucositis.
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