摘要
背景:狄诺塞麦是治疗骨质疏松症单抗类药物,靶向作用于骨代谢核心通路RANKL/RANK。2010年狄诺塞麦在美国批准上市,现已成为美国治疗绝经后妇女骨质疏松症的一线用药。狄诺塞麦相关的颌骨坏死是狄诺塞麦较为严重的不良反应之一,严重影响患者的生活质量。目的:对狄诺塞麦相关颌骨坏死的可能发生机制及治疗等方面进行综述。方法:第一作者检索近十年PubMed数据库、万方数据库收录的与狄诺塞麦相关颌骨坏死有关的文献。英文检索词为"denosumab-related osteonecrosis of the jaw;denosumab;osteonecrosis of the jaw;osteoclast;RANKL/RANK;bisphosphonate-related osteonecrosis of the jaw",中文检索词为"狄诺塞麦相关颌骨坏死;狄诺塞麦;颌骨坏死;破骨细胞;RANKL/RANK;双膦酸盐相关颌骨坏死"。共选取54篇文献纳入讨论。结果与结论:狄诺塞麦作为治疗骨质疏松症的新型药物,在临床上有良好的应用前景。狄诺塞麦相关颌骨坏死的研究仍处于探索阶段,其潜在机制可能与骨代谢异常以及免疫功能异常有关,治疗方面主要以预防为主,保守治疗仍然是治疗的主流,手术治疗有更大的机会根治,停药和减少刺激有积极的意义。临床用药过程中要严格把控风险-效益关系,与患者沟通好治疗的利弊,让狄诺塞麦的应用更为合理、安全、有效。
BACKGROUND: Denosumab is a monoclonal antibody agent for treating osteoporosis. It targets the RANKL/RANK signaling pathway, which is the core pathway of bone metabolism. Denosumab has been approved for listing in the US in 2010, and has been applied to the first-line treatment for postmenopausal osteoporosis currently. Denosumab-related osteonecrosis of the jaw is one of the serious adverse effects of denosumab, which severely affects patients’ quality of life.OBJECTIVE: To review the possible mechanisms and treatment of denosumab-related osteonecrosis of the jaw.METHODS: The first author retrieved the literature related to denosumab-related osteonecrosis of the jaw in the PubMed and WanFang databases for recent decade. The keywords were "denosumab-related osteonecrosis of the jaw, denosumab, osteonecrosis of the jaw,osteoclast, RANKL/RANK, bisphosphonate-related osteonecrosis of the jaw" in English and Chinese, respectively. Fifty-four eligible articles were finally reviewed.RESULTS AND CONCLUSION: As a new drug for osteoporosis, denosumab has a good clinical application prospect. The study of denosumab-related osteonecrosis of the jaw is still in the exploratory stage. The underlying mechanism of denosumab-related osteonecrosis of the jaw may be related to abnormal bone metabolism and immune dysfunction. Prevention is the main treatment for osteonecrosis of the jaw. Although conservative treatment is still the mainstream of treatment, surgery has greater chance to cure the disease. During treatment,discontinuing the drug and reducing the stimulus has positive effect. In the course of clinical drug use, we should strictly control the risk-benefit relationship, and communicate with patients about the advantages and disadvantages of treatment, so as to make the application of denosumab more reasonable, safe and effective.
作者
王乐
张晓明
刘童斌
Wang Le;Zhang Xiaoming;Liu Tongbin(Department of Prosthodontics, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第27期4408-4413,共6页
Chinese Journal of Tissue Engineering Research
基金
山东省医药卫生科技发展计划项目(2016WS0121),项目参与者:刘童斌~~
