中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (27): 4408-4413.doi: 10.3969/j.issn.2095-4344.1394

• 组织构建综述 tissue construction review • 上一篇    下一篇

狄诺塞麦相关颌骨坏死：从破骨细胞靶向治疗方向的思考

王  乐，张晓明，刘童斌   

  1. (滨州医学院附属医院口腔修复科，山东省滨州市  256600)
  • 收稿日期:2019-04-19 出版日期:2019-09-28 发布日期:2019-09-28
  • 通讯作者: 张晓明，硕士，副教授，硕士生导师，滨州医学院附属医院口腔修复科，山东省滨州市 256603
  • 作者简介:王乐，女，1994年生，山东省济南市人，汉族，滨州医学院在读硕士，主要从事口腔修复学研究。
  • 基金资助:

    山东省医药卫生科技发展计划项目(2016WS0121)，项目参与者：刘童斌

Denosumab-related osteonecrosis of the jaw: thinking from the direction of osteoclast targeted therapy

Wang Le, Zhang Xiaoming, Liu Tongbin   

  1.  (Department of Prosthodontics, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China)
  • Received:2019-04-19 Online:2019-09-28 Published:2019-09-28
  • Contact: Zhang Xiaoming, Master, Associate professor, Master’s supervisor, Department of Prosthodontics, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
  • About author:Wang Le, Master candidate, Department of Prosthodontics, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
  • Supported by:

    the Medical and Health Technological Development Program of Shandong Province, No. 2016WS0121 (to LTB)

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摘要：

文章快速阅读：

文题释义：
颌骨坏死：①颌面部区域有暴露的骨骼，时间持续8周以上；②有抗吸收剂治疗史；③颅面部没有接受过放射治疗。
骨免疫学：骨细胞和免疫细胞都起源于骨髓，两者共享多种细胞因子及受体，并通过复杂的相互作用共同调节骨代谢的平衡，骨骼系统及免疫系统之间密切的病理生理联系构成了骨免疫学的主要内容。
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。

关键词: 狄诺塞麦, 颌骨坏死, 破骨细胞, 双膦酸盐, 骨质疏松, RANKL, RANK

Abstract:

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.

Key words:  denosumab, osteonecrosis of the jaw, osteoclast, bisphosphonate, osteoporosis, RANKL, RANK

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