何种局部治疗能缓解口干？
发表者：收集
日期：2015-03-05
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摘要（英国） 背景：口干很普遍，尤其是老年人。口干原因包括药物、自身免疫病（如干燥综合征）、肿瘤放疗或化疗、性激素疾病和感染。
目的： 判断哪种局部治疗对缓解口干有效。
检索方法： 我们检索了如下数据库：Cochrane Oral Health Group Trials Register (2011年10月28日)、 Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane 图书馆,2011年4期)、MEDLINE via OVID (1950年2011年10月28日)、EMBASE via OVID (1980到2011年10月28日), CINAHL via EBSCO (1980到2011年10月28日), AMED via OVID (1985到2011年10月28日), ANCERLIT via PubMed (1950 到2011年10月28日)。
选择标准： 选择局部制剂如含片、喷雾剂、漱口水、凝胶、嘴嚼胶或牙膏治疗口干症状的随机对照试验。把治疗制剂分两类：唾液腺刺激剂和人工唾液，它们与安慰剂或其他制剂相对比，包括平行对照和交叉对照试验。
资料收集和分析：由2位以上研究者对治疗和偏倚风险进行独立的评估。必要时与试验研究者联系，了解其他信息。
主要结果： 共有36项随机对照试验和1597例患者满足入选标准。唾液刺激物与安慰剂对比有2项试验，人工唾液与安慰剂对比有9项试验，唾液刺激物与人工唾液直接对比有5项试验，直接对比两种以上人工唾液试验有18项，直接对比2种以上唾液刺激物试验有2项。仅有一项试验存在低度偏倚，17项试验有高风险偏倚。由于试验中有很多的治疗措施、对比和结局测定，仅有少数对比中可能采用荟萃分析。与电解质喷雾剂相比，氧合甘油三脂人工唾液喷雾剂对口干疗效较好（标准化均数差为0.77,95%的可信区间为0.38~1.15），用10cm的VAS（视觉模拟尺）几乎有2cm的平均差改善。不管是综合口腔护理系统（牙膏+凝胶+漱口水）和口腔贮水设备，均有前途，但目前尚无足够证据推荐其使用。虽然对于大多数有唾液腺残存功能的患者来说，嚼口香糖可增加唾液，但无证据表明，口香糖比人工唾液更有效。
结论：无强烈证据显示，任何局部治疗对缓解口干有效。 氧合甘油三脂喷雾剂比水性电解质喷雾剂更有效（标准化均数差为0.77，95%的可信区间为0.38~1.15），用10cm的VAS几乎有2cm的平均差改善。嚼口香糖对有唾液腺残存功能的患者来说似乎能增加唾液产生，患者可能愿意用，但无证据提示，口香糖好于或差于人工唾液。综合口腔护理系统（牙膏+凝胶+漱口水）和口腔贮水设备可能有帮助，但需进一步的研究证实，需要设计良好、高效的随机对照试验（根据CONSORT指南设计和报告）来观察局部治疗口干的疗效，以提供临床使用指南。对于许多人来说，口干是慢性病，试验应评价治疗措施对缓解口干是否有效而可口，及对慢性口干患者的生活质量是否有长期疗效。
附原文： Abstract BACKGROUND: Xerostomia (the feeling of dry mouth) is a common symptom especially in older adults. Causes of dry mouth include medications, autoimmune disease (Sjögren's Syndrome), radiotherapy or chemotherapy for cancer, hormone disorders and infections.OBJECTIVES: To determine which topical treatments for dry mouth are effective in reducing this symptom.SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (28 October 2011), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4 2011), MEDLINE via OVID (1950 to 28 October 2011), EMBASE via OVID (1980 to 28 October 2011), CINAHL via EBSCO (1980 to 28 October 2011), AMED via OVID (1985 to 28 October 2011), CANCERLIT via PubMed (1950 to 28 October 2011).SELECTION CRITERIA: We included randomised controlled trials of topical interventions such as lozenges, sprays, mouthrinses, gels, oils, chewing gum or toothpastes for the treatment of dry mouth symptom. We classified interventions into two broad categories, saliva stimulants and saliva substitutes, and these were compared with either placebo or another intervention. We included both parallel group and crossover trials.DATA COLLECTION AND ANALYSIS: Two or more review authors independently carried out data extraction and assessed risk of bias. Trial authors were contacted for additional information as required.MAIN RESULTS: Thirty-six randomised controlled trials involving 1597 participants met the inclusion criteria. Two trials compared saliva stimulants to placebo, nine trials compared saliva substitutes to placebo, five trials compared saliva stimulants directly with saliva substitutes, 18 trials directly compared two or more saliva substitutes, and two trials directly compared two or more saliva stimulants. Only one trial was at low risk of bias and 17 were at high risk of bias. Due to the range of interventions, comparisons and outcome measures in the trials, meta-analysis was possible for only a few comparisons. Oxygenated glycerol triester (OGT) saliva substitute spray shows evidence of effectiveness compared to an electrolyte spray (standardised mean difference (SMD) 0.77, 95% confidence interval (CI) 0.38 to 1.15) which corresponds to approximately a mean difference of 2 points on a 10-point visual analogue scale (VAS) for mouth dryness. Both integrated mouthcare systems (toothpaste + gel + mouthwash) and oral reservoir devices show promising results but there is insufficient evidence at present to recommend their use. Although chewing gum is associated with increased saliva production in the majority of those with residual capacity, there is no evidence that gum is more or less effective than saliva substitutes.AUTHORS' CONCLUSIONS: There is no strong evidence from this review that any topical therapy is effective for relieving the symptom of dry mouth. OGT spray is more effective than an aqueous electrolyte spray (SMD 0.77, 95% CI 0.38 to 1.15) which is approximately equivalent to a mean difference of 2 points on a 10-point VAS scale for mouth dryness. Chewing gums appear to increase saliva production in those with residual secretory capacity and may be preferred by patients, but there is no evidence that gum is better or worse than saliva substitutes. Integrated mouthcare systems and oral reservoir devices may be helpful but further research is required to confirm this. Well designed, adequately powered randomised controlled trials of topical interventions for dry mouth, which are designed and reported according to CONSORT guidelines, are required to provide evidence to guide clinical care. For many people the symptom of dry mouth is a chronic problem and trials should evaluate whether treatments are palatable, effective in reducing xerostomia, as well as the long-term effects of treatments on quality of life of those with chronic dry mouth symptoms.
引自：Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R.Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD008934. doi: 10.1002/14651858.CD008934.pub2. （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）
目的： 判断哪种局部治疗对缓解口干有效。
检索方法： 我们检索了如下数据库：Cochrane Oral Health Group Trials Register (2011年10月28日)、 Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane 图书馆,2011年4期)、MEDLINE via OVID (1950年2011年10月28日)、EMBASE via OVID (1980到2011年10月28日), CINAHL via EBSCO (1980到2011年10月28日), AMED via OVID (1985到2011年10月28日), ANCERLIT via PubMed (1950 到2011年10月28日)。
选择标准： 选择局部制剂如含片、喷雾剂、漱口水、凝胶、嘴嚼胶或牙膏治疗口干症状的随机对照试验。把治疗制剂分两类：唾液腺刺激剂和人工唾液，它们与安慰剂或其他制剂相对比，包括平行对照和交叉对照试验。
资料收集和分析：由2位以上研究者对治疗和偏倚风险进行独立的评估。必要时与试验研究者联系，了解其他信息。
主要结果： 共有36项随机对照试验和1597例患者满足入选标准。唾液刺激物与安慰剂对比有2项试验，人工唾液与安慰剂对比有9项试验，唾液刺激物与人工唾液直接对比有5项试验，直接对比两种以上人工唾液试验有18项，直接对比2种以上唾液刺激物试验有2项。仅有一项试验存在低度偏倚，17项试验有高风险偏倚。由于试验中有很多的治疗措施、对比和结局测定，仅有少数对比中可能采用荟萃分析。与电解质喷雾剂相比，氧合甘油三脂人工唾液喷雾剂对口干疗效较好（标准化均数差为0.77,95%的可信区间为0.38~1.15），用10cm的VAS（视觉模拟尺）几乎有2cm的平均差改善。不管是综合口腔护理系统（牙膏+凝胶+漱口水）和口腔贮水设备，均有前途，但目前尚无足够证据推荐其使用。虽然对于大多数有唾液腺残存功能的患者来说，嚼口香糖可增加唾液，但无证据表明，口香糖比人工唾液更有效。
结论：无强烈证据显示，任何局部治疗对缓解口干有效。 氧合甘油三脂喷雾剂比水性电解质喷雾剂更有效（标准化均数差为0.77，95%的可信区间为0.38~1.15），用10cm的VAS几乎有2cm的平均差改善。嚼口香糖对有唾液腺残存功能的患者来说似乎能增加唾液产生，患者可能愿意用，但无证据提示，口香糖好于或差于人工唾液。综合口腔护理系统（牙膏+凝胶+漱口水）和口腔贮水设备可能有帮助，但需进一步的研究证实，需要设计良好、高效的随机对照试验（根据CONSORT指南设计和报告）来观察局部治疗口干的疗效，以提供临床使用指南。对于许多人来说，口干是慢性病，试验应评价治疗措施对缓解口干是否有效而可口，及对慢性口干患者的生活质量是否有长期疗效。
附原文： Abstract BACKGROUND: Xerostomia (the feeling of dry mouth) is a common symptom especially in older adults. Causes of dry mouth include medications, autoimmune disease (Sjögren's Syndrome), radiotherapy or chemotherapy for cancer, hormone disorders and infections.OBJECTIVES: To determine which topical treatments for dry mouth are effective in reducing this symptom.SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (28 October 2011), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4 2011), MEDLINE via OVID (1950 to 28 October 2011), EMBASE via OVID (1980 to 28 October 2011), CINAHL via EBSCO (1980 to 28 October 2011), AMED via OVID (1985 to 28 October 2011), CANCERLIT via PubMed (1950 to 28 October 2011).SELECTION CRITERIA: We included randomised controlled trials of topical interventions such as lozenges, sprays, mouthrinses, gels, oils, chewing gum or toothpastes for the treatment of dry mouth symptom. We classified interventions into two broad categories, saliva stimulants and saliva substitutes, and these were compared with either placebo or another intervention. We included both parallel group and crossover trials.DATA COLLECTION AND ANALYSIS: Two or more review authors independently carried out data extraction and assessed risk of bias. Trial authors were contacted for additional information as required.MAIN RESULTS: Thirty-six randomised controlled trials involving 1597 participants met the inclusion criteria. Two trials compared saliva stimulants to placebo, nine trials compared saliva substitutes to placebo, five trials compared saliva stimulants directly with saliva substitutes, 18 trials directly compared two or more saliva substitutes, and two trials directly compared two or more saliva stimulants. Only one trial was at low risk of bias and 17 were at high risk of bias. Due to the range of interventions, comparisons and outcome measures in the trials, meta-analysis was possible for only a few comparisons. Oxygenated glycerol triester (OGT) saliva substitute spray shows evidence of effectiveness compared to an electrolyte spray (standardised mean difference (SMD) 0.77, 95% confidence interval (CI) 0.38 to 1.15) which corresponds to approximately a mean difference of 2 points on a 10-point visual analogue scale (VAS) for mouth dryness. Both integrated mouthcare systems (toothpaste + gel + mouthwash) and oral reservoir devices show promising results but there is insufficient evidence at present to recommend their use. Although chewing gum is associated with increased saliva production in the majority of those with residual capacity, there is no evidence that gum is more or less effective than saliva substitutes.AUTHORS' CONCLUSIONS: There is no strong evidence from this review that any topical therapy is effective for relieving the symptom of dry mouth. OGT spray is more effective than an aqueous electrolyte spray (SMD 0.77, 95% CI 0.38 to 1.15) which is approximately equivalent to a mean difference of 2 points on a 10-point VAS scale for mouth dryness. Chewing gums appear to increase saliva production in those with residual secretory capacity and may be preferred by patients, but there is no evidence that gum is better or worse than saliva substitutes. Integrated mouthcare systems and oral reservoir devices may be helpful but further research is required to confirm this. Well designed, adequately powered randomised controlled trials of topical interventions for dry mouth, which are designed and reported according to CONSORT guidelines, are required to provide evidence to guide clinical care. For many people the symptom of dry mouth is a chronic problem and trials should evaluate whether treatments are palatable, effective in reducing xerostomia, as well as the long-term effects of treatments on quality of life of those with chronic dry mouth symptoms.
引自：Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R.Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD008934. doi: 10.1002/14651858.CD008934.pub2. （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）