Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
Biol Blood Marrow Transplant. 2019 Jun;25(6):1055-1061. doi: 10.1016/j.bbmt.2019.01.026. Epub 2019 Jan 30.
Severe oral problems, including oral mucositis (OM) and xerostomia, often occur after conditioning therapy for hematopoietic stem cell transplantation (HSCT). Saliva plays a major role in protecting the oral mucosa and teeth. Alterations in salivary flow rate or salivary components resulting in decreased salivary defence mechanisms may affect oral/mucosal health and may influence the severity of OM. A systematic review was conducted to assess the current scientific knowledge on changes in salivary function and composition before and after HSCT. All English or Dutch articles examining salivary flow rate or salivary components before and after HSCT were included after title/abstract selection by 2 independent reviewers (weighted κ = .91). After quality assessment and exclusion of all research groups with both children age <14 years and adults, 33 articles were included for data analysis. Overall, the salivary flow rate was decreased at several days and months after HSCT. Although several salivary components were studied, most components were examined in only 1 or 2 studies with different patient populations or at different time points after HSCT. At 7 days after HSCT, albumin and proinflammatory cytokines were increased, whereas secretory IgA and components of the salivary antioxidant system were decreased. Secretory IgA levels were still reduced at 1 month after HSCT but returned to pre-HSCT values at 6 months after HSCT. Lactoferrin, secretory leukocyte protease inhibitor, and β-microglobulin levels were increased at 6 months after HSCT. Our findings show that changes in saliva reflect an inflammatory response occurring immediately after HSCT, followed by evidence of increased salivary antimicrobial defense mechanisms by 6 months after HSCT.
造血干细胞移植（HSCT）后常发生严重口腔问题，包括口腔黏膜炎（OM）和口干症。唾液在保护口腔黏膜和牙齿方面发挥着重要作用。唾液流率或成分的改变导致唾液防御机制减弱，可能会影响口腔/黏膜健康，并可能影响 OM 的严重程度。本系统评价旨在评估 HSCT 前后唾液功能和成分变化的现有科学知识。通过 2 位独立评审员（加权κ=0.91）对标题/摘要进行选择后，纳入所有研究 HSCT 前后唾液流率或唾液成分的英文或荷兰文文章。经过质量评估并排除所有同时纳入年龄<14 岁儿童和成人的研究组后，有 33 篇文章纳入数据分析。总体而言，HSCT 后数天和数月唾液流率降低。尽管研究了几种唾液成分，但大多数成分仅在 1 或 2 项研究中进行了研究，这些研究的患者人群不同或在 HSCT 后不同时间点进行。HSCT 后 7 天，白蛋白和促炎细胞因子增加，而分泌型免疫球蛋白 A 和唾液抗氧化系统成分减少。HSCT 后 1 个月分泌型免疫球蛋白 A 水平仍降低，但在 HSCT 后 6 个月恢复至 HSCT 前水平。HSCT 后 6 个月，乳铁蛋白、分泌型白细胞蛋白酶抑制剂和β-微球蛋白水平增加。我们的研究结果表明，唾液的变化反映了 HSCT 后立即发生的炎症反应，随后在 HSCT 后 6 个月时证据表明唾液抗菌防御机制增强。
