Sales Paulo Victor Alves de, Godói Isabella Piassi Dias, Brito Gerly Anne de Castro, Leitão Renata Carvalho, Araújo Aurigena Antunes de, Medeiros Caroline Addison Carvalho Xavier de
Universidade Federal do Rio de Janeiro - Institute of Pharmaceutical Sciences - Multidisciplinary Center of Macaé - Macaé (RJ) - Brazil.
Universidade Federal do Rio de Janeiro - Health Technology Assessment Center - Management, Economics, Health Education and Pharmaceutical Services - Rio de Janeiro (RJ) - Brazil.
Acta Cir Bras. 2025 Mar 31;40:e403125. doi: 10.1590/acb403125. eCollection 2025.
To conduct a systematic review of the mechanisms of photobiomodulation therapy (PBMT) for treating or preventing oral mucositis (OM) caused by antineoplastic therapy.
Following PRISMA 2020 guidelines, a search was conducted in Medline, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), and Bibliografia Brasileira de Odontologia from August to September 2023 using descriptors related to OM and laser therapy. Studies on the mechanisms of photobiomodulation in OM were included. Randomized (RCTs) or non-randomized trials from the past 10 years were reviewed. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools.
A total of 355 studies was identified. After the screening, seven met the eligibility criteria. The RCTs showed a low risk of bias. PBMT reduced OM incidence in patients undergoing chemotherapy/radiotherapy. PBMT decreased pro-inflammatory cytokines (interleukin-6, tumor necrosis factor-α) and increased anti-inflammatory cytokines (interleukin-4, interleukin-10). It also modulated inflammatory mediators, enhancing the antioxidant enzyme superoxide dismutase and overexpressing genes for keratinocyte differentiation, aiding injury repair.
The findings suggested that the mechanism of action of PBMT in OM involves modulation of the inflammatory response, balancing oxygen reactive species generation, and expression of factors related to healing or repair. Further studies are needed to elucidate these mechanisms and optimize treatment protocols.
对光生物调节疗法（PBMT）治疗或预防抗肿瘤治疗引起的口腔黏膜炎（OM）的机制进行系统评价。
按照PRISMA 2020指南，于2023年8月至9月在Medline、拉丁美洲和加勒比卫生科学文献数据库（LILACS）、科学电子在线图书馆（SciELO）以及巴西牙科学文献数据库中，使用与OM和激光治疗相关的描述词进行检索。纳入关于OM中光生物调节机制的研究。对过去10年的随机对照试验（RCT）或非随机试验进行综述。使用RoB 2.0和ROBINS - I工具评估偏倚风险。
共识别出355项研究。筛选后，7项符合纳入标准。RCT显示偏倚风险较低。PBMT降低了接受化疗/放疗患者的OM发生率。PBMT降低了促炎细胞因子（白细胞介素 - 6、肿瘤坏死因子 - α）水平，并增加了抗炎细胞因子（白细胞介素 - 4、白细胞介素 - 10）水平。它还调节炎症介质，增强抗氧化酶超氧化物歧化酶活性，并使角质形成细胞分化相关基因过表达，有助于损伤修复。
研究结果表明，PBMT在OM中的作用机制涉及调节炎症反应、平衡氧自由基生成以及与愈合或修复相关因子的表达。需要进一步研究以阐明这些机制并优化治疗方案。
