口腔黏膜下纖維化之流行病學

Epidemiology of Oral Submucous Fibrosis: a Review

邱重榕(Chung-Jung Chiu) ； 陳建仁(Chien-Jen Chen)

《台灣公共衛生雜誌》 20卷2期 (2001/04) Pp. 84-92

https://doi.org/10.6288/TJPH2001-20-02-03

摘要

本文綜述口腔黏模下纖維化(oral submucous fibrosis,簡稱OSF)之流行病學特徵與危險因子之文獻回顧，並提出可能的研究方向與預防策略。無論國內或國外的研究均顯示，嚼食檳榔的地區有較高的口腔癌發生率，而國內的研究也一致地認為，嚼食檳榔是台灣地區口腔癌發生最重要的危險因子。臨床觀察研究顯示，口腔癌的發生大多伴隨在口腔癌前病變之後，而在口腔癌前病變當中，OSF是與嚼食檳榔有特殊相關的一種口腔癌前狀態。由於嚼食檳榔的文化與習慣的差異，OSF主要發生於印度、巴基斯坦、東南亞各國、台灣，以及南非、歐洲、澳洲等地的亞洲移民及其後裔。在臺灣它好發於20-40歲的男性。此疾病是一種慢性的口腔黏膜病變，可侵犯口腔內任何部位的黏膜，有時甚至擴張至咽喉及食道，它的主要特徵是由於口腔黏膜下的膠原蛋白的異常堆積，最終導致病人口腔黏膜僵硬、張口困難及吞嚥困難，嚴重影響病人的進食、說話及接受牙科醫療照護的便利性，大大地降低其生活品質。由過去的研究歸納可知，嚼食檳榔是OSF最重要的危險因子，其可歸因百分比可達到98%。嚼食菸草或抽菸雖然與OSF的發生無關，但是卻在OSF演變成口腔癌的過程中扮演重要的角色。除了嚼食檳榔以外，食用辛辣食物、營養素缺乏、免疫因子、遺傳基因也被報告可能和OSF的形成有關，其中辛辣食物之攝取與OSF之相關仍有爭議，相關的營養素缺乏與免疫反應則仍需進一步之研究以釐清其間之因果關係，遺傳基因易感性則為解釋個體差異性之研究方向之一，各危險因子之間或遺傳基因與環境因子之間有無特定的交互作用存在亦有待探討。目前對於OSF的治療方法包括類固醇局部注射、外科手術、胎盤素局部注射與雷射療法等，只能舒緩、改善症狀或停止惡化，但無法完全田復黏膜之原貌。近十年來，台灣地區嚼食檳榔的人口日益增加，估計超過2百萬人，且有年齡下降的趨勢，國人罹患OSF之病例亦有增加之趨勢。一般相信預防OSF的發生要比治療OSF來得重要。大部分的研究皆建議，經由戒除嚼食檳榔來降低OSF的發生，因此除了預防教育的方式，釜底抽薪的方法無非根除暴露的機會，眼前首務當是先將販賣檳榔納入管理，仿照菸、酒課以檳榔捐，一方面抑制檳榔的消耗量，一方面可將其所得用於社會教育與OSF及口腔癌的防治。由於OSF不僅是一種口腔癌前狀態，更已成為一個迫切的公共衛生問題，因此，未來除了必須致力於杜絕檳榔的健康危害，在OSF的病因、治療方法以及OSF與口腔癌之間的相關研究也應積極開展。(台灣衛誌2001；20(2):84－92)

關鍵字

口腔黏膜下纖維化 ； 流行病學 ； 危險因子 ； 檳榔 ； 口腔癌

並列摘要

This review focouses on the epidemiological characteristics and risk factors of oral submucous fibrosis (OSF).The future perspective in research and prevention are also described,There is a higher oral cancer incidence in the areas where betel-quid chewing habit is prevalent. [n Taiwan, betel-quid chewing is the most important risk factor of oral cancer. According to clinical observation, oral cancer often occurs after some precanceL OSF is a betel quid chewing-specific precancerous condition. Because of the difference in betel-quid chewing habit, OSF mainly affects residents in India, Pakistan, southeastern Asia and Taiwan as well as Asian mIgrants and their offsprings who have moved from these regions to Europe, South Africa and Australia. In Taiwan, it frequently affects men aged between 20-40 years old. It is a chronic disease of oral mucosa and can affect any part of it. The disease can even involve pharynx and esophagus. Its main characteristic is the deposition of collagen in oral submucosa. This may eventually impair the ability of eating and speaking and even the convenience of dental care Betel quid chewing is the most important risk factor with an attributable risk percentage of 98%. Although there is no evidence showing a direct causal relationship between tobacco use and OSF, tobacco is thought to play an important role in the malignant transformation of OSF. In addition to betel quid chewing, spicy food, nutritional deficiency, immunological factors and genetic susceptibility have been reported to be associated with OSF. Till today the detail mechanism of OSF is unclear. Whether there exixt interactions between different environ-mental factors or between gene and environmental factors remains to be elucidated. The treatment of OSF, including steroid injections, sugery, submucosal injections of placental extract and soft laser, has been concentrated upon symptom-atic relief and can never recover oral mucosa. In the recent decade, there is an increase in the number of betel quid chewers with an estimation of over 2 million in Taiwan. The age at which hetel quid chewing has also decreased. There is also an increase in the number of OSF cases in Taiwan. It is believed that prevention of OSF is likely to prove more effective than treatment. Most of the studies have suggested focusing on reducing exposure to the known risk factors, particular use of bring betel quid. In addition to educational intervention the first priority is to include the bring betel quid selling under government supervision and taxation. This will inhibit the consumption of betel quid, and the income can be used on the social education and the prevention of oral cancer. Being an important precancerous condition of oral cancer, OSF has become an emerging public health issue in Taiwan. In the future, attempts must focus not only on the eradication of health hazards of betel quid but also on the OSF-reluted study.(Taiwan J Public Health. 2001 ;20(2):84-92)

並列關鍵字

Oral submucous fibrosis ； epidemiology ； risk factors ； betel quid ； oral cancer.