背景:几种全身状况可导致不同程度的唾液腺损伤和随之而来的功能减退。由于唾液的复杂性,开发成功的管理方案非常具有挑战性。本研究旨在系统地绘制有关唾液腺物理刺激的文献,以根据引起唾液损害的不同全身状况进行唾液分泌管理以及个体的反应。
方法:在文献中进行了系统的检索。两名评审员独立选择的临床试验,随机化与否,使用物理刺激来治疗由全身疾病引起的唾液分泌不足。包括评估没有唾液分泌不足的健康受试者的研究作为对照。还包括单臂临床研究或病例系列用于方案映射(用于范围审查的PRISMA扩展)。
结果:在24项纳入研究中,10名评估健康的受试者,其中9人测试了经皮神经电刺激(TENS),1人测试了针灸和电针。14项研究评估了唾液分泌不足的个体:6应用TENS,6应用低水平激光治疗(LLLT),和2应用针灸,在化疗后进行,药物使用,绝经后妇女,血液透析患者,吸烟者,糖尿病患者,干燥综合征(SS)。所有治疗后流涎增加,除了两项针对SS患者的LLLT研究。
结论:在不同的患者组中,患有干燥综合征(SS)的个体表现出最差的反应,而那些药物引起的唾液分泌减少的患者表现出最有利的治疗结果,独立于唾液刺激的管理策略。这意味着唾液腺的物理刺激有望在可逆性腺体损伤的情况下作为管理唾液分泌不足的替代方法。然而,在当前实践中做出明智的决定,有必要用适当的方法进行新的精心设计的随机临床试验.
BACKGROUND: Several systemic conditions can result in distinct degrees of salivary gland damage and consequent hypofunction. The development of successful management schemes is highly challenging due to the complexity of saliva. This study aimed to systematically map the literature on the physical stimulation of salivary glands for
hyposalivation management and the response of individuals according to different systemic conditions causing salivary impairment.
METHODS: A systematic search in the literature was performed. Two reviewers independently selected clinical trials, randomized or not, that used physical stimulation to treat
hyposalivation caused by systemic conditions. Studies evaluating healthy subjects without
hyposalivation were included as controls. Single-arm clinical studies or case series were also included for protocol mapping (PRISMA extension for scoping reviews).
RESULTS: Out of 24 included studies, 10 evaluated healthy subjects, from which 9 tested transcutaneous electrical nerve stimulation (TENS) and 1 tested acupuncture and electroacupuncture. Fourteen studies evaluated individuals with
hyposalivation: 6 applied TENS, 6 applied low-level laser therapy (LLLT), and 2 applied acupuncture, carried out in post-chemotherapy, medication use, postmenopausal women, hemodialysis patients, smokers, diabetics, Sjögren\'s syndrome (SS). All showed increased salivation after treatment, except for two LLLT studies in individuals with SS.
CONCLUSIONS: Among the different patient groups, individuals with Sjögren\'s syndrome (SS) exhibited the poorest responses, while those with medication-induced hyposalivation demonstrated the most favorable treatment outcomes, independently of the management strategy for saliva stimulation. It means that physical stimulation of salivary glands holds promise as an alternative for managing
hyposalivation in cases of reversible gland damage. However, to make informed decisions in current practice, it is necessary to conduct new well-designed randomized clinical trials with appropriate methodologies.