目的:单纯疱疹病毒1型(HSV-1)是引起疱疹感染的主要病原体。在13-30%的病例中,原发性HSV-1导致原发性疱疹性牙龈炎(PHGS),通常是自限性感染;然而,它可以限制喝/吃的能力,有时,需要住院治疗。已经提出了多种治疗方法。本系统评价旨在收集和批判性评估有关PHGS临床管理的现有证据。
方法:文献检索包括三个数据库(PubMed,Scopus,Embase),研究设计,数据分析是按照PRISMA指南进行的,根据PICO工具(PROSPERON°CRD42023391386)。使用RoB2和ROBINS-I评估偏倚风险。
结果:共有364名患者(平均年龄:7.6岁)的5项研究被确定。在阿昔洛韦;阿昔洛韦蜂蜜;液体和镇痛药;maalox苯海拉明;利多卡因;氯己定(CHX);CHX透明质酸;CHXMucosyte®;抗菌光动力疗法(aPDT);局部抗病毒;局部抗病毒+aPDT等。
结论:尽管PHGS是一种全球患病率很高的疾病,对治疗管理缺乏共识表明现有证据存在差距.大多数提出的治疗包括对病毒复制无效的经验性治疗方案的症状药物。实现随机临床试验的主要限制是由于疾病的快速发作和缓解。事实上,诊断延迟,估计在72小时内,降低任何抗病毒药物的有效性。
结论:在本系统评价中包含的五项研究中,只有一个人能够提供一些微弱的证据证明ACV是一种有效的治疗方法,改善口腔病变的愈合和减少症状的持续时间。
OBJECTIVE: Herpes simplex virus 1 (HSV-1) is the main pathogen responsible for herpes infections. In 13-30% of the cases, primary HSV-1 leads to the primary herpetic gingivostomatitis (PHGS), often a self-limiting infection; however, it can limit the ability to drink/eat with, sometimes, the need for hospitalization. Multiple therapeutic methods have been proposed. This systematic
review aims to collect and critically appraise the available evidence about the clinical management of PHGS.
METHODS: Literature search including three databases (PubMed, Scopus, Embase), study design, and data analysis were performed following PRISMA guidelines, according to the PICO tool (PROSPERO n° CRD42023391386). Risk of bias was assessed with RoB 2 and ROBINS-I.
RESULTS: Five studies on a total of 364 patients (average age: 7.6 years) were identified. The treatment regimens were summarized in acyclovir; acyclovir + honey; fluids and analgesic; maalox + diphenhydramine; lidocaine; chlorhexidine (CHX); CHX + ialuronic acid; CHX + Mucosyte®; antimicrobial photodynamic therapy (aPDT); topical antiviral; topical antiviral + aPDT; and others.
CONCLUSIONS: Although PHGS is a disease with a high worldwide prevalence, the lack of consensus about therapeutic management indicates gaps in existing evidence. Most of the proposed treatment consists in symptomatic drugs with empiric regimens which are ineffective for the viral replication. The main limit to realize randomized clinical trial is due to the rapid onset and remission of the disease. In fact, the diagnostic delay, estimated in 72 h, decreases the effectiveness of any antiviral drugs.
CONCLUSIONS: Out of the five studies included in this systematic
review, only one was able to provide some weak evidence that ACV is an effective treatment, improving healing of oral lesions and reducing duration of symptoms.