J Dent Res:牙科医学中的A型肉毒杆菌毒素

2019-09-25 lishiting MedSci原创

肉毒杆菌素(BoNTs)是细菌肉毒梭菌的产物。通过进入神经末梢,它们能够清除和失活SNARE蛋白,对于神经物质传递的释放十分重要。阻碍神经肌肉结点乙酰胆碱的释放会导致长期以及潜在的致命性弛缓性麻痹-肉毒中毒的主要症状。然而,肌肉注射小剂量的BoNTs, 原始A型(BoNT-A),对于长时间维持痉挛型运动障碍的肌肉放松具有明显效果。由此,BoNT-A的这种特征在神经学和化妆品领域得到了广泛的应用。

肉毒杆菌素(BoNTs)是细菌肉毒梭菌的产物。通过进入神经末梢,它们能够清除和失活SNARE蛋白,对于神经物质传递的释放十分重要。阻碍神经肌肉结点乙酰胆碱的释放会导致长期以及潜在的致命性弛缓性麻痹-肉毒中毒的主要症状。然而,肌肉注射小剂量的BoNTs, 原始A型(BoNT-A),对于长时间维持痉挛型运动障碍的肌肉放松具有明显效果。由此,BoNT-A的这种特征在神经学和化妆品领域得到了广泛的应用。

在过去的数十年中,研究已发现,BoNT-A的功能不仅能够应用于肌肉放松或自主胆碱能效应,并且它也可以作为镇痛剂得以应用。近期研究发现,这种镇痛效应发生于进入感觉神经末梢后,并且这些药剂是通过轴突运输至中央神经系统,表明这种镇痛效果至少部分为中枢来源。基于它的镇痛作用,目前BoNT-A被证实具有治疗慢性偏头痛的效果;然而,有病例报告、临床前和临床试验表明,它在许多潜在痛苦状况中的作用均有所增加。而在口腔领域中,美国食品和药品管理局规定BoNT-A只能用于流涎。而其他国家BoNT-A应用的法律地位还未可知。然而,有临床对照试验表明,它在其他状态下依旧具有效果,如:磨牙症、颞颌关节病和三叉神经痛。因此,参照美国神经学研究会的使用标准,作者严格分析了BoNT-A在口腔医学中的应用,并且发现,它对三叉神经痛(A类)有效,同时可能对颞颌关节病以及磨牙症有一定效果。

原始出处:

Muñoz Lora VRM, Del Bel Cury AA, et al. Botulinum Toxin Type A in Dental Medicine. J Dent Res. 2019 Sep 18:22034519875053. doi: 10.1177/0022034519875053.

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