维生素和口腔溃疡

从小一溃疡，父母，医生就提到缺VB12，除了用药之外，常建议喝小米粥。 但是，对我来说，这个办法并不管用，至少从没有坚持到看见效果。这个说法如此深入人心，证明在哪儿呢？

我 能查到的最早的一篇文献，是1954年发表的，但没有摘要。 英国医学杂志1974发表的这篇文章(1)， 发现130 个病人里， 有5个缺B12， 7个缺folic acid，15个缺铁。 对这些几个病人，针对治疗有一定效果 (缺什么补什么)。但是，这随后30多年，进一步的文献寥寥无几，我一共找到十几篇。大致说来，缺B12的病人很少，用B12，或复合维生素治疗，不同的 实验，效果并不显著，一致。

所以，如果查血查出缺VB12 (或任何其它维生素)，一定需要补充 (既使没有口腔溃疡)；但如果身体维生素正常的话，用维生素治溃疡，临床证据严重不足。换句话说，不管用。


12。 Oral Dis. 2005 Nov;11(6):374-8.
Norwegian LongoVital and recurrent aphthous ulceration: a randomized, double-
blind, placebo-controlled study. Kolseth I, Herlofson BB, Pedersen A.
OBJECTIVE: LongoVital (LV) is a herbal-based tablet enriched with the recommended
daily doses of vitamins. The present study was undertaken to investigate possible prevention of recurrent aphthous ulceration (RAU) during 4 months daily intake of the Norwegian LV. DESIGN: The study was a placebo-controlled, double-blind, randomized, clinical trial. SUBJECTS: Sixty otherwise healthy patients with at least one attack of minor RAU per 2 months were included in the study. METHODS: After an introduction period (IP) of 60 days, the patients were randomly divided into three groups and given either LV, the herbs of LV only, or placebo. Three test tablets were taken every day together with breakfast for 4 months [tablet period (TP)] and the patients followed up for another 4 months (F-UP). The number of new ulcers (NU) and ulcer-free days (UFD) were observed. RESULTS: Fifty-two patients completed the study. Neither NU nor UFD showed any statistical significant differences between any of the groups in any of the periods. All three groups, however, showed a significant increase in UFD during the first 2 months of TP compared to IP. Within the LV group only, there was a further increase in UFD after 2 months intake of the tablets. The number of NU and UFD decreased significantly in both the LV and the herbal group in F-UP compared with TP. CONCLUSION: Neither the Norwegian LV nor the herbal component alone was superior to
placebo in the prevention of RAU. The results, however, indicate that neither the LV nor the herbal group benefited from the treatment.

11。 Oral Health Prev Dent. 2005;3(1):3-8. The effect of LongoVital on recurrent aphthous stomatitis in a controlled clinical trial. Bratel J, Hakeberg M, Jontell M.
PURPOSE: The aim of this study was to evaluate the effect of daily intake of LongoVital (LV) (herbal vitamin tablets) in the prevention of RAS. MATERIALS AND METHODS: A group of 78 consecutively referred patients was enrolled to a three-months pretreatment period. Fifty subjects were then randomly allocated to an LV-group (n = 25) or a placebo group (N = 25). A double blind, stratified-randomised clinical case-control study was performed during six months. Number and size of the ulcers were registered by the patients using a standardized chart. The degree of discomfort was recorded on a 100 mm horizontal visual analogue scale (VAS-scale). RESULTS: The three-months pretreatment period revealed that the most dominant symptoms were pain (78%) followed by burning sensation (18%). No significant differences between the two groups were found during this period when a comparison was made
at the end of the study. After the intervention period the number of aphthous ulcers/month decreased significantly in the LV-group (p = 0.02). The number of days in pain/month were also reduced (p < style="color: rgb(204, 0, 0);">10。 Southeast Asian J Trop Med Public Health. 2002 Dec;33(4):872-7. Hematologic abnormalities in recurrent oral ulceration. Thongprasom K, Youngnak P, Aneksuk V.
The aim of this study was to analyse the hematologic status in patients with recurrent oral ulceration (ROU). Twenty-three patients with ROU and
19 control subjects were examined consecutively for hematological abnormalities
including serum folate, red cell folate and vitamin B12 levels. Their complete
blood counts, hemoglobin typing, serum and red cell folate and serum vitamin
B12 levels were studied. Low red cell folate levels were found in 11 out
of 23 patients (47.83%) with ROU. They were defined as having folate deficiency
(n=5), folate deficient erythropoiesis (n=1), and folate depletion (n=5).
The serum and red cell folate levels in the control group were within normal
range. There was a statistically significant low red cell folate in the
ROU compared to the control group (p=0.000). The serum vitamin B12 levels
were within normal range in both ROU and control groups. Hemoglobin, hematocrit
and mean corpuscular hemoglobin concentrations were in the normal range
in both groups and none had anemia or macrocytosis.

9。 J Am Dent Assoc. 2003 Feb;134(2):200-7. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. Scully C, Gorsky M, Lozada-Nur F. BACKGROUND: Recurrent aphthous stomatitis, or RAS, is a common oral disorder
of uncertain etiopathogenesis for which symptomatic therapy only is available.
This article reviews the current data on the etiopathogenesis, diagnosis
and management of RAS in a primary care setting. METHODS: The authors reviewed
publications on Medline from 1995 through 2000, the period since the last
major reviews were published. RESULTS: RAS may have an immunogenetic background
owing to cross-reactivity with Streptococcus sanguis or heat shock protein.
Predisposing factors seen in a minority include haematinic (iron, folate
or vitamin B12) deficiency, stress, food allergies and HIV infection. While
topical corticosteroids remain the mainstay for therapy, a number of other
immunomodulatory modalities now are available. CONCLUSIONS: There is still
no conclusive evidence relevant to the etiopathogenesis of RAS, and therefore
therapy can attempt only to suppress symptoms rather than to address the
basic issues of susceptibility and prevention. CLINICAL IMPLICATIONS: In
the majority of patients, symptomatic relief of RAS can be achieved with
topical corticosteroids alone, with other immunomodulatory topical agents
or by combination therapy.

8。 J Eur Acad Dermatol Venereol. 2002 Jan;16(1):66-7. Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis. Piskin S, Sayan C, Durukan N, Senol M.
BACKGROUND: The exact aetiology of recurrent aphthous stomatitis (RAS) is
still unknown, but different predisposing factors, including iron, vitamin
B12 and folic acid deficiencies, have been proposed. MATERIAL AND METHODS:
Serum iron, ferritin, folic acid and vitamin B12 levels were investigated
in 35 patients with RAS and in 26 healthy controls. RESULTS: Vitamin B12
levels were found significantly lower in subjects with RAS than in controls.
No significant differences were found in other parameters. CONCLUSION: We
concluded that vitamin B 12 deficiency may be an aetiological factor in recurrent
aphthous stomatitis.

7。Neth J Med. 1998 Oct;53(4):172-5.Aphthous ulcers and vitamin B12 deficiency. Weusten BL, van de Wiel A.
Aphthous ulcers of the oral cavity are frequently encountered in general
practice. Although the exact pathophysiology remains obscure, many factors
can contribute to the pathogenesis of these lesions, such as immunological
factors, local trauma, smoking, stress, hormonal state, family history,
food hypersensitivity, and infection. We describe three patients in whom
a clear relationship appeared to exist between recurrent aphthous ulcers
and a deficiency of vitamin B12. It is concluded that in all patients with
recurrent aphthous ulceration, deficiency of vitamin B12 should be considered.

6。 Ann Dent. 1992 Winter;51(2):14-6. Recurrent aphthous stomatitis: the efficacy of replacement therapy in patients with underlying hematinic deficiencies. Porter S, Flint S, Scully C, Keith O.
A group of thirty-four patients with recurrent aphthous stomatitis (RAS)
and single hematinic deficiencies were given replacement therapy after any
reason for the deficiency had been sought and excluded. The response of
the RAS was assessed in an open trial. The aphthae in 70% of patients subjectively
improved with hematinic replacement therapy, a benefit exceeding the defined
placebo response in recurrent aphthous stomatitis.

5。 J Oral Pathol Med. 1991 Sep;20(8):389-91. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. Nolan A, McIntosh WB, Allam BF, Lamey PJ.
An evaluation of the thiamine, riboflavin and pyridoxine (vitamin B1, B2
and B6) status of 60 patients with recurrent mouth ulcers was performed.
Seventeen patients (28.2%) were found to be deficient in one or more of
these vitamins. Replacement therapy of these vitamins was given to a study
group of deficient patients and a non-deficient group for one month. At
the end of therapy and after a follow-up period of 3 months, only those patients
who had a B complex deficiency had a significant sustained clinical improvement
in their mouth ulcers. Vitamin B1, B2 and B6 deficiencies should, therefore,
be considered as another possible precipitating factor in recurrent aphthous
ulceration.

4。 J Oral Pathol Med. 1990 Sep;19(8):371-5. LongoVital in the prevention of recurrent aphthous ulceration.Pedersen A, Hougen HP, Klausen B, Winther K.
LongoVital (LV) (DK. Reg. No. 5178/75) is a herbal based tablet enriched
with recommended doses of vitamins. The present study was undertaken to
investigate prevention of recurrent aphthous ulceration (RAU) during 6 months'
daily intake of LV as compared with placebo in a double-blind, randomized
clinical, cross-over 1-yr study. The population comprised 29 otherwise healthy
minor RAU patients (18 F, 11 M), mean age 36 (18-67), with an estimated
average number of recurrences the previous year of 12.8 (3-30). The number
of recurrences was significantly reduced on LV the latter 4 of the 6 months
(P less than 0.01) where 31% were totally free of recurrences. Subjective
all-over evaluation of treatment period was significantly in favor of LV.
LV induced no adverse reactions and is the first harmless systemic treatment
which has proved better than placebo in the prevention of RAU.

3。 Oral Surg Oral Med Oral Pathol. 1988 Jul;66(1):41-4. Hematologic status in recurrent aphthous stomatitis compared with other oral disease. Porter SR, Scully C, Flint S.
The hematologic status of 144 consecutive patients in the United Kingdom
with oral disease (69 with recurrent aphthous stomatitis; 75 with other
disorders) was examined in an attempt to resolve the controversy as to whether
levels of hemoglobin, blood cell numbers and indices, and blood film are
adequate in the screening of patients with aphthae. Though hemoglobin levels
and red blood cell indices were normal in patients with recurrent aphthous
stomatitis, there was still a small minority of patients with deficiencies
of iron (low serum ferritin), folate (low red blood cell levels), or vitamin
B12 (low serum levels) that would have remained undetected. Full hematologic
screening of patients with recurrent aphthous stomatitis thus reveals latent
deficiency states, at least in some parts of the world, and there are good
reasons for elucidating the underlying cause and correcting these deficiencies,
particularly vitamin B12 deficiency. Therapeutic studies are now required
to establish the frequency with which deficiencies actually predispose to
recurrent aphthous stomatitis.

2。 Serum vitamin B12, folate, and iron levels in recurrent aphthous ulceration.Olson JA, Feinberg I, Silverman S Jr, Abrams D, Greenspan JS.
Hematologic deficiencies have previously been described in some cases of
recurrent aphthous ulceration (RAU). Ninety patients with RAU and twenty-three
healthy control subjects were evaluated by complete blood count, serum iron,
and total iron-binding capacity, serum vitamin B12, and serum or red blood
cell folate. Only three of ninety RAU patients proved to have abnormalities.
There were no statistically significant differences between the patient
and control populations, and no one in either group had abnormal serum vitamin
B12 or serum or RBC folate assays. None of the patients or controls gave
a history or symptoms suggestive of iron-deficiency or megaloblastic anemia,
and all were without gastrointestinal complaints. These results suggest
that hematologic tests other than a complete blood count are not routinely
indicated for patients with RAU.

1。 Brit Med J. Recurrent aphthae: treatment with vitamin B12, folic acid, and iron. Wray D, Ferguson MM, Mason DK, Hutcheon AW, Dagg JH.
A series of 130 consecutive outpatients with recurrent aphthous stomatitis
were screened at the oral medicine department, Glasgow Dental Hospital,
for deficienciesin vitamin b12, folic acid, and iron. In 23 patients (17.7%)
such deficiencies werefound; five were deficient in vitamin B12, seven in
folic acid, and 15 in iron. Four had more than one deficiency. Out of 130
controls matched for age and sex 11 (8.5%) were found to have deficiencies.
The 23 deficient patients with recurrent aphthaewere treated with specific
replacement therapy, and all 130 patients were followed up for at least
one year. Of the 23 patients on replacement therapy 15 showed complete remission
of ulceration and eight definite improvement. Of the 107 patientswith no
deficiency receiving local symptomatic treatment only 33 had a remission
or wereimproved. This difference was significant (P less than 0.001). Most
patients withproved vitamin B12 or folic acid deficiency improved rapidly
on replacement therapy;those with iron deficiency showed a less dramatic
response. The 23 deficient patientswere further investigated to determine
the cause of their deficiencies and detect the presence of any associated
conditions. Four were found to have Addisonian perniciousanaemia. Seven
had a malabsorption syndrome, which in five proved to be a gluten-induced
enteropathy. In addition, there were single patients with idiopathic proctocolitis,
diverticular disease of the colon, regional enterocolitis, and adenocarcinoma
of thecaecum. We suggest that the high incidence of deficiencies found in
this series andthe good response to replacement therapy shows the need for
haematological screening of such patients.