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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 34  |  Issue : 2  |  Page : 166-170

Serum lipid profile and C-Reactive protein as prognostic markers in oral submucous fibrosis


1 Chinthamani Laser Dental Clinic and Implant Centre, Chennai, Tamil Nadu, India
2 Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
3 Department of Physiology, Sri Muthukumaran Medical College Hospital and Research Institute, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India

Date of Submission09-Jun-2021
Date of Decision12-May-2022
Date of Acceptance19-May-2022
Date of Web Publication22-Jun-2022

Correspondence Address:
K Jayanthiswari
Consultant Oral Medicine and Radiologist, Chinthamani Laser Dental Clinic and Implant Centre, Chennai - 600 056, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_160_21

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   Abstract 


Introduction: Oral submucous fibrosis is a chronic, premalignant condition of the oral mucosa, affecting millions of people globally and it is one of the precancerous conditions most prevalent in India. Previously published studies have evaluated the serum lipid profile and C-reactive protein in various potentially malignant disorders and oral squamous cell carcinoma, but to our knowledge, no studies are available comparing the pre- and post-treatment serum lipid profile and C-reactive protein values in oral potentially malignant disorders, so that their real prognostic value can be assessed. Aim: The present study aims to evaluate the serum lipid profile and C-reactive protein as a prognostic marker in Oral Submucous Fibrosis patients. Materials and Methods: A total of 30 clinically diagnosed OSF patients of either gender in the age group of 20 – 50 years were selected. A complete history taking followed by a thorough oral examination was done on all patients. About 5 mL of blood sample was collected before treatment and after 6 weeks of treatment for estimation of serum lipid profile and C-reactive protein Results: The mean values of serum lipid profile were decreased among OSF patients and the difference between pre- and post-treatment was statistically significant. The comparison of the mean values of the pre- and post-treatment CRP level of the study subjects among OSF patients was found to be statistically significant (P = 0.022). Conclusion: Hence, pre- and post-treatment serum lipid profile and CRP levels contribute to being of prognostic value in OSF.

Keywords: C-reactive protein, lipid profile, oral submucous fibrosis


How to cite this article:
Jayanthiswari K, Manoharan G V, Muthukumar S. Serum lipid profile and C-Reactive protein as prognostic markers in oral submucous fibrosis. J Indian Acad Oral Med Radiol 2022;34:166-70

How to cite this URL:
Jayanthiswari K, Manoharan G V, Muthukumar S. Serum lipid profile and C-Reactive protein as prognostic markers in oral submucous fibrosis. J Indian Acad Oral Med Radiol [serial online] 2022 [cited 2022 Dec 7];34:166-70. Available from: http://www.jiaomr.in/text.asp?2022/34/2/166/347911




   Introduction Top


Pindborg (1966) defined OSF as “an insidious, chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with juxta-epithelial inflammatory reaction followed by a fibroelastic change of the lamina propria, with epithelial atrophy leading to stiffness of the oral mucosa and causing trismus and inability to eat.”[1]

Over the years, the incidence of OSF has increased in various parts of the Indian subcontinent. Its prevalence ranges up to 0.4% in the Indian rural population and the malignant transformation rate is 7.6%.[2] The etiology of OSF is multifactorial. Chewing of areca nut seems to be a primary etiological factor that modulates matrix metalloproteinase, lysyl oxidases, and collagenases affecting the metabolism of collagen leading to increased fibrosis.[3] Various biochemical markers are available for the detection of potentially malignant disorders. One such important marker is serum lipid profile. As the neoplastic disease is related to new growth, there is greater utilization of lipids, including total cholesterol (TC), lipoproteins, and triglycerides (TGs) for new membrane biogenesis.[4] The aims and objectives of this study are to evaluate the serum lipid profile including (i) TC, (ii) LDL, (iii) HDL, (iv) VLDL, (v) triglycerides, and (vi) C-reactive protein in patients with various stages of OSF and to correlate alterations in serum lipid profile and C-reactive protein pre- and post-treatment with improvement in symptoms.


   Materials and Methods Top


This is a prospective study involving 30 clinically diagnosed OSF patients of either gender in the age group of 20 – 50 years. Assuming that 85% of the subjects with OSF have dyslipidemia, the study would require a sample size of 27 for estimating the expected proportion with 10% absolute precision and 85% confidence. The sample size was rounded off to 30 and was selected by systematic random sampling method from the patients reporting to the Department of Oral Medicine and Radiology. Ethical clearance was obtained from the Institutional Ethical committee review board (7/IRB/2017 dated 13.11.2017). Written Informed consent was obtained from all patients participating in the study. A complete history taking followed by a thorough oral examination was done on all patients. The burning sensation of the patient was assessed by using a visual analog scale and the mouth opening was measured using a caliper and measuring scale. These 30 patients were subdivided into four stages according to Khanna et al.'s[5] staging system of OSF. All the OSF patients were subjected to tobacco cessation counseling. About 5 mL of intravenous blood sample was collected before and after treatment, and estimation of serum lipid profile and CRP was done using an auto analyzer.

Inclusion criteria

Clinically diagnosed OSF patients (up to Stage IVa), both genders of ages 20–50 years.

Exclusion criteria

Patients with systemic diseases like obesity, diabetes mellitus, thyroid disorder, liver dysfunction, malabsorption syndrome, cardiac patients, autoimmune collagen diseases, osteomyelitis, inflammatory bowel disorder, tuberculosis, malignancy, pneumonia, severe infection, pregnancy, patient under oral contraceptives, and patients undergoing treatment for OSF.

Clinical parameter

Symptoms like burning sensation or pain were assessed using a visual analog scale [Figure 1] and mouth opening was assessed by measuring inter-incisal distance and transferred to a scale in mm.
Figure 1: Visual analog scale

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Method of drug administration

Grade I OSF patients were given supplemental medication of capsule antioxidant twice daily, tablet vitamin B complex twice daily, and topical 20% benzocaine gel application before food for 6 weeks whereas patients in Grade II, Grade III, and Grade IVa were administered an intralesional injection of 2 mL of dexamethasone with 0.5 mL of lignocaine twice weekly and supplemental medication as above was given for 6 weeks.

Patients in Grade 1 were recalled once a week whereas patients in Grade II, Grade III, and Grade IVa were recalled twice a week and evaluated for improvement in signs and symptoms such as burning sensation and mouth opening. The final changes in burning sensation and mouth opening were recorded after the complete course of treatment.

Data analysis

The data collected were entered into a Microsoft Excel sheet and data analysis was done using SPSS version 17 with descriptive statistics, ANOVA, and paired student “t” test. A P value < 0.05 was considered as statistically significant.


   Result Top


The age group of the study subjects ranged from 20 to 50 years and the mean age was 30.73 ± 7.5 years [Table 1].
Table 1: Age descriptive of the study subjects in the different staging of OSF *

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On comparing the pre- and post-mouth opening values of different stages of OSF, there was a statistically significant difference noted in stage II (P-value = 0.038) and stage III (P-value = 0.000) [Table 2], while the difference in pre- and post-mouth opening values of all the subjects was statistically significant (P-value = 0.000) [Table 3].
Table 2: Comparison of pre- and post-mean (±SD) values of mouth opening and VAS in different stages

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Table 3: Comparison of pre-treatment and post-treatment mean (±SD) values of mouth opening and VAS * of the overall study subjects

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On comparing the pre- and post–Visual Analog Scale. Scores of different stages of OSF, there was a statistically significant difference noted in stage II (P-value = 0.039) and stage III (P-value = 0.000) [Table 2], while the difference in pre- and post-VAS scores of all the subjects was statistically significant (P-value = 0.000) [Table 3].

Also, the pre- and post-mean values of mouth opening and VAS scores among different stages of OSF were found to be statistically significant (P-value = 0.000) [Table 4].
Table 4: Comparison of mean (±SD) values of mouth opening and visual analog scale score among different stages of OSF * patients

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[Table 5] shows the comparison of mean values of the pre- and post-treatment lipid profile viz. TC (P-value = 0.000), triglycerides (P-value = 0.007), HDL (P-value = 0.000), LDL (P-value = 0.020), VLDL (P-value = 0.007), of all the study subjects and was found to be statistically significant.
Table 5: Comparison of pre-treatment and post-treatment mean (±SD) values of lipid profile and CRP * of the overall study subjects

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The comparison of the mean values of the pre- and post-treatment C-reactive protein levels (P-value = 0.022), of all the study subjects was found to be statistically significant [Table 5].


   Discussion Top


In our study, 96.6% were male patients and 3.33% were female patients. Such male predominance was also reported by Rawson et al.[3] and Apala Baduni et al.[6] reported a 95% male predominance.

On comparing the pre- and post-mouth opening values of different stages of OSF, there was a statistically significant difference in stages II and III [Table 2]. Also, the overall pre- and post-mouth opening values showed a statistically significant difference [Table 3]. The mean increase in mouth opening post-treatment was 6.03 ± 1.7. However, comparing the mean values of mouth opening among different stages of OSF was found to be statistically significant [Table 4].

Kumar et al.[7] and Maher et al.[8] observed a significant improvement in mouth opening post-treatment.

In our study, the overall pre- and post-VAS scores showed a statistically significant difference [Table 3] and the difference in the mean values of the visual analog scale score was 3.30 ± 1.1.

All patients (100%) in stages I and II reported complete relief from pain/burning sensation post-treatment and patients in stages III and IV reported a significant reduction in their symptoms. However, on comparing the pre- and post-VAS scores, there was a statistically significant difference noted only in stages II and III [Table 2].

Also, the comparison of the mean values of the pre- and post-treatment visual analog scale score among different stages of OSF was found to be statistically significant [Table 4].

Gupta et al.[9] has reported similar results of reduction in burning sensation with a biweekly injection of intralesional steroids.

The comparison of the mean values of the pre- and post-treatment TC level of all the study subjects was found to be statistically significant in our study [Table 5]. The mean TC levels increased by 12.91 ± 16.8 post-treatment.

Mehrotra et al.[10] and Ajai et al.[11] reported that serum TC levels were significantly decreased in OSF patients in comparison to normal healthy subjects.

Patel et al;[12] reported a significant decrease in plasma TC in patients with oral premalignant condition as compared to the controls.

Lohe et al.[13] found that there was a significant decrease in TC in the oral precancer group as compared to the controls. A study by Sharma et al.[14] observed a significant decrease in serum cholesterol and LDL in OSF patients.

The comparison of the mean values of the pre- and post-treatment triglyceride level among different stages of OSF was found to be statistically significant [Table 5]. The mean triglyceride levels increased by 30.76 ± 57.6 post-treatment.

Studies by Rawson et al.,[3] Ajai et al.,[11] and Anusha et al.,[15] also observed a decrease in serum triglycerides among OSF patients in comparison to normal healthy subjects. These findings were similar to our study.

In our study, the comparison of the mean values of the pre- and post-treatment HDL levels of all the study subjects among different stages of OSF was found to be statistically significant [Table 5]. The mean HDL levels increased by 6.54 ± 7.6 post-treatment.

Findings similar to our present study were observed by Ajai et al.,[11] Mehrotra et al.,[10] and Lohe et al.[13]

In this study, the comparison of the mean values of the pre- and post-treatment LDL levels of all the study subjects among different stages of OSF was found to be statistically significant [Table 5] The mean LDL levels increased by 8.07 ± 18.0 post-treatment.

Deepanshu Garg et al.,[16] observed decreased LDL levels among oral precancer patients and cancer patients compared to controls. This finding is in similarity to our present study.

In this study, the comparison of the mean values of the pre- and post-treatment VLDL levels of all the study subjects among different stages of OSF was found to be statistically significant [Table 5] The mean VLDL levels increased by 6.07 ± 11.5 post-treatment.

Similar to our findings, Rawson et al;[3] and Anusha et al.[15] also observed a significant decrease in the VLDL levels in OSF patients in comparison with the control group.

In this study, the comparison of the mean values of the pre- and post-treatment CRP levels of all the study subjects among OSF patients was found to be statistically significant [Table 5]. The mean CRP levels decreased by 0.55 ± 1.2 post-treatment.

Bhattacharjee et al.[17] also showed an increase in the level of CRP in both leukoplakia and OSF patients in their study.


   Conclusion Top


Our study findings show the evidence of an inverse relationship between serum lipid profile levels in the potentially malignant condition OSF before treatment and a significant increase in serum lipid profile levels post-treatment. The CRP levels were increased in OSF patients before treatment and a significant decrease was observed post-treatment. The alterations in lipid profile and CRP levels play a prognostic role in the detection of the disease in its early stages.

A thorough review of the literature revealed most of the published studies have compared the serum lipid profile and C-reactive protein in various potentially malignant disorders and normal healthy controls, but our study compares the pre-treatment and post-treatment lipid profile and C-reactive protein values in the same patient with OSF, and has established their real prognostic value.

Limitations and future study prospects

Further studies involving an equal number of large samples among different stages of OSF are required to establish statistically significant results among different stages of the disease. Inclusion of stage IV b OSF in future studies may explore the role of serum lipid profile and CRP as a prognostic marker in all stages of OSF.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Mehrotra R, Pandya S, Chaudhary AK, Singh HP, Jaiswal RK, Singh M, et al. Lipid profile in oral submucous fibrosis. Lipids Health Dis 2009;8:29. doi: 10.1186/1476-511X-8-29.  Back to cited text no. 10
    
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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