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Meta-Analysis
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Evaluation of the Salivary Level of Cortisol in Patients With Oral Lichen Planus: A Meta-Analysis

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Meta-Analysis

Evaluation of the Salivary Level of Cortisol in Patients With Oral Lichen Planus: A Meta-Analysis

Pia Lopez-Jornet et al. Medicina (Kaunas).

Abstract

Background and objective: Cortisol, as the main human glucocorticoid, is considered to be a biological marker of stress and anxiety. Since it is known that oral lichen planus (OLP) can appear and worsen during stressful events, cortisol levels have been previously studied in OLP patients. The present meta-analysis aims to assess the salivary concentration of cortisol in OLP patients compared to healthy controls. Materials and methods: Web of Science, PubMed, Cochrane Library, and Scopus databases were searched up to October 2018. The RevMan 5.3 software was used with the mean difference (MD) and 95% confidence intervals (CIs). The CMA 2.0 Software was used to evaluate the publication bias, sensitivity analysis, and meta-regression as possible sources of heterogeneity. Results: 10 studies were analyzed and a total of 269 OLP patients and 268 controls were included. The pooled MD of the salivary levels of cortisol in OLP patients compared with controls was 4.27 ng/mL (95% CI: 2.33, 6.21; P < 0.0001), thus, the salivary level of cortisol in OLP patients was significantly higher than in controls. In Indian-based population studies, a significant difference in the salivary cortisol levels in OLP patients compared with controls was detected (MD = 5.62 ng/mL; 95% CI: 2.67, 8.56; P = 0.0002). In addition, a significant difference in the salivary cortisol levels in the OLP patients compared with the controls was obtained in studies performed with enzyme-linked immunosorbent assay (ELISA) method (MD = 5.33 ng/mL; 95% CI: 2.72, 7.93; P < 0.0001). Conclusion: We suggest that supportive psychological treatment together with the conventional therapy could increase patients' capability to prevent stress, anxiety, and depression.

Keywords: cortisol; meta-analysis; oral lichen planus; saliva.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study selection.
Figure 2
Figure 2
Forest plot of random-effects analysis: Salivary cortisol levels in the OLP patients vs. the controls. The green box on each line shows the mean difference (MD) for each study and the black diamond at the bottom of the graph shows the overall MD of the ten studies. Abbreviations: OLP, oral lichen planus; SD, standard deviation; CI, confidence interval.
Figure 3
Figure 3
Funnel plot of random effect analysis: Salivary cortisol levels in the OLP patients vs. the controls. Abbreviations: MD, mean difference; SE, standard error
Figure 4
Figure 4
Meta-regression analysis of the study period versus the mean difference of the salivary cortisol levels.

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