發(fā)布時(shí)間：2018-04-30 19:32

  本文選題：藥物性牙齦增生 + 膠原��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:藥物性牙齦增生是一種藥物不良反應(yīng),指服用藥物引起的牙齦增生和體積增大,主要見于三類常用藥物即鈣通道阻滯劑(硝苯地平),癲癇藥物(苯妥英鈉)和免疫抑制劑(環(huán)孢素)。藥物性牙齦增生發(fā)病機(jī)制尚無(wú)定論,影響因素主要包括藥物的作用、炎癥和基因方面影響牙齦的增生程度。藥物性牙齦增生的治療主要包括菌斑控制、去除局部刺激因素、更換或停用能引起牙齦增生的系統(tǒng)用藥及牙周手術(shù)治療。本研究目的在于分析牙齦增生的病因,評(píng)價(jià)規(guī)范化牙周系統(tǒng)治療對(duì)藥物性牙齦增生的治療效果,為藥物性牙齦增生的治療提供依據(jù)。研究方法:收集2014年至2016年青島大學(xué)附屬醫(yī)院就診的藥物性牙齦增生的6例病例。服用可引起藥物性牙齦增生的藥物持續(xù)時(shí)間1月以上。近1年內(nèi)未予牙周科就診治療且3個(gè)月內(nèi)未服用過(guò)任何抗生素。所有患者經(jīng)同一牙周醫(yī)生實(shí)施牙周評(píng)定。患者在知情同意的情況下參加本研究。本研究針對(duì)患有藥物性牙齦增生的6例患者行病史記錄,牙周各項(xiàng)指標(biāo)檢查,在暫時(shí)不更換口服藥物的情況下,行牙周基礎(chǔ)治療、必要的牙周手術(shù)和牙周支持治療。牙周系統(tǒng)性治療后進(jìn)行效果觀察及病因分析。評(píng)價(jià)牙齦增生在治療前與治療后3個(gè)月、6個(gè)月的探診深度(PD)、出血指數(shù)(BI)、菌斑指數(shù)(PLI)和牙齦增生指數(shù)(GHI)的變化。牙周治療后隨訪觀察病變進(jìn)展情況。結(jié)果:患者治療前與經(jīng)過(guò)牙周序列治療3個(gè)月和6個(gè)月的PLI、PBI、PD和GHI等指數(shù)較基線水平有顯著差異。130個(gè)增生位點(diǎn)中有115個(gè)位點(diǎn)牙齦增生完全消失。隨訪6月-2年均無(wú)明顯復(fù)發(fā)。部分菌斑控制差的患者有牙齦炎癥復(fù)發(fā)的傾向,但菌斑控制后好轉(zhuǎn),無(wú)牙齦增生復(fù)發(fā)。結(jié)論:藥物性牙齦增生通過(guò)牙周基礎(chǔ)治療有效菌斑控制聯(lián)合切除性手術(shù)可以得到理想的治療效果。牙齦增生中由炎癥引起的增生大部分為可逆且能在菌斑控制后短時(shí)間內(nèi)消退,再通過(guò)牙周手術(shù)去除牙齦中堆積的膠原成分,恢復(fù)牙齦的外觀和功能。因此以菌斑控制為主的牙周基礎(chǔ)治療是牙齦增生治療的首要程序�；谀壳坝^察的病例及觀察時(shí)間,本實(shí)驗(yàn)中的所有病例均未更換治療藥物,觀察期內(nèi)均取得較好的臨床療效。本研究針對(duì)藥物性牙齦增生的發(fā)病機(jī)制及臨床治療,對(duì)指導(dǎo)醫(yī)療專業(yè)人員有效的防止藥物性牙齦增生的發(fā)生有一定的意義。本研究尚需增加補(bǔ)充病例和延長(zhǎng)觀察時(shí)間,以期對(duì)臨床治療起到更進(jìn)一步的指導(dǎo)作用。
[Abstract]:Objective: drug induced gingival hyperplasia is a kind of adverse drug reaction. It is mainly found in three kinds of common drugs: calcium channel blockers (nifedipine), epileptic drugs (phenytoin sodium) and immunosuppressants (cyclosporine). The pathogenesis of drug-induced gingival hyperplasia is still unknown. The main influencing factors include drug action, inflammation and gene influence on the degree of gingival hyperplasia. The treatment of drug-induced gingival hyperplasia mainly includes plaque control, removal of local stimuli, replacement or discontinuation of systemic medication and periodontal surgery. The purpose of this study was to analyze the etiology of gingival hyperplasia, to evaluate the therapeutic effect of standardized periodontal system therapy on drug induced gingival hyperplasia, and to provide evidence for the treatment of drug induced gingival hyperplasia. Methods: six cases of drug-induced gingival hyperplasia were collected from 2014 to 2016 in Qingdao University affiliated Hospital. Medication that can cause drug-induced gingival hyperplasia lasts for more than one month. No periodontal treatment was given within 1 year and no antibiotics were taken within 3 months. All patients were assessed by the same periodontists. The patient participated in the study with informed consent. In this study, 6 patients with drug-induced gingival hyperplasia were treated with medical history, periodontal indexes, periodontal basic treatment, periodontal surgery and periodontal support therapy. The effect and etiology were observed and analyzed after systemic periodontal treatment. To evaluate the changes of probing depth, bleeding index (BI), plaque index (PLI) and gingival hyperplasia index (GHI) of gingival hyperplasia before treatment and 3 months and 6 months after treatment. The progress of the disease was observed after periodontal treatment. Results: there were significant differences in PD and GHI indexes between the patients before treatment and after periodontal sequence therapy for 3 months and 6 months, and 115 of 130 proliferative sites disappeared completely. There was no significant recurrence in 6 months after follow-up. Some patients with poor plaque control tended to recur of gingival inflammation, but no recurrence of gingival hyperplasia occurred after plaque control. Conclusion: drug-induced gingival hyperplasia can be effectively treated by plaque control combined with excision surgery. Most of the hyperplasia caused by inflammation in gingival hyperplasia is reversible and can recede in a short time after plaque control. Then the collagen accumulated in the gingiva is removed by periodontal surgery to restore the appearance and function of the gingival. Therefore, the primary procedure of gingival hyperplasia treatment is the periodontal basic therapy based on plaque control. Based on the present observed cases and the observation time, all the cases in this experiment did not change the therapeutic drugs, and good clinical effect was obtained during the observation period. This study aims at the pathogenesis and clinical treatment of drug-induced gingival hyperplasia, which has a certain significance for guiding medical professionals to prevent the occurrence of drug-induced gingival hyperplasia. This study needs to increase the number of supplementary cases and prolong the observation time in order to provide further guidance for clinical treatment.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R781.4

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