肾移植术后环孢素A诱导牙龈增生的临床因素及血清亲环素浓度分析  

Clinical factors of cyclosporine A-induced gingival overgrowth and serum cyclophilin A in renal transplant recipients

作　　者：姜蕾[1] 高明津[1] 赵婧[1] 赵舒薇[2] 赵云富[1] 

机构地区：[1]第二军医大学长征医院口腔科,上海200003 [2]第二军医大学长征医院耳鼻咽喉科,上海200003

出　　处：《第二军医大学学报》2013年第5期515-520,共6页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81170966)~~

摘　　要：目的分析服用环孢素A(CsA)的肾移植患者相关临床因素与牙龈增生(GO)程度的关系,初步探讨血清亲环素(CyPA)浓度与CsA诱导的牙龈增生(CUGO)的关系。方法本研究以65例用CsA为主要免疫抑制剂抗排斥患者为研究对象,经牙龈增生指数(GOI)评价后将患者分为牙龈增生组(GO^+)和牙龈无增生组(GO)。比较两组患者年龄、性别、服药时间、服药剂量、血清CsA和CyPA服药浓度、尿素、肌酐、牙龈评价之间的差异,观察血清CyPA浓度与CIGO发生及严重程度的关系。结果 GO(GOI≥30)发生率为21.54%(14/65)。GO^+组和GO^-组间年龄、性别、服药时间、尿素、肌酐、服药剂量和血清CsA浓度差异均无统计学意义。GO^+组血清CyPA浓度低于GO^-组[0.23(0.16～0.30)ng/mL vs 0.34(0.22～0.54)ng/mL,P=0.04)];血清CyPA浓度与GO严重程度呈负相关(r=-0.264,P=0.03),但与CsA服药剂量和其血清浓度无关(r=-0.014,P=0.91;r=0.012,P=0.9 3);牙龈评价结果:GO^+组的菌斑指数和龈乳头出血指数均高于GO^-组(1.41±0.27 vs 1.15±0.34,P=0.01;0.49±0.30 vs 0.25±0.11,P=0.01)。结论 CIGO的发生可能是局部因素与系统因素共同作用的结果;血清CyPA浓度可能是独立于CsA服药剂量和血药浓度之外的CIGO风险因素,对其进行检测有助于临床医师预判GO的发生。Objective To investigate the relationship between the clinical factors of renal transplant recipients medicated with cyclosporine A （CsA） and gingival overgrowth （GO）, so as to evaluate the association of serum cyclophilin A （CyPA） with CsA-induced GO. Methods Totally 65 renal transplant recipients were enrolled in this study. The degrees of GO were evaluated using gingival overgrowth index （GOI） and the patients were subsequently grouped into overgrowth （GO＋） and nonovergrowth （GO-）. The age, gender, medication duration, dosage of immunosuppressive agents, serum concentrations of CsA and CyPA, creatinine, ureal and gingival assessments were compared between the two groups. The possible correlation between CyPA level and the development and severity of CsA-induced GO was also identified. Results The number of GO＋ subjects （GOI≥30） was 14 （21. 54%） in the present patients. There were no significant differences in age, gender and medication duration, dosage of immunosuppressive agents, serum concentration of CsA, serum creatinine or ureal level between the two groups. Serum CyPA level in GO＋ group was significantly lower than that in GO group （0.23 [0.16-0.30] ng/mL vs 0.34 [0.22-0.54] ng/mL, P= 0. 04）. Serum CyPA concentration was negatively correlated with GO degree （r=-0. 264, P=-0.03）, and was not correlated with dosage or concentration of CsA （r=-0.014, P=0.91; r=0.012, P=0.93）. In addition, the patients with GO presented a significantly high plaque index and papilla bleeding index than those without GO （1.41±0.27 vs 1.15±0.34, P=0.01; 0.49±0.30 vs 0. 25±0.11, P=0.01）. Conclusion Development of CsA-induced GO may be due to a co-work of both local and system factors; serum CyPA level might be an risk factor for CsA-induced GO independent to dosageand serum level of CsA, which may help to detect GO in clinic.

关 键 词：牙龈增生 环孢素 亲环素A 肾移植 

分 类 号：R781.4[医药卫生—口腔医学]