机械治疗同期口服抗生素对侵袭性牙周炎龈下菌斑和唾液中牙周致病菌的影响  

Effect of systemic use of amoxicillin and metronidazole during mechanical therapy on the periodontal microorganisms in subgingival plaque and saliva of patients with aggressive periodontitis

作　　者：冯向辉[1] 路瑞芳[1] 张立[1] 徐莉[1] 陈智滨[1] 孟焕新[1] Feng Xianghui;Lu Ruifang;Zhang Li;Xu Li;Chen Zhibin;Meng Huanxin(Department of Periodontology,Peking University School and Hospital of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Laboratory for Digital and Material Technology of Stomatology&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院牙周科,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,100081

出　　处：《中华口腔医学杂志》2020年第7期475-481,共7页Chinese Journal of Stomatology

基　　金：国家自然科学基金(81100748)。

摘　　要：目的探索机械治疗同期全身辅助应用抗生素对广泛型侵袭性牙周炎(generalized aggressive periodontitis,GAgP)患者第一磨牙的临床治疗效果和口内牙周致病微生物的影响。方法收集2006年1月至2009年12月就诊于北京大学口腔医学院·口腔医院牙周科的23例GAgP患者,按随机数字表将其随机分为两组:未用药组[12例,年龄(24.5±3.3)岁]和用药组[11例,(26.5±4.0)岁],未用药组进行洁治、刮治和根面平整术,用药组洁治后口服阿莫西林和甲硝唑1周,再行刮治和根面平整术。两组治疗前和治疗后2、4和6个月分别进行牙周临床指标检查和唾液、集合龈下菌斑(来源于4颗第一磨牙近中颊侧位点)采集,治疗后2周仅采集唾液。应用PCR方法检测样本中8种牙周致病微生物并对红色复合体微生物[牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)、福赛坦菌(Tannerella forsythia,Tf)和齿垢密螺旋体(Treponema denticola,Td)]进行半定量分析。结果两组患者治疗后不同时间第一磨牙近中菌斑指数、探诊深度和出血指数与治疗前相比均显著改善,用药组治疗后2、4和6个月探诊深度[分别为(4.21±1.50)、(4.00±1.54)、(3.84±1.89)mm]均显著低于未用药组[分别为(5.29±1.27)、(5.30±1.34)、(4.98±1.36)mm](P<0.05)。用药组治疗后不同时间龈下菌斑(治疗后2、4和6个月Pg、Tf和Td的中位数均降为0.0 ng)和唾液中Pg、Td和Tf含量(治疗后2、4和6个月Tf和Td的中位数均降为0.0 ng,Pg分别为16.3、59.6和22.4 ng)均显著低于治疗前(P<0.05)。未用药组唾液中Td和Tf含量治疗后各时间点与治疗前相比差异均无统计学意义(P>0.05),龈下菌斑中Td和Tf含量仅在治疗后2个月与治疗前相比显著下降(P<0.05)。结论机械治疗同时辅助全身应用抗生素能更好地降低第一磨牙的探诊深度,控制GAgP患者唾液和龈下菌斑中红色复合体微生物的含量,疗效可以维持到治疗后6个月。Objective To explore the effect of systemic use of amoxicillin and metronidazole during mechanical therapy on the clinical parameters of the first molars and periodontal microorganisms in subgingival plaque and saliva in patients with generalized aggressive periodontitis(GAgP).Methods A total of 23 GAgP patients were recruited from Peking University School and Hospital of Stomatology from January 2006 to December 2009 and then randomly divided into two groups according to random number table:12 patients received scaling and root planning(SRP)only and 11 patients received SRP combined with systemic administration of antibiotics(amoxicillin and metronidazole for a week after supragingival scaling).Clinical examination of periodontal parameters and collection of saliva and pooled subgingival plaque samples from mesial-buccal sites of 4 first molars were performed before initial therapy and 2,4 and 6 months respectively after mechanical therapy,and saliva samples were also collected 2 weeks after therapy.Eight different periodontal microorganisms were detected in these samples by PCR.In addition,semiquantitative analysis of red complex microorganisms[Porphyromonas gingivalis(Pg),Tannerella forsythia(Tf),Treponema denticola(Td)]was performed.Results Both therapies led to significant decrease of the plaque index(PLI),probing depth(PD)and bleeding index(BI)from mesial-buccal sites of first molars.Meanwhile the PD of antibiotics group[(4.21±1.50),(4.00±1.54),(3.84±1.89)mm of 2,4 and 6 months respectively after therapy]was significantly lower than the SRP group[(5.29±1.27),(5.30±1.34),(4.98±1.36)mm of 2,4 and 6 months respectively after therapy]at 3 different time points after mechanical therapy(P<0.05).In the antibiotics group,the quantities of Pg,Tf and Td in subgingival plaque samples(the median quantity decreased to 0.0 ng at 2,4 and 6 months after therapy)and saliva samples(the median quantity of Tf and Td decreased to 0.0 ng at 2,4 and 6 months after therapy(P<0.05),and the median quantity of Pg decreased to 1

关 键 词：侵袭性牙周炎 抗生素 微生物 龈下菌斑 唾液 

分 类 号：R781.4[医药卫生—口腔医学]