A型肉毒杆菌毒素治疗青年夜磨牙症的初步研究  

Preliminary study on botulinum toxin therapy to patients with young sleep bruxism

作　　者：朱宁 黄莎 卢眺眺 陶明 陈建治 ZHU Ning;HUANG Sha;LU Tiaotiao;TAO Ming;CHEN Jianzhi(School of Stomatology,Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang,China;Department of Plastic Surgery,Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College,Hangzhou 310022,Zhejiang,China;Department of Mental Health,the Second Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,Zhejiang,China;Department of Stomatology,Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College,Hangzhou 310022,Zhejiang,China)

机构地区：[1]浙江中医药大学口腔医学院,浙江杭州310053 [2]浙江树人大学树兰国际医学院附属树兰(杭州)医院整形科,浙江杭州310022 [3]浙江中医药大学附属第二医院精神卫生科,浙江杭州310006 [4]浙江树人大学树兰国际医学院附属树兰(杭州)医院口腔科,浙江杭州310022

出　　处：《中国现代医生》2023年第11期65-68,共4页China Modern Doctor

摘　　要：目的研究A型肉毒杆菌毒素(botulinum toxin,BTX-A)对青年磨牙患者的临床治疗效果。方法选取2020年9月至2022年3月浙江树人大学树兰国际医学院附属树兰(杭州)医院接诊的42例夜磨牙症患者,采用随机数字表法分为对照组(n=21)和试验组(n=21)。治疗前对两组进行多导睡眠监测和疼痛视觉模拟评分(visual analog scale,VAS)评估,试验组咬肌区注射BTX-A,对照组咬肌区注射生理盐水,注射4周后再次进行多导睡眠监测和疼痛评估,比较两组治疗前后多导睡眠监测参数、咀嚼肌节律性运动(rhythmic masticatory muscle activity,RMMA)事件参数、疼痛水平和不良反应情况。结果注射4周后,两组多导睡眠监测参数比较,差异均无统计学意义(P>0.05)。试验组患者咀嚼肌节律性运动发作期间咬肌肌电爆发的峰值幅度(peak amplitude of electromyography burst in the masseter muscle during rhythmic masticatory muscle activity,RMMA.MA)及咬肌最大自主收缩时咬肌肌电爆发的峰值幅度(peak amplitude of electromyography burst in the masseter muscle during maximal voluntary clenching,MVC.MA)均低于对照组,差异均有统计学意义(P<0.05)。两组VAS均低于注射前且试验组低于对照组,差异均有统计学意义(P<0.05)。两组均未报告吞咽困难或咀嚼不良事件。结论A型肉毒杆菌毒素注射不能减少夜磨牙的发生,但其通过降低咬肌的强度能缓解夜磨牙症的牙齿磨损和咬肌酸痛,但长期效果仍需进一步观察。Objective To study the clinical efficacy of botulinum toxin(BTX-A)in the treatment of young patients with sleep bruxism.Methods A total of 42 patients with bruxism received by Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College from September 2020 to March 2022 were divided into the control group(n=21)and the test group(n=21).Before treatment,polysomnography and visual analog scale(VAS)assessment of pain were performed in both groups,and BTX-A was injected into the masseter muscle area of the test group,normal saline was injected into the masseter muscle area of the control group.Polysomnography and pain assessment were repeated 4 weeks after injection to compare polysomnography parameters,rhythmic masticatory muscle activity(RMMA)event parameters,pain levels and adverse effects before and after treatment in both groups.Results After 4 weeks of injection,there was no statistically significant difference in any of the polysomnography parameters between the two groups(P>0.05).In the test group,the peak amplitude of electromyography burst in the masseter muscle during rhythmic masticatory muscle activity(RMMA.MA)and the peak amplitude of electromyography burst in the masseter muscle during maximal voluntary clenching(MVC.MA)were lower than those of the control group,and the differences were statistically significant(P<0.05).VAS were lower in both groups than those before injection and the test group was lower than that in the control group,and the differences were statistically significant(P<0.05).None of the two groups reported dysphagia or adverse mastication events.Conclusions BTX-A injection cannot reduce the occurrence of sleep bruxism,but it can alleviate the tooth wear and masseter soreness of bruxism by reducing the strength of masseter muscle.However,the long-term effect still needs further observation.

关 键 词：夜磨牙症 肉毒杆菌毒素 多导睡眠图 咀嚼肌节律性运动 

分 类 号：R787[医药卫生—口腔医学]