摘要
目的 研究米诺环素联合维他派克斯(vitapex)对慢性根尖周炎伴牙髓病患者的临床疗效及细胞因子的影响.方法 112例慢性根尖周炎伴牙髓病患者随机均分为对照组(n=56,常规根管治疗)和观察组(n=56,对照组基础上采用米诺环素联合Vitapex治疗),治疗4周并随访8周,收集2组患者一般临床资料,比较2组患者治疗第4周的临床疗效;采用视觉模拟评分法(VAS)、口腔健康影响程度量表中文版(OHIP-14)评分评估2组患者治疗前及治疗第1、4、8周的口腔疼痛程度及口腔健康影响程度;采用牙周探针检测2组患者治疗前及治疗第4周的牙周指数[包括菌斑指数(PLI)、出血指数(BI)、牙周袋探诊深度(PD)及牙龈指数(GI)];取2组患者治疗前及治疗第4周患牙不可治愈的根尖周组织,采用免疫荧光双染法检测根尖周肉芽组织中Janus蛋白酪氨酸激酶2(JAK2)、信号转导子和转录激活子3(STAT3)及细胞因子信号传导抑制因子3(SOCS3)的表达;取2组患者治疗前及治疗第4周的龈沟液,采用酶联免疫吸附法检测肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-17及IL-23的水平.结果 2组患者一般情况比较,差异均无统计学意义(P＞0.05);对照组患者治疗总有效率高于对照组(P＜0.05);2组患者治疗第1、4、8周VAS评分较治疗前下降(P＜0.05),观察组低于对照组且下降幅度更明显(P＜0.001);2组患者治疗第1、4、8周OHIP-14评分较治疗前下降(P＜0.05),观察组治疗后第4、8周低于对照组且下降幅度更明显(P＜0.001);2组患者治疗第4周PLI、BI、PD、GI较治疗前明显下降(P＜0.001),且观察组低于对照组(P＜0.05);2组患者治疗第4周根尖周肉芽组织中JAK2、STAT3、SOCS3阳性细胞表达较治疗前明显下降(P＜0.001),且观察组低于对照组(P＜0.05);2组患者治疗第4周龈沟液中TNF-α、1L-1β、IL-17及IL-23水平较治疗前明显下降(P＜0.001),且观察组低于对照组(P＜0.05).结论 米诺环素联合Vitapex治疗慢性根尖周炎伴牙髓病患者有较好的临床疗效,可降低患者口腔疼痛感及口腔健康影响程度,改善牙周指数和JAK2、STAT3、SOCS3的表达及牙周炎症反应.
Abstract
Objective To investigate effects of minocycline combined with vitapex on clinical efficacy and cytokines in patients with chronic apical periodontitis(CAP)companying pulp disease.Methods A total of 112 patients with CAP companying pulp disease were randomly divided into a control group(n=56,conventional root canal treatment)and an observation group(n=56,treatment with minocycline combined with Vitapex on the basis of control group).The patients were treated for 4 weeks and followed up for 8 weeks.General clinical data was collected from two groups of patients.Clinical efficacy was compared at the 4th week of treatment.Degree of oral pain and oral health impact of two groups of patients were evaluated before treatment and at the 1st,4h,and 8th weeks treatment using visual analogue scale(VAS)and The Chinese version of the Oral Health Impact Profile-14(OHIP-14).Periodontal probes were used to detect the periodontal indexes[including plaque index(PLI),bleeding index(BI),periodontal pocket probing depth(PD),and gingival index(GI)]of two groups of patients before treatment and at the 4th week of treatment.Periapical tissues were taken from the patients with incurable teeth in two groups before treatment and at the 4th week of the treatment.Dual immunofluorescent staining was used to detect the expressions of Janus kinase 2(JAK2),signal transducer and transcriptional activator 3(STAT3)and suppressor of cytokine signaling 3(SOCS3)in periapical granulation tissue.Gingival crevicular fluid was collected from two groups of the patients before treatment and after the 4th week of treatment.Enzyme-linked immunosorbent assay(ELISA)was applied to detect the levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),IL-17,and IL-23.Results There was no statistically significant difference in the general data between two groups of patients(P＞0.05).Total effective rate of treatment was higher in observation group than that in control group(P＜0.05).At the 1st,4th,and 8th weeks of treatment,VAS scores of two groups of the patients were decreased when compared to before treatment(P＜0.05).VAS score was lower in observation group than that in control group,and the decline was more obvious in observation group than in control group(P＜0.001).At the 1st,4th,and 8th weeks of treatment,OHIP-14 scores of two groups of patients were decreased when compared to before treatment(P＜0.05).OHIP-14 scores at the 4th and 8th weeks were lower in observation group than those in control group,and the decline was more obvious in observation group than in control group(P＜0.001).During the 4th week of treatment,PLI,BI,PD and GI in two groups of the patients were significantly decreased when compared to before treatment(P＜0.001),and lower in observation group than those in control group(P＜0.05).During the 4h week of treatment,JAK2,STAT3,SOCS3 positive cells were significantly decreased in periapical granulation tissues in two groups of the patients when compared to before treatment(P＜0.001),and lower in observation group than those in control group(P＜0.05).During the 4h week of treatment,the levels of TNF-α,IL-1 β,IL-17,and IL-23 were significantly decreased in gingival crevicular fluids in in two groups of the patients when compared to before treatment(P＜0.001),and lower in observation group than those in control group(P＜0.05).Conclusion Combination of minocycline and vitapex has good clinical efficacy in treating patients with chronic apical periodontitis companying pulp disease.It can reduce oral pain and the degree of oral health impact,and improve periodontal index,expressions of JAK2,STAT3,and SOCS3 as well as periodontal inflammatory response.
基金项目
2020年度河北省医学科学院研究课题计划(20200258)
秦皇岛市科学技术研究与发展计划(202101A065)
维普
万方数据