臺灣博碩士論文加值系統

中文摘要
突變形鏈球菌在動物實驗及人類都被公認是引起齲齒最重要的致病因子。目前，突變形鏈球菌被分成血清型 a ~ h 八種；但是，其中只有S. mutans ( 血清型 c/e/f ) 及 S. sorbrinus ( 血清型d/g/h ) 是經常在人類的口腔中被分離出來的。許多的研究顯示，不同的年齡、不同的人種、不同的地區都有可能有不一樣的突變形鏈球菌血清型或生物型的分佈狀況。
幼兒齲齒 ( ECC ) 是發生在嬰幼兒口中的一種猛爆性齲齒。常造成乳牙齒列的快速破壞。研究報告顯示，在前牙的牙菌斑內突變形鏈球菌的濃度是很高的。此外，突變形鏈球菌的感染時間是很重要的，研究顯示越早感染則齲齒的情況也會越嚴重。
近年來，台灣的齲齒狀況越來越嚴重。依據1997年的資料，三歲以下兒童罹患奶瓶性齲齒的更高達 40 ~ 50% 。但是，突變形鏈球菌血清型在台灣的分佈狀況還不是很清楚。因此本實驗的研究目的是針對突變形鏈球菌作血清型鑑定，瞭解血清型的分佈狀況；以及罹患幼兒齲齒的兒童和無齲齒的兒童之間，口中的突變形鏈球菌血清型的分佈及其含量有無差異。
實驗包括15位無齲齒的學齡前兒童及25位患有幼兒齲齒的學齡前兒童，採取牙菌斑樣本作微生物學的檢查。此外還有來自134 位成人，突變形鏈球菌的臨床分離菌在實驗中作進一步的血清型鑑定。本實驗是採用雙向免疫擴散法來作突變形鏈球菌血清型的鑑定。
實驗結果發現突變形鏈球菌血清型主要是血清型 c 型，其他血清型 e 及 d/g 也有出現，但血清型 d/g 在學齡前兒童或成人組中單獨出現或與其他血清型一起出現的比例都比其他研究報告低。實驗中有一些臨床分離菌無法以現有之抗血清鑑定出其血清型，但我們以蛋白質SDS-聚丙醯胺凝膠 ( SDS-PAGE ) 電泳分析則發現他們屬於血清型 f 型。此外，學齡前兒童口內有血清型 f 型及兩種以上血清型的受試者，有較高的齲齒指數，變形鏈球菌的含量也較高。
雖然本實驗嘗試著用蛋白質SDS-聚丙醯胺凝膠 ( SDS-PAGE ) 電泳分析想找出不同齲齒狀態分離出來的突變形鏈球菌是否有不同的致病因子，但是在蛋白質的表現上看不出明顯的差異。未來可能需要利用其他方法來找出突變形鏈球菌的致病因子。

英文摘要
Mutans streptococci ( MS ) have been considered to be the most important etiological factor of dental caries initiation in experimental animals and in human. At present, MS was divided into eight serotypes ( a ~h ) 。Among MS only S. mutans ( serotypes c/e/f ) and S. sorbrinus ( serotype d/g/h ) have frequently been isolated from human population. Several investigators showed geographic、age and population differences in the distribution of the various serotypes of mutans streptococci.
Early childhood caries ( ECC ) is kind of rampant caries pattern which appeared in infants and youngsters. ECC will make the deciduous dentition rapidly destruction. MS are the principal microorganisms associated with ECC. Some report indicated that plaque from carious and sound upper anterior tooth surfaces contained very high levels of S. mutans. Otherwise, the age at which a child becomes colonized is important since some studies suggest that the earlier MS colonize a child's mouth the higher the caries experience.
Several longitudinal studies have shown that basic caries levels among children in Taiwan have increased rapidly in recent years. The ECC prevalence of the children under 3 years old were as high as 40~50%. However, the distribution of MS serotypes in Taiwanese children is not yet clearly known. The aim of the study is to identify the MS serotypes and to determine the distribution of the serotypes. In another way, try to examine if there were different distribution of MS serotypes and MS level between caries free and ECC children.
The study included 15 caries free children and 25 children with ECC, collecting their plaque sample for microbiology test. In another group, identify the MS clinical isolates from 134 young adults as their serotypes. The serotype identification in the study, were carried out by double immunodiffusion method.
In our study, serotype c was predominant, but type e and d/g were also found. The proportion of children or young adults in the study harboring serotype d/g alone or in combination with other serotypes was lower than that reported in most other studies. There are some clinical isolates that could not be serotyped with available antisera but which were shown, by using SDS-PAGE, to belong to the serotype f. Otherwise, higher MS level and higher caries experience was observed in subjects with multiple serotypes and in subjects with serotype f mutans streptococci.
In the study, we try to evaluate, by using SDS-PAGE, if there are any different virulence factor between the clinical isolates from children with different caries experiences. But the differences in protein profile were not clear, so it needs to re-evaluate by using other methods in the future.

目 錄
中文摘要……………………………………………………………1
英文摘要……………………………………………………………3
前言……………………………………………………………5
文獻回顧……………………………………………………………8
實驗目的……………………………………………………………24
材料與方法 …………………………………………………………25
結 果……………………………………………………………32
討 論……………………………………………………………42
結 論……………………………………………………………53
附 表……………………………………………………………54
附 圖……………………………………………………………66
參考文獻……………………………………………………………85
附 錄……………………………………………………………97

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