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研究生:楊芳泰
研究生(外文):Fang-Tai Yang
論文名稱:服用環孢靈之肝臟移植幼童牙齦腫大現象之調查研究
論文名稱(外文):A Study of Gingival Overgrowth in the Cyclosporine-Administered Liver Transplant Children
指導教授:林瑩澤林瑩澤引用關係
指導教授(外文):Yng-Tzer Lin
學位類別:碩士
校院名稱:長庚大學
系所名稱:顱顏口腔醫學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:72
中文關鍵詞:免疫抑制劑環孢靈肝臟移植牙齦腫大
外文關鍵詞:immunosuppressant agentgingival overgrowthcyclosporineliver transplantation
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環孢靈(cyclosporine)自從西元1972年被發現具有免疫抑制效果後,已廣泛運用在器官移植手術上,並使手術的成功率大幅度地提昇。但是相對地,環孢靈常常導致器官移植病人牙齦出現過度腫大( gingival overgrowth )的副作用。文獻上,接受器官移植的成人患者牙齦出現過度腫大的機率約為10% 至30% 之間。此外,Daley在觀察了100位服用環孢靈的病患口內牙齦腫大現象2.5年後發現,小孩子在服用環孢靈後牙齦腫大的發生率有比較大的傾向。但很少有文獻特別針對使用環孢靈的肝臟移植幼童牙齦過度腫大發生率做過研究。
本研究的主要目的是調查在高雄長庚醫院肝臟移植中心接受肝臟移植手術且正在服用環孢靈的乳牙齒列幼童牙齦腫大的發生機率與嚴重程度,並且探討影響肝臟移植幼童牙齦腫大的可能因素。
本次研究觀察了15位男性、10位女性,共25位,4歲以下且正在服用環孢靈的肝臟移植幼童在移植手術後一年當中牙齦腫大的現象。所有患童於移植手術前、手術後、術後3個月、術後6個月以及術後12個月時皆記錄其血中環孢靈濃度、牙齦腫大指數(Gingival enlargement index)、牙菌斑指數(Plaque index)以及牙齦出血指數(Gingival bleeding index),以便觀察肝臟移植手術前後牙齦的臨床變化。
研究發現,患童的年齡、性別、牙齦發炎現象以及血中環孢靈(cyclosporine)濃度與牙齦腫大無關( p > 0.05 )。相對地,整個觀察期間患童牙菌斑指數與牙齦腫大之間,皆有統計學上的顯著性存在( p < 0.05 )。此外,肝臟移植幼童在手術後6個月及12個月的牙齦腫大程度及發生率和手術前未使用環孢靈時相當。但是在剛手術後及術後3個月,牙齦腫大的發生率則超過 80 % 而且牙齦腫大程度也有增加的傾向。
本次研究結果顯示,影響服用環孢靈的肝臟移植幼童牙齦腫大現象發生的最主要因素為患童的牙菌斑指數。因此,為了預防患童牙齦腫大現象的發生,牙科定期回診時除了例行的口腔檢查、治療之外,應提醒家長口腔衛生的重要性並加強教導正確口腔衛生清潔方法。
Cyclosporine, a potent immunosuppressant agent discovered in 1972, has significantly reduced the morbidity and mortality associated with organ transplantations and improved the five-year success rate for solid organ transplants from 50% to 96%. The major side effect of this drug in the oral cavity is gingival overgrowth, especially in the transplant patients. Cyclosporine-induced gingival overgrowth was reported variable in between 10 and 30 % of the transplant patients, according to reports from different transplant centers, which were more for pediatric liver transplant patients.
The aims of this study were to investigate the effects of cyclosporine on the gingival tissues of liver transplant pediatric patients, to determine the prevalence and severity of gingival overgrowth in twenty-five cyclosporine-treated children, and to relate such changes to plaque scores, gingival inflammation and serum concentrations of the drug.
25 pediatric patients(15 males and 10 females), with end-stage of liver disease and receiving liver transplantation less than 4 years of age, were selected for this study. During the pre-transplantation period, these patients had the baseline data collection including the serum level of cyclosporine, gingival enlargement index, plague index and gingival bleeding index. After liver transplantation, these patients were received cyclosporine as an immunosuppressant agent. These children had the same data collections immediately, 3 months, 6 months and 12 months after liver transplantation.
The results showed that cyclosporine-induced gingival overgrowth of these children was not associated with their age, sex, gingival inflammation and the serum level of cyclosporine ( p > 0.05). Statistically, gingival overgrowth of these children was associated with dental plaque score in each time period until 12 months after liver transplantation ( p < 0.05). There was an increased tendency of gingival overgrowth ( > 80% ) in the children who received cyclosporine as an immunosuppressant agent during the immediate and 3 months after transplantation.
In summary, the major side effect of gingival overgrowth after receiving cyclosporine as an immunosuppressant agent in this study showed that gingival overgrowth was statistically more related to plaque scores than other factors, such as age, sex, gingival inflammation and the serum level of cyclosporine, suggesting that oral hygiene instruction is important during and after liver transplantation.
第一章 前言----------------------------------------------1
1.1 研究背景------------------------------------------1
1.2 研究目的與方法------------------------------------3
第二章 文獻回顧------------------------------------------5
2.1牙齦腫大的原因-------------------------------------5
2.1.1 局部刺激因素引起的發炎性牙齦腫大---------------5
2.1.2 非單純性局部刺激因素引起的牙齦腫大-------------6
2.1.2.1 長期服用藥物------------------------------6
2.1.2.2 體內賀爾蒙改變----------------------------7
2.1.2.3 全身系統疾病誘發--------------------------7
2.1.2.4 原發性牙齦腫大----------------------------8
2.2 肝臟移植的口腔表徵---------------------------------8
2.2.1 牙齒發育----------------------------------------8
2.2.2 牙齒染色----------------------------------------9
2.2.3 牙齦腫大----------------------------------------9
2.3 器官移植患者牙齦腫大的原因------------------------10
2.3.1 患者的年齡-------------------------------------10
2.3.2 患者的性別-------------------------------------11
2.3.3 患者的口腔衛生---------------------------------11
2.3.4 藥物使用的種類---------------------------------11
2.3.5 藥物使用的劑量---------------------------------12
2.3.6 藥物使用的時間---------------------------------13
2.4 環孢靈--------------------------------------------13
2.4.1 起源-------------------------------------------13
2.4.2 結構-------------------------------------------14
2.4.3 給藥方式---------------------------------------15
2.4.4 作用機轉---------------------------------------15
2.4.5 應用-------------------------------------------16
2.4.6 副作用-----------------------------------------17
2.4.6.1 腎毒性-----------------------------------18
2.4.6.2 肝毒性-----------------------------------19
2.4.6.3 高血壓-----------------------------------19
2.4.6.4 神經毒性---------------------------------20
2.4.6.5 內分泌代謝異常---------------------------20
2.4.6.6 腫瘤發生---------------------------------20
2.4.6.7 牙齦腫大---------------------------------21
第三章 研究對象與方法-----------------------------------23
3.1 研究對象取樣-------------------------------------23
3.2 研究方法-----------------------------------------24
3.2.1 牙齦腫大程度之調查----------------------------25
3.2.2 牙菌斑指數之調查------------------------------26
3.2.3牙齦發炎程度之調查-----------------------------27
3.2.4血中環孢靈濃度之調查---------------------------28
3.3 統計方法-----------------------------------------28
第四章 研究結果-----------------------------------------30
4.1 患童的性別分佈與接受肝臟移植手術年齡-------------30
4.2 患童觀察期間各項調查指數的變化-------------------31
4.3 患童性別分佈與牙齦腫大的相關性-------------------32
4.4 患童接受肝臟移植手術年齡與牙齦腫大的相關性-------33
4.5 患童牙菌斑指數與牙齦腫大的相關性-----------------34
4.6 患童牙齦發炎現象與牙齦腫大的相關性---------------36
4.7 患童血中環孢靈濃度與牙齦腫大的相關性-------------37
第五章 討論---------------------------------------------40
5.1 研究的設計---------------------------------------40
5.2 使用環孢靈患者牙齦腫大的發生率-------------------42
5.3影響使用環孢靈患者牙齦腫大的因素------------------43
第六章 結論---------------------------------------------47
參考文獻------------------------------------------------50
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