坏死性溃疡性牙周炎

M. John Novak Dr.
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引用次数: 76

摘要

在没有已知全身性疾病或免疫功能障碍的患者中,坏死性牙周炎(NUP)似乎具有坏死性溃疡性牙龈炎(NUG)的许多临床和病因学特征,除了NUP患者表现出临床附着和受影响部位的牙槽骨丧失。在这些患者中,NUP可能是单次或多次NUG发作的后遗症,也可能是先前牙周炎影响部位发生坏死性疾病的结果。免疫功能障碍的存在可能使患者易患NUG和NUP,特别是当与经常与牙周病相关的微生物感染相关时,如密螺旋体和硒单胞菌、核梭菌、中普雷沃氏菌和牙龈卟啉单胞菌。免疫功能障碍的作用体现在艾滋病毒感染或营养不良患者偶尔出现的坏死性牙周病的侵袭性,这两种疾病都可能影响宿主的防御。对艾滋病毒感染患者的临床研究表明,NUP患者的CD4+细胞计数低于200细胞/mm3的可能性高出20.8倍。然而,这些相同的研究表明,大多数CD4+细胞计数低于200细胞/毫米的患者没有NUP,3表明除了免疫功能低下外,还涉及其他因素。需要进一步的研究来确定微生物,或病毒,坏死性病变的病因学和免疫功能低下的宿主之间复杂的相互作用。因此,建议根据NUG和NUP的临床特点,将其归为坏死性牙周病组。牙周病杂志1999;4:74- 77。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Necrotizing Ulcerative Periodontitis

In patients with no known systemic disease or immune dysfunction, necrotizing periodontitis (NUP) appears to share many of the clinical and etiologic characteristics of necrotizing ulcerative gingivitis (NUG) except that patients with NUP demonstrate loss of clinical attachment and alveolar bone at affected sites. In these patients, NUP may be a sequela of a single or multiple episodes of NUG or may be the result of the occurrence of necrotizing disease at a previously periodontitis-affected site. The existence of immune dysfunction may predispose patients to NUG and NUP, especially when associated with an infection of microorganisms frequently associated with periodontal disease such as Treponema and Selenomonas species, Fuscobacterium nucleatum, Prevotella intermedia, and Porphyromonas gingivalis. The role of immune dysfunction is exemplified by the occasionally aggressive nature of necrotic forms of periodontal disease seen in patients with HIV infection or malnutrition, both of which may impact host defenses. Clinical studies of HIV infected patients have shown that patients with NUP are 20.8 times more likely to have CD4+ cell counts below 200 cells/mm3. However, these same studies have demonstrated that most patients with CD4+ cell counts below 200 cells/mm do not have NUP,3 suggesting that other factors, in addition to immunocompromisation, are involved. Further studies are needed to define the complex interactions between the microbial, or viral, etiology of necrotic lesions and the immunocompromised host. It is, therefore, recommended that NUG and NUP be classified together under the grouping of necrotizing periodontal diseases based on their clinical characteristics. Ann Periodontol 1999;4:74- 77.

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