钙拮抗剂对环孢素A所致药物性牙龈增生的协同作用

目的 探讨钙拮抗剂对环孢素A(CsA)所致药物性牙龈增生的协同作用.方法 130例服用CsA的肾移植受者,根据术后是否联合使用钙拮抗剂,分为钙拮抗剂组和未使用钙拮抗剂(对照组),记录和分析两组受者的年龄、性别、牙周指数、牙龈增生情况及严重程度、服用CsA的时间和剂量、血CsA浓度及血清肌酐等临床指标,并对牙龈增生者与牙龈未增生者进行进一步分析;分析使用不同钙拮抗剂者牙龈增生的发生率和严重程度.结果 钙拮抗剂组牙龈增生发生率为60%(44/73),显著高于对照组的39%(22/57,P＜0.05);钙拮抗剂组轻度牙龈增生受者的比例为37%,显著高于对照组的19%(P＜0.05);两组发生中、重度牙龈增生受者的比例差异无统计学意义(P＞0.05).两组受者中,牙龈增生者的牙龈菌斑指数和乳头出血指数均显著高于牙龈未增生者(P＜0.05),牙龈菌斑指数和乳头出血指数与牙龈增生严重程度呈正相关(P＜0.01).联合使用硝苯地平的受者,其牙龈增生发生率(77%)高于使用氨氯地平(57%)和非洛地平(50%)的受者.结论 联合使用钙拮抗剂对CsA所致药物性牙龈增生具有明显的协同作用;服用CsA的肾移植受者应避免使用硝苯地平以防止可能发生的牙龈增生.

The synergistic effect of calcium channel blocker on cyclosporine-induced gingival overgrowth

Objective To investigate the synergistic effect of calcium channel blocker on cyclosporine-induced gingival overgrowth (GO). Methods 130 renal transplant patients treated with cyclosporine were divided into group A (with calcium channel blocker) and group B (without calcium channel blocker). Demographic, pharmacologic and periodontal data were recorded. The prevalence and severity of GO were compared between the two groups. Three calcium channel blockers, including nifedipine, amlodipine and felodipine, were administered in the patients of group A. The relationships between these three calcium channel blockers and the prevalence of GO were analyzed. Results The patients receiving calcium channel blocker showed significantly higher prevalence of GO (44/73,60 % ) than those without calcium channel blocker (22/57, 39 %) (P＜0. 05). A higher proportion of mild GO (37 %) in group A was also observed than in group B (19 %, P＜0. 05). There were no significant differences in the proportions of moderate and/or severe GO between the two groups (P＞0. 05). Periodontal variables, including plaque index and papilla bleeding index, were significantly higher in GO patients than in those without GO in both two groups (P＜0. 05). In addition, the prevalence of GO in patients receiving nifedipine (77 %) was higher than in those receiving amlodipine (57 %) or felodipine (50 %). Conclusion The combination with calcium channel blocker is a risk factor of cyclosporine-induced GO and the use of nifedipine should be avoided for these at-risk patients.