钙离子拮抗剂致药物性牙龈增生的危险因素分析

目的：探讨高血压患者服用钙离子拮抗剂后出现牙龈增生的患病率。方法：对我院查体中心和心血管内科门诊服用钙离子拮抗剂抗高血压类药物的262和未服用钙离子拮抗剂的197例患者进行横断面调查。方法包括问卷调查和口腔牙周检查,其中牙龈增生的判定以牙龈增生指数（HI ）为诊断标准。对调查结果进行统计学分析。结果：服用钙离子拮抗剂类药物患者的牙龈增生患病率为20．23％,显著高于对照组的2．54％（χ2＝32．276,P＜0．05）。随年龄增大,药物性牙龈增生的患病率降低（r＝－0．155,P＜0．05）;单一用药者较联合用药者患病率高;服药时间越长患病率降低;随服药剂量的增加,患病率明显增长;口腔卫生状况差者可加重牙龈增生程度。结论：药物性牙龈增生是多方面作用的结果,其主要影响因素为患者年龄、服药方式、剂量、时间和牙周局部因素。     

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目的评价牙周基础治疗及维护期治疗对使用硝苯地平导致牙龈增生的治疗效果。方法选择2010年9月至2011年12月在佳木斯大学附属口腔医院牙周黏膜病科就诊的因高血压服用硝苯地平导致牙龈增生20例,随机分为试验组（10例）和对照组（10例）,在均不更换药或未停药的情况下,试验组进行牙周基础治疗和维护期治疗,而对照组仅进行牙周基础治疗。在治疗前和治疗后1、12个月时记录各组患者牙龈增生指数（GHI）、茵斑指数（PLI）、龈沟出血指数（SBI）和探诊深度（PD）。结果试验组在观察期间,各项指标（GHI、PLI、SBI、PD）持续改善（P〈0．01）,牙龈炎症减轻,牙龈增生状况明显改善且未复发;对照组在基础治疗后1个月牙龈各项指标改善（P〈0．01）,但12个月后复诊时牙龈出血等复发,且各指标与治疗前比较差异无统计学意义（P〉0．05）。结论牙周基础治疗可改善硝苯地平引起的牙龈增生,定期维护治疗对于预防硝苯地平导致的牙龈增生复发疗效明显。     

唾液中IL-6与硝苯地平所致药物性牙龈增生的关系

目的探讨硝苯地平所致药物性牙龈增生程度与非刺激性全唾中IL-6水平之间的关系。方法从北京石景山社区服用硝苯地平6个月以上的205名个体中,按照增生指数分层,随机抽取66名个体作为本研究的评价对象,并完成以下检查：一般检查包括身高,体重;牙周临床检查包括菌斑指数（Plaqueindex,PLI）,探诊深度（Probing Depth,PD）,探诊出血指数（Bleedingindex,BI）,附着丧失（Attachment Loss,AL）。实验室检查：抽取受检者空腹前臂静脉血,采用全自动分析仪检测空腹血糖（Fasting Plasma Glucose,FPG）,并收集非刺激性全唾,用ELISA法检测唾液中IL-6水平。拍摄每位受检者前牙区数码相,评价每位受检者的牙龈增生指数（Gingival Overgrowth Score,GOS）。结果牙龈增生程度由低到高分为五组,各组IL-6水平（x±SD）分别为4．72±1．20pg／ml,10．77±2．79pg／ml,11．21±2．83pg／ml,15．424±3．12pg／ml,29．82±12．61pg／ml。Pearson检验显示非刺激性全唾中的IL-6水平与牙龈增生指数显著相关（P〈0．05,r=0．604）。应用SPSS13．0分析软件控制BI,PD,BMI,Glu,PLI,AL后,偏相关分析显示,非刺激性全唾中IL-6水平仍与牙龈增生指数正相关（P〈0．05,r=0．379）。结论非刺激性全唾中IL-6水平与硝苯地平所致的牙龈增生有关。     

钙离子拮抗剂致药物性牙龈增生的危险因素分析

目的调查高血压患者服用钙离子拮抗剂后引起药物性牙龈增生的患病率,并分析其危险因素。方法将北京医院心血管内科的681例高血压或冠心病患者纳入本研究,其中330例服用钙离子拮抗剂(CCB组),351例未服用钙离子拮抗剂(对照组)。记录患者的性别、年龄、用药种类、持续时间、剂量、是否联合用药。临床检查牙龈出血指数(BI)、菌斑指数(PLI)、牙龈增生指数(HI)。结果服用钙离子拮抗剂组牙龈增生的患病率为41.21%,显著高于对照组4.84%(P<0.05)。对调查的各种因素进行Logistic回归分析,结果显示:BI(OR=2.17,95%可信区间:1.60-2.94)PLI(OR=1.99,95%可信区间:1.38-2.87)是患者出现牙龈增生的危险因素。结论口腔卫生状况和牙龈炎症反应是药物性牙龈增生的危险因素。     

硝苯地平性牙龈增生的临床研究

目的 研究服用硝苯地平患者牙龈增生的发病情况。方法 对75名服用硝苯地平患者作牙周检查。并与134名非服用者作对照。结果 服用硝苯地平患者牙龈增生的发病率和发病严重程度均明显较对照组高。结论 提示服用硝苯地平是导致牙龈增生的重要原因。     

单纯牙周基础治疗对苯妥英钠所致药物性牙龈增生疗效评价

目的 评价单纯牙周基础治疗对苯妥英钠（PHT）所致药物性牙龈增生的治疗效果。方法 选择佛山市禅城区向阳医院·禅城区口腔医院2011年1月至2013年6月因服用PHT导致牙龈增生的患者16例,在不停药亦不换药的情况下行牙周基础治疗,并于治疗前及治疗后1、3、6个月进行牙龈增生指数（GHI）、菌斑指数（PLI）、龈沟出血指数（SBI）、探诊深度（PD）等临床指标检查。结果 单纯牙周基础治疗后1、3、6个月的GHI、PLI、SBI、PD各项临床指标逐步改善,牙龈炎症逐步减轻,牙龈增生状况持续好转;与治疗前基线相比,差异均有统计学意义（均P < 0.05）。结论 单纯牙周基础治疗对PHT所致药物性牙龈增生有效。     

非硝苯地平钙离子拮抗剂与牙龈增生的关系研究

目的:探讨服用非硝苯地平的钙离子拮抗剂(除硝苯地平之外的其他钙离子拮抗剂)与牙龈增生的关系.方法:选择北京医院内科高血压门诊就诊的成年高血压病患者,进行问卷调查和口腔健康检查.分为服用非硝苯地平钙离子拮抗剂的患者(简称服药组)及从未服用过钙离子拮抗剂的患者(简称对照组).问卷调查内容包括患者的一般状况,高血压患病史,服药史以及口腔卫生习惯等.口腔健康检查包括菌斑指数(plaque index PLI)、简化牙石指数(simple calculus index CI-S)、以及牙龈增生指数(gingival hyperplasia index HI)的检查和记录.结果:对照组患者牙龈增生患病率6.03%,服药组患者牙龈增生患病率31.25%,两者间的差异有显著性(P＜0.001),并且服药组患者中严重牙龈增生的患病率19.23%也显著高于对照组1.59%(P＜0.001).对照组平均HI值为1.4%,服药组平均HI值为10%,两者间的差异有显著性(P＜0.001).结论:服用非硝苯地平钙离子拮抗剂与高血压患者牙龈增生的患病间有显著相关性.     

一位药物性牙龈增生患者的诊断、治疗和长期疗效

本文报告了1例服用环孢素和硝苯地平相关牙龈增生（肥大）患者的诊断、治疗和长期疗效。该患者在未更换全身用药情况下对牙龈增生进行了成功治疗。治疗的主要目的是降低牙龈增生的程度,进而恢复牙齿的健康、功能和美观。治疗过程是先行牙周基础治疗,后行牙周手术治疗,术后观察2年．牙龈增生未见复发。     

硝苯地平诱导药物性牙龈肥大牙周基础治疗临床效果评价

目的    评价牙周基础治疗对硝苯地平诱导药物性牙龈肥大的治疗效果。方法    选择2012年6月至2013年6月于中国医科大学附属第四医院心内科门诊与病房、中国医科大学口腔医院牙周科门诊患者中诊断为高血压且服用硝苯地平后出现牙龈增生者23例,在初诊及牙周基础治疗后1、3、6个月分别记录患者牙周指标（牙龈增生指数、菌斑指数、出血指数和探诊深度等）,分析牙龈增生指数与菌斑指数的相关性。结果    所有患者各牙周指标在牙周基础治疗后1、3、6个月均有明显改善,与初诊比较差异有统计学意义（P＜0.05）;牙龈增生指数与菌斑指数存在显著正相关（P＜0.05）。结论    牙周基础治疗有利于硝苯地平诱导的药物性牙龈肥大的临床治疗。     

应用心痛定所致牙龈增生的临床调查

应用心痛定所致牙龈增生的临床调查于京选，温伟生，桂伟为了解高血压、冠心病患者服用Ｃａ拮抗剂类药物，如心痛定（Ｎｉｆｅｄｉｐｉｎｅ，ＮＦ）引起的牙龈增生，作者对我院１４８名患者进行了牙龈增生情况的调查分析。１．调查方法和标准：（１）对象与方法：调查了我...     

Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study

BACKGROUND: The prevalence of gingival overgrowth induced by chronic medication with calcium channel blockers is uncertain. Although there have been several studies examining this question, the results are conflicting, with previous estimates ranging from 20% to 83%. There have been only 2 studies examining the prevalence of overgrowth induced by diltiazem and amlodipine, with estimates of 74% and 3.3%, respectively. METHODS: The current study aimed to address the problems associated with these studies by examining a sample of patients taking one of 3 calcium channel blockers, who were drawn from a community-based population in northeastern England. Nine hundred eleven (911) subjects were recruited from general medical practices in the area. Of these, 442 were taking nifedipine, 181 amlodipine, and 186 diltiazem. In addition, 102 control subjects were examined. Drug and demographic data for each subject were recorded. The periodontal condition of all subjects was assessed including plaque index, papillary bleeding index, and a photograph of the anterior gingivae for subsequent analysis of overgrowth severity. RESULTS: More than six percent (6.3%) of subjects taking nifedipine were seen to have significant overgrowth. This overgrowth was statistically greater than the amount of overgrowth seen in either of the other 2 drug groups or the control population. The prevalence of gingival overgrowth induced by amlodipine or diltiazem was not statistically significant when compared to the control group. The severity of overgrowth within the nifedipine group was found to be related to the amount of gingival inflammation and also to the gender of the subject, with males being 3 times as likely to develop overgrowth than females. CONCLUSIONS: The prevalence of clinically significant overgrowth related to chronic medication with calcium channel blockers is low, i.e., 6.3% for nifedipine. Males are 3 times as likely as females to develop clinically significant overgrowth. The presence of gingival inflammation is an important cofactor for the expression of this effect.     

Disposition of nifedipine in plasma and gingival crevicular fluid in relation to drug-induced gingival overgrowth

The present study investigates the relationship between the pharmacokinetic variables of nifedipine with the incidence and severity of gingival overgrowth in 9 adult male patients medicated with the drug for at least 6 months. Five of the patients had experienced significant gingival changes and were thus designated "responders". The remaining four patients exhibited no gingival overgrowth, and thus acted as a control. A baseline periodontal examination (plaque scores, bleeding index and gingival overgrowth assessment) was carried out on each patient, and confined to the upper and lower anterior teeth. Serial blood and gingival crevicular fluid samples were collected over an eight-hour investigation period. Samples were analyzed for nifedipine by gas chromatography. No significant difference (p>0.05) was seen between responders and non-responders with regard to drug therapy, periodontal parameters or plasma pharmacokinetics of nifedipine. Nifedipine was detected in the gingival crevicular fluid of seven subjects (all responders, and two non-responders). The peak concentration of nifedipine in crevicular fluid was 15–90 fold greater than levels observed in plasma.     

The calcium channel blocker used with cyclosporin has an effect on gingival overgrowth

BACKGROUND/AIMS: To investigate whether the choice of calcium channel blocker, used in conjunction with cyclosporin A, affected the prevalence of gingival overgrowth. METHOD: A cohort of 135 renal transplant recipients who had been medicated with cyclosporin A in combination with either nifedipine (89) or amlodipine (46) since transplant, took part in the study. The inclusion criteria were that eligible subjects had been in receipt of a kidney transplant for at least 12 months, had at least 10 teeth and had not received specialist periodontal treatment. The age, gender, current drug regimen and dosage were recorded for each participant and alginate impressions taken of both arches. The presence and severity of gingival overgrowth were scored from plaster models. RESULTS: A higher proportion (72%) of the amlodipine group were categorised as having gingival overgrowth compared with only 53% of the nifedipine group, chi square=4.5, p<0.05. Logistic regression analysis was used to explore the relationship between the presence or absence of gingival overgrowth (dependent variable) and age, gender, time since transplant, dose of cyclosporin A, centre in which the patient was treated, and the calcium channel blocker used (independent variables). Independent predictors of gingival overgrowth in this multivariate analysis were whether the individual was treated with amlodipine or nifedipine (p=0.01) and whether the individual was young or old (p=0.01). Within the multivariate analysis, the odds ratio for amlodipine to be associated with gingival overgrowth compared with nifedipine was 3.0 (confidence interval 1.3-6.9). CONCLUSIONS: The prevalence of gingival overgrowth in renal transplant recipients maintained on cyclosporin A and nifedipine is lower than those treated with cyclosporin A and amlodipine.     

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目的评价单纯牙周基础治疗对苯妥英钠(PHT)所致药物性牙龈增生的治疗效果。方法选择佛山市禅城区向阳医院·禅城区口腔医院2011年1月至2013年6月因服用PHT导致牙龈增生的患者16例,在不停药亦不换药的情况下行牙周基础治疗,并于治疗前及治疗后1、3、6个月进行牙龈增生指数(GHI)、菌斑指数(PLI)、龈沟出血指数(SBI)、探诊深度(PD)等临床指标检查。结果单纯牙周基础治疗后1、3、6个月的GHI、PLI、SBI、PD各项临床指标逐步改善,牙龈炎症逐步减轻,牙龈增生状况持续好转;与治疗前基线相比,差异均有统计学意义(均P<0.05)。结论单纯牙周基础治疗对PHT所致药物性牙龈增生有效。     

Prevalence and risk of gingival enlargement in patients treated with nifedipine

BACKGROUND: Gingival enlargement is a known side effect of nifedipine use. This study was conducted to determine the prevalence and risk factors for gingival enlargement in nifedipine-treated patients. METHODS: A cross-sectional study was conducted in a primary care center. Data from 65 patients taking nifedipine were compared with 147 controls who had never received the drug. All patients were examined for the presence of gingival enlargement using 2 different indices: vertical gingival overgrowth index (GO) in 6 points around each tooth, and horizontal MB index in the interdental area. Gingival index, plaque index, and probing depth were also evaluated. RESULTS: The prevalence of gingival enlargement was significantly higher in nifedipine-treated cases than in controls (GO index, 33.8% versus 4.1%; MB index, 50.8% versus 7.5%, respectively). Higher gingival and plaque indices were observed in patients taking nifedipine. Among the possible risk factors, only the gingival index showed a significant association with gingival enlargement. The risk (odds ratio [OR]) of gingival enlargement associated with nifedipine therapy was 10.6 (3.8-29.1) for the GO index and 14.4 (6-34.6) for the MB index. Gingival index-adjusted ORs were 9.6 (3.3-28.1) and 9.7 (3.9-23.3), respectively. In the subset of high nifedipine exposure patients, the odds ratio for gingival enlargement increased to 17.4 (5.3-56.3) for the GO index and 23.6 (7.7-72.3) for the MB index. The concordance between GO and MB indices showed a kappa value of 0.689 in controls and 0.642 in patients treated with nifedipine. CONCLUSIONS: Patients taking nifedipine are at high risk for gingival enlargement, and gingivitis acts as a predisposing factor.     

Nifedipine pharmacological variables as risk factors for gingival overgrowth in organ-transplant patients

The prevalence and severity of gingival overgrowth in organ-transplant patients medicated with cyclosporin are greater in patients concomitantly medicated with nifedipine; however, no relationship between the gingival overgrowth and any of the nifedipine pharmacological variables has been demonstrated. The study examined the effect of five nifedipine pharmacological variables (nifedipine dosage, plasma concentration and gingival crevicular fluid concentration, M1 metabolite plasma concentration and the nifedipine:M1 ratio). The effect of the nifedipine variables on the gingival overgrowth score were examined using univariate and multivariate regression analysis. Adjustment for the effect of other risk factors was made by adding the distribution of each of the nifedipine variables in turn to a stepwise regression model containing previously identified risk factors for this condition. Despite the high levels of nifedipine sequestered in the GCF, only the plasma concentration of nifedipine was identified as a risk factor for the severity of gingival overgrowth in these patients (P = 0.01) once adjusted for other known risk factors (r ² for the model = 55%).     

Clinical and pharmacological variables as a risk factor for nifedipine-induced gingival overgrowth

BACKGROUND: Gingival enlargement is usually noted within one to two months after the initiation of nifedipine therapy. The aetiology of nifedipine-induced gingival overgrowth is uncertain. The aim of this study was to determine the relationship between plasma and gingival crevice fluid (GCF) nifedipine concentrations and the degree of gingival overgrowth in patients treated with nifedipine, and also to assess the correlations between clinical and pharmacological variables. METHODS: Eighteen patients taking nifedipine in regular doses for at least six months participated in the study. Gingival enlargement was evaluated with two indices to score vertical and horizontal overgrowth. Gingival index (GI), plaque index (PI), gingival bleeding time index (GBTI), probing depth (PD) and clinical attachment level (CAL) were also evaluated. GCF and plasma nifedipine concentrations were determined by using high performance liquid chromatography. RESULTS: There was no significant difference between responders and non-responders for PI, GI and GBTI. The mean concentration of nifedipine in GCF was significantly greater than concentration in plasma. No significant difference was observed for GCF and plasma nifedipine concentration between responders and non-responders. CONCLUSIONS: The present study showed that neither GCF nor plasma nifedipine levels appeared to be a risk factor for nifedipine-induced gingival overgrowth. Improving the oral hygiene in patients using nifedipine may help control the degree of drug-induced gingival enlargement.