影响糖尿病患者口腔颌面部多间隙感染治疗结果的因素分析

目的:分析影响口腔颌面部多间隙感染患者治疗结果 (住院天数和并发症)的转归因素,并比较糖尿病患者与非糖尿病患者口腔颌面部多间隙感染的临床特征。方法:对2007—2010年间收治的117例口腔颌面部多间隙感染病例进行回顾分析。研究变量包括一般资料、病因学、临床指标(症状发作到入院治疗的时间、受累间隙的种类和数量)和实验室检查(细菌学、入院时血糖水平、入院时血白细胞总数和中性粒细胞百分比),结果变量为患者住院天数和并发症。采用SAS8.0软件包对数据进行t检验、卡方检验、方差分析、Logistic回归和线性回归分析。结果:糖尿病口腔颌面部多间隙感染患者与非糖尿病患者相比,前者受累的间隙更多,住院时间更长,全身各种并发症情况更多见,严重者可导致死亡。糖尿病存在与否与口腔颌面部多间隙感染的治疗转归(住院时日和并发症)直接相关。入院时血糖水平是影响口腔颌面部多间隙感染并发症严重程度的主要因素。结论:糖尿病患者与非糖尿病患者口腔颌面部多间隙感染的临床特征和转归不同,为临床上治疗糖尿病口腔颌面部多间隙感染提供了重要的参考依据。     

糖尿病患者口腔颌面部多间隙感染的临床特征分析

目的:通过与非糖尿病患者的比较,分析口腔颌面部多间隙感染的糖尿病患者的临床特征.方法:对上海第九人民医院口腔颌面外科收治的191例诊断为口腔颌面部多间隙感染的病例进行回顾分析.根据有无罹患糖尿病分为糖尿病组和非糖尿病组.研究内容包括一般资料、病因学、临床指标(症状发作到入院治疗的时间、受累间隙的数量和分布)、实验室检查(细菌学、入院血糖水平、入院血白细胞总数和中性粒细胞百分比)和治疗结果(切口数量、住院天数和并发症).采用SAS8.0软件包对数据进行t检验、x2检验和方差分析.结果:2组患者中,牙源性感染是最常见的病因,最容易受累的间隙是下颌下间隙.糖尿病组分离出的最常见的细菌是肺炎克雷伯菌,而非糖尿病组是链球菌.与非糖尿病相比,口腔颌面部多间隙感染的糖尿病患者受累的间隙更多,切开引流的切口数量更多,住院时间更长,全身各种并发症更多见,严重者可导致死亡.结论:通过与非糖尿病患者比较,本研究揭示了口腔颌面部多间隙感染中的糖尿病患者的临床特征,为临床上治疗糖尿病口腔颌面部多间隙感染提供了重要的参考依据.     

口腔颌面部间隙感染疗效的影响因素分析

目的：探讨口腔颌面部间隙感染疗效的影响因素。方法：选取2009年7月～2015年7月110例口腔颌面部间隙感染病例为研究对象,运用抗生素等规范治疗,观察口腔颌面部间隙感染疗效的影响因素。结果：口腔颌面部间隙感染疗效的影响因素也是独立危险因素有病因、合并症、白细胞计数（≥20×109／L）、住院天数（≥14 d）、累及间隙数量（＞2个）、细菌培养、联合应用抗生素等（P＜0．05）;与患者性别、年龄、民族无关（P＞0．05）。结论：影响口腔颌面部间隙感染疗效的因素与疾病本身和医护无菌操作等有紧密关系。     

伴与不伴糖尿病的口腔颌面部多间隙感染的临床诊治研究

目的对比分析伴糖尿病及不伴糖尿病的口腔颌面多间隙感染患者的临床特征及治疗结果。方法对2014年1月至2017年10月收治的104例口腔颌面部多间隙感染患者进行回顾性分析,按是否伴糖尿病,划分为伴糖尿病组(n=38)、无糖尿病组(n=66)。对比两组临床特征及治疗结果。结果与无糖尿病组对比,伴糖尿病组年龄更高,受累间隙数量更多,入院时血糖水平、中性粒细胞计数更高,肺炎克雷伯菌检出率更高,切开引流切口数量更多,住院时间更长,并发症发生率更高,上述差异有统计学意义(P<0.05)。两组病因均以牙源性感染为主,累及间隙无明显差异(P>0.05)。结论伴糖尿病的口腔颌面部多间隙感染患者病情更严重,表现为感染间隙更多,并发症更多,切开引流的切口更多,住院时间更长。     

影响口腔颌面部多间隙感染老年患者治疗结果的因素分析

目的：分析影响口腔颌面部多间隙感染老年患者的治疗结果的转归因素。方法：对上海第九人民医院口腔颌面外科收治的242例诊断为口腔颌面部多间隙感染的病例进行回顾性分析,根据年龄分为老年组和中青年组。研究内容包括一般资料,临床指标（全身系统性疾病、病因、症状发作到人院治疗的时间、受累间隙的数量和分布）,实验室检查（细菌学、入院血糖水平、入院血白细胞总数和中性粒细胞百分比）和治疗结果（切口数量、住院天数和并发症）。对数据进行多元线性回归、logistic回归、t检验和x2检验分析。结果：在老年患者中,切口数量和并发症与受累间隙的数量有关。而在中青年患者中,切口数量和住院天数与受累间隙的数量有关,并发症与入院血糖浓度和人院白细胞总数。结论：分析阐明了影响口腔颌面部多间隙感染老年患者治疗转归的因素。其中,受累间隙的数量是一个重要的影响因素。     

糖尿病患者颌面部间隙感染的临床特点与治疗

目的:探讨糖尿病患者并发颌面部间隙感染的临床特点和治疗方法。方法:比较糖尿病(67例)与非糖尿病(70例)患者颌面部间隙感染的严重程度、疗程长短和治疗措施。结果:糖尿病患者颌面部间隙感染的疗程明显延长;易累及多个间隙;应用同等抗生素,疗效不及非糖尿病患者。结论:糖尿病并发颌面部间隙感染好发于中老年人,临床症状严重,感染反复,病程迁延。治疗应同时控制感染和血糖,积极处理病灶及全身支持治疗。     

口腔颌面部多间隙感染老年患者与中青年患者的临床比较

目的:通过与中青年患者的比较,分析口腔颌面部多间隙感染老年患者的临床特征。方法:对上海第九人民医院口腔颌面外科收治的242例诊断为口腔颌面部多间隙感染的病例进行回顾性分析。所有病例根据年龄分为老年组和中青年组。研究内容包括一般资料、临床指标(全身系统性疾病、病因、症状发作到入院治疗的时间、受累间隙的数量和分布)、实验室检查(细菌学、入院时血糖水平、入院时白细胞总数和中性粒细胞百分比)和治疗结果(切口数量、住院天数和并发症)。采用SAS 8.0软件包对数据进行t检验、Fisher’s确切概率和χ2检验分析。结果:与中青年患者相比,老年患者患有更多的系统性疾病(P=0.0002),住院时程更长(P=0.02),全身各种并发症情况更多见(P=0.04)。结论:通过与中青年患者比较,揭示了口腔颌面部多间隙感染中的老年患者的临床特征,为临床上治疗老年口腔颌面部多间隙感染提供了重要的参考依据。     

糖尿病患者并发重症口腔颌面部多间隙感染的综合处理

糖尿病患者长期高血糖状态,导致系列生化代谢紊乱及抗体免疫功能低下,从而易并发颌面部感染,有资料表明：普通患者重症口腔颌面部多间隙感染死亡率可达61．5％。糖尿病患者一旦并发重症口腔颌面部多间隙感染,极易诱发酮症,将使感染进一步恶化,并导致死亡率大大上升。我院近年来诊治糖尿病患者并发重症口腔颌面部多间隙感染8例,取得较好疗效,现报道如下。     

口腔颌面部间隙感染患者预后不良的影响因素分析

目的 ：探讨口腔颌面部间隙感染患者不良结局的发生情况及相关影响因素,为其治疗和预防提供参考。方法 ：选择长沙市第四医院2011年1月—2020年6月收治的口腔颌面部间隙感染的患者为研究对象。通过医院信息管理系统（hospital information system,HIS）收集患者的临床资料,采用描述流行病学分析方法进行分析,采用单因素分析和多因素Logistic线性回归方法对口腔颌面部间隙感染患者不良结局的相关影响因素进行分析。结果：共收集到249例口腔颌面部间隙感染患者的临床资料,其中32例出现不良结局,发生率为12.85%,其中发生相关严重并发症27例、放弃治疗3例、死亡2例。多因素Logistic回归分析结果显示,年龄越大（OR=0.563）、感染至就诊时间越长（OR=1.324）、累及间隙越多（OR=0.441）、呼吸困难（OR=1.715）、合并糖尿病（OR=2.261）、中性粒细胞计数>0.9×109/L(OR=1.505)、C-反应蛋白≥10 mg/mL(OR=2.231)是口腔颌面部间隙感染患者发生不良结局的危险因素。结论：口腔颌面部间隙感染患者不良结局的发生...     

144例颌面部间隙感染患者的流行病学分析

目的：探讨口腔颌面部间隙感染患者的流行病学特点。方法：回顾分析144例口腔颌面部间隙感染患者的病历资料。结果：144例口腔颌面间隙感染患者男女比为1．18∶1;60岁以上人群（34．02％）为好发人群;牙源性感染为首要致病原因（65．97％）;单间隙感染70例（48．61％）,多间隙感染74例（51．39％）,下颌下间隙在单间隙感染患者和多间隙感染患者受累间隙所占比率分别为31．43％和30．81％。合并危及生命的并发症以气道梗阻最为常见（16．67％）。结论：口腔颌面部间隙感染患者以牙源性引起的间隙感染最为常见,应及早有针对性（特别是危及生命的并发症）进行相应处理。     

D二聚体和纤维蛋白原在口腔颌面部间隙感染中的表达及意义

目的：分析血浆D二聚体（DD）和纤维蛋白原（FIB）在口腔颌面部间隙感染患者中的表达水平和诊断效能。方法：选择浙江大学医学院附属第二医院2019年1月—2019年9月住院治疗的口腔颌面部间隙感染（oral and maxillofacial space infection, OMSI）患者72例为病例组,同期选取无炎症的腮腺良性肿物患者77例为对照组,检测所有患者治疗前血浆DD、FIB、C-反应蛋白（CRP）和白细胞计数（WBC）,分析DD、FIB与临床特征的关系。采用SPSS 20.0软件包对数据进行统计学分析。结果：OMSI患者血浆DD和FIB较非间隙感染患者显著增高（P<0.01）;血浆DD和FIB升高与OMSI患者的住院时间显著延长（t=4.104,P=0.002;t=2.825,P=0.006）和术后需要ICU监护有显著相关性（t=2.305,P=0.024;t=5.675,P=0.000）。Logistic回归分析显示,两者升高均是导致OMSI患者住院时间显著延长（P=0.006,P=0.015）和ICU监护的危险因素（P=0.002,P=0.000）;血浆DD和FIB可以联合CRP和WBC作为OMSI的诊断指标（DD：AUC=0.929;FIB：AUC=0.999）。结论：血浆DD和FIB可联合CRP和WBC高效准确地诊断OMSI,高水平DD和FIB是OMSI患者住院时间延长和术后需要ICU监护的重要参考指标。     

The clinical features of severe multi-space infections of the head and neck in patients with diabetes mellitus compared to non-diabetic patients

We have recorded the clinical features of diabetic patients with multispace infections of the head and neck and compared them with those of non-diabetic patients. We retrospectively studied 191 patients who were treated for severe multispace infections of the head and neck, and compared the patients’ background, the aetiology of the infection, clinical variables, laboratory values (microbiology, and blood glucose concentration, white cell count (WCC), and percentage of neutrophils on admission) and treatment (the number of incisions, complications and duration of hospital stay). Statistical analyses of the differences between groups were made with Student's t test, the chi square test, and analysis of variance, as appropriate. Diabetic patients had more spaces involved concurrently (P = 0.02), required more incisions for drainage (P = 0.002), had longer hospital stays (P < 0.0001), and developed more complications (P = 0.02). Two diabetic patients died. We conclude that diabetic patients are more likely to develop complications and the complications are more likely to be severe than those in non-diabetic patients.     

Salivary IgA and periodontal treatment needs in diabetic patients

Salivary IgA can serve as a first line of defense against pathogens that colonize and invade mucosal surfaces and may be protective against periodontal disease. The aim of this study was to assess salivary immunoglobulin A levels in diabetic and non-diabetic patients with different periodontal treatment needs. The Periodontal Screening & Recording (PSR) system was used to evaluate the periodontal treatment needs of 41 diabetic and 42 non-diabetic patients. Unstimulated whole saliva was collected from each patient immediately before clinical examination and stored at -20 °C until analysis. Salivary immunoglobulin A (s-IgA) levels were determined using an enzyme-linked immunosorbent assay, and values were expressed as optical density. Diabetic and non-diabetic patients were compared using clinical and laboratory data. PSR data indicated that periodontal disease was more frequent and more severe in diabetic patients. A higher prevalence of codes 3 and 4 was observed in diabetics as compared with non-diabetics (odds ratio = 2, P < 0.05). Furthermore, non-diabetic patients had more healthy sextants (code 0) than did diabetic patients. Over half of diabetic patients (～54%) presented with s-IgA levels that were lower than the normal range (optical density from 0.4 nm to 0.6 nm; P < 0.05). In addition, diabetic patients showed a higher variability in s-IgA levels as compared with non-diabetic patients. In conclusion, diabetic individuals had lower s-IgA levels, more-frequent and more-severe periodontal disease, and a greater need for periodontal treatment as compared with non-diabetic patients.     

Periodontal disease in pregnancy complicated by type 1 diabetes mellitus.

BACKGROUND: Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non-diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women. METHODS: Thirty-three (13 diabetic and 20 non-diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non-diabetics was 28.5 +/- 7.1 (SD) and 27.0 +/- 7.3 years, respectively. The following parameters were assessed at Ramfjord's reference teeth: plaque index (PI), gingival inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL). RESULTS: Diabetic subjects had significantly (P<0.001) higher PI (1.48 +/- 0.69) and GI (1.77 +/- 0.44) scores than non-diabetics (PI = 0.63 +/- 0.38; GI = 0.93 +/- 0.48). Mean PD for diabetics (2.95 +/- 0.69 mm) was significantly different (P<0.024) from that of non-diabetics (2.44 +/- 0.32 mm). Although mean GM location was coronal to the cemento-enamel junction (CEJ) in both groups, gingival margins were at a more apical position (P<0.001) in the diabetics (-0.20 +/- 1.24 mm) compared to non-diabetics (-1.76 +/- 0.53 mm). Mean CAL values also varied significantly (P<0.001) between diabetics (2.60 +/- 1.54 mm) and non-diabetics (0.68 +/- 0.65 mm). Significant differences were seen for GI (P<0.001), PD (P=0.005), GM location (P<0.001), and CAL (P<0.001) when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI (P=0.001). CONCLUSIONS: The results of this study demonstrate that periodontal inflammation and destruction are increased in pregnant diabetics as compared to non-diabetic pregnant patients. These findings may have implications for diabetic control and, hence, maternal and fetal outcomes in pregnant diabetic patients.     

口腔颌面部间隙感染诊疗专家共识

口腔颌面部间隙感染（oral and maxillofacial space infections,OMSI）是颌面部潜在筋膜间隙的感染,是口腔颌面部的常见疾病。OMSI病例具有耐药菌感染增多、重症感染增多、致死风险增加等特点。为提高OMSI的治愈率,其治疗原则与方法需与时俱进。因此,依据国内部分专家当前诊治OMSI的...     

Secretor status, candidal carriage and candidal infection in patients with diabetes mellitus

One hundred and nine patients with diabetes mellitus and 100 age-, sex- and denture-status-matched, non-diabetic individuals were investigated prospectively. Comparison was made of oral candidal carriage, clinical infection and inherited ability to secrete blood group antigens in saliva. Diabetic patients had a significantly higher prevalence of oral candidal carriage and infection (P less than 0.001) than non-diabetic individuals, but the candidal load between the 2 groups, was not significant. A comparable proportion of insulin-dependent, non-insulin dependent and control groups were secretors of blood group antigens, and there was no difference in the oral candidal carriage and infection rates between secretors and non-secretors.     

Secretor status, candidal carriage and candidal infection in patients with diabetes mellitus

One hundred and nine patients with diabetes mellitus and 100 age-, sex- and denture-status-matched, non-diabetic individuals were investigated prospectively. Comparison was made of oral candidal carriage, clinical infection and inherited ability to secrete blood group antigens in saliva. Diabetic patients had a significantly higher prevalence of oral candidal carriage and infection (P < 0.001) than non-diabetic individuals, but the candidal load between the 2 groups, was not significant. A comparable proportion of insulin-dependent, non-insulin dependent and control groups were secretors of blood group antigens, and there was no difference in the oral candidal carriage and infection rates between secretors and non-secretors.