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UDC [616.314.17-008.1:616.516]-08:612.017.1
EFFECTIVENESS EVALUATION OF COMPREHENSIVE TREATMENT OF PATIENTS WITH CHRONIC GENERALIZED
PERIODONTITIS ASSOCIATED WITH ORAL LICHEN PLANUS BY MONITORING OF LOCAL IMMUNITY INDICES
O. V. Yeliseyeva, I. I. Sokolova
Kharkov National Medical University, Ukraine, Kharkov
Relevance. Changes in the oral mucosa, parodontium tissues are in most cases clinical and sometimes only signs of disorders in functioning of different organs and systems. Lichen planus is one of the most wide-spread and manifest as for clinical implications diseases of the oral mucosa.
In this regard the goal of our research is assessment of sIgA in the oral fluid, C3 components of the complement, activity of lysozyme and beta-lysins in patients suffering from CGP and lichen planus before and after treatment, as indices of positive influence of suggested complex therapy on the immunological course of CGP pathogenesis.
Object and methods of the research. 72 patients were examined and divided into 4 groups. The first group (20 people) comprised patients with CGP of initial and mild severity without lichen planus. 32 patients with conjoint course of cGp (initial and mild severity) associated with planus (typical form) were divided into 2 groups (2 and 3). The fourth observational group comprised patients with intact parodontium (20 people).
Results of the research and their consideration. After conservative treatment firm increase of lysozyme activity in the oral fluid of the patients of all observational groups after two weeks of treatment and while control measurement of lysozyme intake in 3 months is noted. However, only in the patients, who were undergoing treatment according to elaborated scheme, indices of lysozyme activity achieved the level of control ones and corresponded to it during the whole period of observation (from 34,86% до 36,38%).
Conclusions. With reference to the foregoing it is possible to draw a conclusion that CGP as well as conjoint course of CGP and lichen planus are accompanied by significant changes of local immunity of the oral cavity which become apparent in the form of sharp decrease of lysozyme and beta-lysins activity, reduction of the amount of C3 components of complement and increase sIgA level in the oral fluid.
Key words: chronicle generalized periodontitis, oral lichen planus, local immunity characteristics, lysozyme containing medicine.
ОЦЕНКА ЭФФЕКТИВНОСТИ КОМПЛЕКСНОГО ЛЕЧЕНИЯ БОЛЬНЫХ С ХРОНИЧЕСКИМ ГЕНЕРАЛИЗОВАННЫМ ПАРОДОНТИТОМ НА ФОНЕ КРАСНОГО ПЛОСКОГО ЛИШАЯ МОНИТОРИРОВАНИЕМ ПОКАЗАТЕЛЕЙ ЛОКАЛЬНОГО ИММУНИТЕТА
О. В. Елисеева, И. И. Соколова
Харьковский национальный медицинский университет, Харьков, Украина
Введение. Изменения слизистой оболочки полости рта и тканей пародонта зачастую являются первыми клиническими, а иногда и единственными признаками нарушений функционирования различных органов и систем. Красный плоский лишай - одно из самых распространенных и манифестных по клиническим проявлениям заболеваний слизистой оболочки полости рта.
В связи с этим целью нашего исследования стало определение в ротовой жидкости Б!дА, С3 компонента комплемента, активности лизоцима и бета-лизинов у больных ХГП и КПЛ до лечения и после его окончания, как показателей позитивного влияния предложенной комплексной терапии на иммунологическое звено патоленеза ХГП.
Объект и методы исследования. Нами было обследовано 72 пациента, которые были разделены на 4 группы. В 1 группу (20 человек) вошли пациенты с ХГП начальной и легкой степенями тяжести без КПЛ. 32 пациента с сочетанным течением ХГП (начальная и легкая степени тяжести) на фоне КПЛ (типичная форма) были разделены на две группы (2 и 3). Контрольную 4-ю группу составили пациенты с интактным пародонтом (20 человек).
Результаты исследования и их обсуждение
После проведенной консервативной терапии отмечается достоверное увеличение активности лизоцима в ротовой жидкости пациентов всех групп, как через две недели от момента начала лечения, так и при контрольном осмотре через 3 месяца. Однако только у пациентов, получивших лечение по разработанной нами схеме, показатели активности лизоцима вернулись к уровню контрольных и остались таковыми во время всего срока наблюдения (от 34,86% до 36,38%).
Выводы. На основании вышеизложенного можно сделать вывод, что ХГП, а также сочетанное течение ХГП и КПЛ сопровождается существенными изменениями показателей местного иммунитета ротовой полости, которые проявляются в резком снижении активности лизоцима и бета-лизинов, снижении количества С3 компонента комплимента и возрастании в ротовой жидкости Б!дА. Данные изменения варьируют в зависимости от степени повреждения пародонта, сопутствующей патологии, микробной обсемененности и отражают процессы местного воспаления и локальных иммунных механизмов.
Ключевые слова: хронический генерализованный пародонтит, красный плоский лишай, показатели местного иммунитета, лизоцимсодержащие средства.
ЛОКАЛДЫ ИММУНИТЕТ К6РСЕТК1ШТЕР1Н МОНИТОРЛАУМЕН ЖАЛПАК КЫЗЫЛ ТЕМ1РЕТК1 ФОНЫНДА СОЗЫЛМАЛЫ ГЕНЕРАЛИЗДЕНГЕН ПАРОДОНТИТПЕН НАУКАСТАРДЫ КЕШЕНД1 ЕМДЕУД1Н
ТИ1МД1Л1Г1Н БАГАЛАУ
О. В. Елисеева, И. И Соколова
Харьков улттьщ медициналык университету Харьков к-, Украина
Юр^пе. Ауыз куысы сiлемейлi кабыгындагы жэне жэне пародонттыц тшдершН eзгерiстерi кебшесе бiрiншi клиникалык, ал кейде эртYрлi агзалардыц жэне жYЙелердiц кызмет етушН бузылыуыныц жалгыз гана белгiлерi болып табылады. Жалпак кызыл темiреткi - ауыз куысы сiлемейлi кабыгы ауруларыныц клиникалык аныктамалары бойынша ец таралган жэне манифесттершщ бiрi.
Осыган байланысты бiздiц зерттеу максаты емдеуден бурын жэне оны аятаган кезде, СГП патоленезшН иммунологиялык звеносына усынылган кешендi терапияныц оцды эсершН кeрсеткiштерi ретiнде э1дА, С3 компонент комплементшН ауыз iшiлiк суйыктыгын, СГП жэне Ж^Т-мен ауыратын наукастарда лизоцимдi жэне бета-лизиннН белсендiлiгiн аныктау болды.
Зерттеу нысаны жэне эдiстерi. Бiз 72 пациенттi тексердiк, ол 4 топка белшдк 1 топка Ж^Т жок СГП бастапкы жэне жецт дэрежедегi (20 адам) кiрдi. 32 пациент Ж^Т фонында (карапайым тYрi) СГП Yйлескен агымымен (бастапкы жэне жецт дэреже) екi топка бел^ (2 жэне 3). 4 ^ бакылау тобын интактiлi пародонтпен ауыратын наукастар курады.
Зерттеу нэтижелерi мен оларды талкылау. Консервативтi терапия етюзгеннен кейiн емдеу басталган сэтiнен бастап ею аптадан кейiн, сол сиякты 3 ай еткеннен кейiн бакылау тексеруi
кезшде барлыкк топтардагы пациенттердН ауыз суйыктыгында лизоцимнН белсендттнН накты артуы белш болды. Бiрак тек кана бiз эдiстеген схема бойынша емдеу алган пациенттерде гана лизоцимнщ белсендiлiгi кeрсеткiштерi бакылау децгейш кайта келдi жэне бакылаудыц барлыкк мерзiмiнде сондай болып калды (34,86% - 36,38%).
Корытындылар. Жогарыда айтылгандар негiзiнде, СГП, сол сиякты СГП Yйлескен агымымен ауыз куысыныц жергiлiктi иммунитетi ^се^ше^нИ бiршама eзгерiстерiмен iлеседi, олар лизоцимнщ жэне бета-лизиндердН белсендiлiгiн кYрт темендетуде, компонента комплименттН С3 саныныц тeмендеуiмен жэне sIgA ауыз суйыктыгыныц кeбеюiмен айк;ындалады. Осы eзгерiстер пародонтаныц закымдануы дэрежесшен, патологияныц, микробты урыктануыныц iлесуiне байланысты eзгередi жэне жергiлiктi кабынулар жэне локалды иммунды; механизмдер процесстерiн б^редк
Heri3ri сездер: созылмалы генерализденген пародонтит, жалпак кызыл темiреткi, жергiлiктi иммунитет юрсетюштер^ курамындализоцим заттар.
Библиографическая ссылка:
Елисеева О. В., Соколова И. И. Оценка эффективности комплексного лечения больных с хроническим генерализованным пародонтитом на фоне красного плоского лишая мониторированием показателей локального иммунитета / / Наука и Здравоохранение. 2015. № 5. С. 19-25.
Yeliseyeva O. V., Sokolova I. I. Effectiveness evaluation of comprehensive treatment of patients with chronic generalized periodontitis associated with oral lichen planus by monitoring of local immunity indices. Nauka i Zdravoohranenie [Science & Healthcare]. 2015, 5, pp. 19-25.
Елисеева О. В., Соколова И. И. Локалды иммунитет ^сеи^ерт мониторлаумен жалпак кызыл тем1ретк1 фонында созылмалы генерализденген пародонтитпен наукастарды кешенд1 емдеудщ ти1мдт1пн багалау / / Гылым жэне Денсаулык сактау. 2015. № 5. Б. 19-25.
Relevance
The periodontological aspects of oral lichen planus (OLP), especially OLP of the oral cavity mucous membrane (OCMM), relate to the number of those poorly explored, although its autoimmune genesis presupposes the involvement of the most important morphofunctional complex of the oral cavity - the paradentium, with a subsequent development of a graver and generalised combined pathology. According to expert data [3, 8, 9], the frequency of the paradentium specific diseases detection in the presence of the oral cavity oral lichen planus varies from 13,0 to 48,0 per cent. One of such diseases is chronic generalised periodontitis (CGP). CGP is an immune destruction microbe-induced periodontal complex with a high probability of a genetic and general somatic predisposition, proceeding with a free-radical mechanisms disorder in tissues, characterised by a progressing course resulting in the resorption of the alveolar process bone stock [1, 7]. Therefore the problem of the creation of medioprophylactic methods of CGP and OLP treatment is still urgent.
Changes in the oral mucosa, parodontium tissues are in most cases clinical and sometimes only signs of disorders in functioning of different organs and systems. At the same time disorders, which appear in the oral cavity, can increase
severity of the background disease. Lichen planus is one of the most wide-spread and manifest as for clinical implications diseases of the oral mucosa [1, 3].
One of the most important causes, which determine the possibility of conjoint contraction of chronic generalized periodontitis (CGP) and lichen planus and define their course, is the state of local mechanisms of defense of the oral cavity [1, 2, 3, 8]. Therefore, estimation of immune competence of the oral cavity in patients with CGP and lichen planus can be one of possible objective criteria of treatment quality.
In this regard the goal of our research is assessment of sIgA in the oral fluid, C3 components of the complement, activity of lysozyme and beta-lysins in patients suffering from CGP and lichen planus before and after treatment, as indices of positive influence of suggested complex therapy on the immunological course of CGP pathogenesis.
Object and methods of the research. 72 patients were examined and divided into 4 groups. The first group (20 people) comprised patients with CGP of initial and mild severity without lichen planus. 32 patients with conjoint course of CGP (initial and mild severity) associated with planus (typical form) were divided
into 2 groups (2 and 3). The second group (16 people) was represented by patients with CGP and lichen planus without involvement of the oral mucosa; the third group (16 people) was represented by patients with involvement of the oral mucosa. The fourth observational group comprised patients with intact parodontium (20 people). On the basis of treatment methods groups 2 and 3 were divided into subgroups 2a, 2b, 3a 3b (8 patients in each one).
The mouth rinse Perio-Aid 0.12% (Dentaid, Spain) was administered to group 1, 2a, 3 patients twice a day after toothbrushing with "Lacalut Active" tooth paste (Germany). Sea buckthorn oil on affected areas of the oral mucosa was administered to group 3a patients: 810 procedures per 1 course. In such a way group 1, 2a and 3a patients underwent standard treatment. A new therapeutic regimen, which included "Lizomucoid" mouthwash (Production Research Association "Odessa Technology", Ukraine), "Lacalut Active" tooth paste (Germany) and "Lysobact" antiseptic tablets (Bosnalijek d.d., Bosnia and Herzegowina), was elaborated for group 2b and 3b patients. The therapeutic regimen of group 3b also included lysozyme-containing films (Production Research Association "Odessa Technology", Ukraine) applied on affected areas of the oral mucosa and marginal parodontium.
Systemic treatment of lichen planus (after specialized medical consultation) consisted in prescribing of Delagil, 1 pill twice a day, Xantinol nicotinate, 1 pill three times a day and vitamin E in capsules, 1 capsule once a day, to the patients of the second and third groups.
Immunology research of the oral fluid included study of lysozyme activity by means of nephelo-metric method [7] and also assessment of sIgA, C3 components of complement and beta-lysins activity by enzyme linked immunoassay [6, 9, 10].
Informed consent for participation in the study from those examined as well as permission from the Kharkov National Medical University Committee on Medical Ethics and Bioethics were obtained.
For statistical data processing, the Statistica version 6.0 for Windows data processing universal program package was used. The MannWhitney U test was used as a distribution-free method. The trustworthiness of the results received was estimated with the help of the Wilcoxon signed-rank test [4].
Results of the research and their consideration. Efficacy of treatment of the patients representing different groups was assessed through study of indices of local immunity of the oral cavity, of both non-specific (lysozyme, beta-lysins, C3 components of conplement) and specific (sIgA) types of immunity.
As Table 1 shows, in patients of all groups with CGP of initial and mild severity associated with lichen planus of typical form (the second and third groups) as well as without lichen planus (the first group) sharp decrease of lysozyme activity in the oral fluid (activity of lysozyme varies depending on degree of CGP and co-morbidity from 12,51% to 24,88%, in case of activity rate of lysozyme in health people of control group - 38,77%) is marked, and in patients of the second and third groups with CGP associated with lichen planus this index is on average decreased by 2,8 times. As the role of lysozyme (acetylmuramidase ferment) as a mycolytic ferment of the oral cavity is hard to be overestimated (lysis of microorganisms, stimulation of phagocytosis, regeneration of biological tissues), development of marked pathological processes in the oral cavity in significant decrease of its activity becomes clear.
Table 1.
Change of lysozyme content in the oral cavity of patients with CGP and CGP associated with lichen planus before and after treatment (%).
Groups Before treatment In 14 days after treatment In 3 months after treatment
1 (n=20) 24,88±4,41* 27,01±3,20* 27,97±9,72*
2a (n=8) 12,51 ±2,80* 23,53±3,40* 22,80±13,40*
26 (n=8) 15,94±3,19* 34,86±8,89 35,35±5,72
3a (n=8) 15,41 ±2,06* 23,41±6,13* 25,34±2,85*
36 (n=8) 13,42±5,80* 36,22±7,80 36,38±5,15
4 (n=20) 38,77±4,23 - -
index value in comparison with control differences in group were significant at p<0.05
*
After conservative treatment firm increase of lysozyme activity in the oral fluid of the patients of all observational groups after two weeks of treatment and while control measurement of lysozyme intake in 3 months is noted. However, only in the patients, who were undergoing treatment according to elaborated scheme, indices of lysozyme activity achieved the level of control ones and corresponded to it during the whole period of observation (from 34,86% go 36,38%).
Table 2.
Dynamic of control of beta-lysins activity of bactericide factor, which is most active against anaerobic and sporogenous aerobic microorganisms (Table 2), during the whole period of observation has shown that in all patients with CGP and CGP associated with lichen planus of typical form, firm decrease of activity of this bactericide factor of the saliva in comparison with control before treatment and normalization of beta-lysins activity after use of different treatment schemes is identified.
Groups Before treatment In 14 days after treatment In 3 months after treatment
1 (n=20) 39,07±2,20* 25,83±2,91 38,89±2,88*
2а (n=8) 17,55±2,30* 21,45±1,21* 19,30±2,83*
26 (n=8) 17,6±2,12* 32,35±5,05* 27,70±3,48
3а (n=8) 15,47±2,49* 20,95±1,12* 20,01 ±1,75*
36 (n=8) 14,29±1,88* 27,41 ±4,83 22,95±4,22*
4 (n=20) 28,43±3,84 - -
index value in comparison with con
rol differences in group were significant at p<0.05.
The most important component of complement system is C3 fragment, the breakdown of which into C3a and C3b is considered to be a midpoint of each several cascades of activation of complement system which end with formation of membranes of attack complex and lysis of pathogenic bacteria of the oral cavity. Consequently, in all patients with CGP and CGP associated with lichen planus the level of this fragment of complement is reduced in comparison with control by 1,5-2 times (Table 3). The therapeutic regimen, which has been
elaborated and applies by us, regulates this index in patients of groups 2b (923,3 mg/l) and 3b (1002,5 mg/l) in two weeks after beginning of therapy and remains on the level of control data during 3 months of observation (993,5 mg/l and 972,4 mg/l, respectively). When standard schemes of treatment of the patients with CGP (groups 1, 2a and 3a) are used, positive dynamics is also apparent. However, firm normalization of concentration of C3 fragments in the oral fluid is not achieved.
Table 3.
Change of concentration of C3 component in patients with CGP and CGP associated with lichen
Groups Before treatment In 14 days after treatment In 3 months after treatment
1 (n=20) 637,8±39,22* 846,9±82,77* 861,9±80,99*
2а (n=8) 460,8±55,51* 696,2±80,86* 634,8±135,43*
26 (n=8) 483,1 ±66,73* 923,3±151,90 993,5±37,72
3а (n=8) 480,9±55,64* 721,9±85,81 * 609,3±117,24*
36 (n=8) 478,3±34,93* 1002,5±54,80 972,4±141,45
4 (n=20) 984,3±102,90 - -
index value in comparison with control differences in group were significant at p<0.05.
In all patients with CGP associated with lichen planus in the oral fluid, increase of concentration of sIgA (Table 4) by 2 times (in comparison with the norm) has been detected, and in patients of the first group this index was tended to sharp decrease. After performed treatment according to
the elaborated scheme normalization of sIgA level in the oral fluid of the patient of groups 2b and 3b during the whole period of observation was accomplished.
In patients with CGP associated with lichen planus, who underwent standard treatment (2a and
*
*
3a), reliable changes of this index were absent and in patients of the first group normalization of sIgA
Table 4.
level was observed immediately after end of treatment, but in three months it was the same.
Content of sIgA in oral fluid in patients (g/l).
Groups Before treatment In 14 days after treatment In 3 months after treatment
1 (n=20) 0,13±0,05* 0,31 ±0,05 0,17±0,03*
2а (n=8) 0,54±0,03* 0,45±0,05* 0,49±0,12*
26 (n=8) 0,60±0,08* 0,39±0,04 0,35±0,04
3а (n=8) 0,60±0,07* 0,52±0,07* 0,48±0,06*
36 (n=8) 0,57±0,09* 0,36±0,03 0,37±0,06
4 (n=20) 0,29±0,05 - -
* - index value in comparison with conl trol differences in group were significant at p<0.05.
Conclusions
With reference to the foregoing it is possible to draw a conclusion that CGP as well as conjoint course of CGP and lichen planus are accompanied by significant changes of local immunity of the oral cavity which become apparent in the form of sharp decrease of lysozyme and beta-lysins activity, reduction of the amount of C3 components of complement and increase sIgA level in the oral fluid.
Efficiency of our method of treatment of patients with CGP associated with lichen planus is proved through recovery of indices of local nonspecific immunity of the oral cavity such as lysozyme and beta-lysins activity and concentration of C3 fragments of complement as well as normalization of sIgA level directly after the course is finished and in 3 months after treatment.
Normalization of indices of local immunity of the oral cavity is accompanied by absence of symptoms of inflammation of parodontium tissue.
Литература:
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10. Sugerman P. B., Savage N. W. Oral lichen planus: causes, diagnosis and management // Australian dental journal. 2002. Vol. 47, N 4. P. 290-297.
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Контактная информация:
Елисеева Ольга Владимировна - к.м.н., ассистент кафедры стоматологии Харьковского государственного медицинского университета, г. Харьков, Украина.
Почтовый адрес: 61058, Украина, г. Харьков, ул. Культуры, д. 18, кв 19. E-mail: [email protected] Телефон: +38 (050) 444 59 47.
