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17TREATMENT OF PATIENTS WITH CHRONIC GENERALIZED PERIODONTITIS ASSOCIATED WITH ORAL LICHEN PLANUS BY MONITORING OF LOCAL IMMUNITY INDICES
Yeliseyeva O.V.,
Kharkiv National Medical University Kharkiv
ABSTRACT
Immune competence of the oral cavity in patients with CGP associated with lichen planus as one of possible objective criteria of treatment quality has been fludied. Successful treatment of patients according to elaborated scheme ("Lizomucoid", "Lysobact", lysozyme-containing films) is accompa-nied by recovery of indices of local non-specific immunity of the oral cavity - activity of lysozyme and beta-lysins, concentration complement C3 fragment as well as normalization of sIgA level as immediately after course and in 3 months after end of treatment.
Keywords: chronicle generalized periodontitis, oral lichen planus, local immunity charac-teriflics, lysozyme containing medicine.
Changes in the oral mucosa, parodontium tissues are in mofl cases clin-ical and sometimes only signs of disorders in functioning of different organs and syflems. At the same time disorders, which appear in the oral cavity, can increase severity of the background disease. One of the mofl important causes, which determine the possibility of conjoint contraction of chronic general-ized periodontitis (CGP) and lichen planus and define their course, is the flate of local mechanisms of defense of the oral cavity [2, 3, 8]. Therefore, eflima-tion 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 suggefled 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 firfl group (20 people) comprised patients with CGP of initial and mild severity without lichen planus. 32 patients with con-joint 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 com-prised patients with intact parodontium (20 people). On the basis of treat-ment 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 adminiflered to group 1, 2a, 3 patients twice a day after toothbrushing with "Lacalut Active" tooth pafle (Germany). Sea buckthorn oil on affected areas of the oral muco-sa was adminiflered to group 3a patients: 8-10 procedures per 1 course. In such a way group 1, 2a and 3a patients underwent flandard treatment. A new therapeutic regimen, which included "Lizomucoid" mouthwash (Production Research Association "Odessa Technology", Ukraine), "Lacalut Active" tooth pafle
Table 1
Change of lysozyme content in the oral cavity of patients with CGP and CGP associated with lichen planus before and after treatment (%)
(Germany) and "Lysobact" antiseptic tablets (Bosnalijek d.d., Bosnia and Herzegowina), was elaborated for group 2b and 3b patients. The thera-peutic regimen of group 3b also included lysozyme-containing films (Produc-tion Research Association "Odessa Technology", Ukraine) applied on affected areas of the oral mucosa and marginal parodontium.
Syflemic treatment of lichen planus (after specialized medical consulta-tion) consifled in prescribing of Delagil, 1 pill twice a day, Xantinol nico-tinate, 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 fludy of lysozyme activ-ity by means of nephelometric method [7] and also assessment of SIgA, C3 components of complement and beta-lysins activity by enzyme linked immu-noassay [6, 9].
In order to carry out Satirical data processing, general Satirical pack-age Statiflica for Windows of Version 6.0 [4] was used.
Results of the research and their consideration. Efficacy of treatment of the patients representing different groups was assessed through fludy 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 firfl 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 lyso-zyme (acetylmuramidase ferment) as a mycolytic ferment of the oral cavity is hard to be overeflimated (lysis of microorganisms, Simulation of phagocyto-sis, regeneration of biological tissues), development of marked pathological processes in the oral cavity in significant decrease of its activity becomes clear.
Groups Before treatment In 14 days afte 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 Satirically admissible (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 treat-ment 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%).
Dynamic of control of beta-lysins activity of bactericide factor, which is mofl active againfl anaerobic and sporogenous aerobic microorganisms (Ta-ble 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 de-crease 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.
Table 2
Dynamic of activity of oral fluid beta-lysins in patients before and after treatment (%)
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*
2a (n=8) 17.55+2.30* 21.45+1.21* 19.30+2.83*
26 (n=8) 17.16+2.12* 32.35+5.05* 27.70+3.48
3a (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 control Satirically admissible (p<0.05)
The mofl important component of complement syflem 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 syflem 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 flandard 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 planus (mg/l)
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*
2a (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
3a (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 Satirically admissible (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 firfl group this index was tended to sharp decrease. After performed treatment according to the elabo-rated 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 flandard treatment (2a and 3a), reliable changes of this index were absent and in patients of the firfl group normalization of SIgA level was observed imme-diately after end of treatment, but in three months it was the same
Table 4
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 control Satirically admissible (р<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 appar-ent in the form of sharp decrease of lysozyme and beta-lysins activity, reduc-tion 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 non-specific immunity of the oral cavity such as lysozyme and beta-lysins activity and concentration of C3 fragments of complement as well as normalization of SI-gA level directly after the course is finished and in 3 months after treatment.
Normalization of indices of local immunity of the oral cavity is accom-panied by absence of symptoms of inflammation of parodontium tissue.
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