治療抵抗性歯周炎患者のアジスロマイシン投与における臨床的・細菌学的評価  [in Japanese] Clinical and Bacterial Evaluation of Azithromycin Administration for Treatment-resistant Periodontitis  [in Japanese]

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Author(s)

    • 佐藤 哲夫 SATO Tetsuo
    • 松本歯科大学大学院歯学独立研究科健康増進口腔科学講座 Department of Oral Health Promotion, Graduate School of Oral Medicine, Matsumoto Dental University
    • 王 宝禮 WANG Pao-Li
    • 大阪歯科大学歯科医学教育開発室 Department of Innovation in Dental Education, Osaka Dental University
    • 吉成 伸夫 YOSHINARI Nobuo
    • 松本歯科大学大学院歯学独立研究科健康増進口腔科学講座:松本歯科大学歯科保存学第一講座 Department of Oral Health Promotion, Graduate School of Oral Medicine, Matsumoto Dental University:Department of Periodontology, Matsumoto Dental University
    • 平岡 行博 HIRAOKA Yukihiro
    • 松本歯科大学大学院歯学独立研究科硬組織制御再建学講座 Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University
    • 荒 敏昭 ARA Toshiaki
    • 松本歯科大学大学院歯学独立研究科硬組織制御再建学講座:松本歯科大学歯科薬理学講座 Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University:Department of Pharmacology, Matsumoto Dental University
    • 三木 学 MIKI Manabu
    • 松本歯科大学歯科保存学第一講座 Department of Periodontology, Matsumoto Dental University
    • 岩井 由紀子 IWAI Yukiko
    • 松本歯科大学大学院歯学独立研究科健康増進口腔科学講座:松本歯科大学歯科保存学第一講座 Department of Oral Health Promotion, Graduate School of Oral Medicine, Matsumoto Dental University:Department of Periodontology, Matsumoto Dental University

Abstract

目的:通常の歯周病治療を施行しても病状が進行する治療抵抗性歯周炎が,わずかであるが存在する.このような歯周炎には,スケーリング・ルートプレーニング(SRP)と抗菌療法との併用が,治療法の一つとして選択されてきたが,細菌検査法の確立・普及が不十分なこと,原因細菌が不明であるなどの理由から,根拠は乏しいのが現状である.本研究では,治療抵抗性歯周炎に対する抗菌療法の有効性を検証するために,臨床パラメーター,細菌数の変化を検討した.材料と方法:被験者は全身的に健康で,初診より6カ月以内に歯周病治療・抗菌薬服用の既往がなく,16歯以上の現在歯がある者とした.病態は,ブロービング深さ(PD)4mm以上の部位が20%以上,歯槽骨吸収率30%以上の中等度以上の歯周炎患者であった.初診時に歯周組織検査(PD,プロービングによる出血:BOP,歯肉炎指数:GI,歯の動揺度),および細菌検査の試料として唾液を採取した.細菌検査では,総細菌数Porphyromonas gingivalis菌数,Aggregatibacter actinomycetemcomitans菌数をreal-time PCR法にて測定した.歯周基本治療を7〜10日間隔で施行し,SRP終了後4週に再評価検査と唾液採取を施行した.PD 4mm以上の残存部位に対して再SRPを施行,再SRP後4週に再評価検査,唾液採取を施行した.この時点で,BOP部位率が初診時の30%以上残存している被験者を,治療抵抗性歯周炎被験者(アジスロマイシン投与群)として抗菌薬投与へ移行した.一方,BOP部位率が30%未満の被験者を治癒群とした.結果:31名の被験者のうち,5名がアジスロマイシン投与群となった.再SRP後4週までのPD, GI, BOPは,治癒群がアジスロマイシン投与群より良好な改善を示した.アジスロマイシン投与後は,BOPにおいて,アジスロマイシン投与群が治癒群より良好な改善を示した.さらに,アジスロマイシン投与群では,再SRP後4週以後でも総細菌数に対するP. gingivalis菌数の割合の減少が確認された.結論:以上の結果から,SRPに加えてアジスロマイシンを投与することは,治療抵抗性歯周炎の治療に対して有効である可能性が示唆された.

Purpose: Despite routine periodontal therapy, treatment-resistant periodontitis might still progress to the advanced stage. Systemic antimicrobial administration has been chosen as one of the treatments for such periodontitis, however, there is little evidence to explain the establishment and spread of infection in such cases because the causative bacteria cannot be identified on bacteriological examination. Therefore, we studied the efficacy of systemic azithromycin administration for patients with treatment-resistant periodontitis. We analyzed the patients from their first visit throughout the duration of the study period, and evaluated the changes of clinical parameters and microbiology to provide indicators of therapeutic effects following therapy. Subjects and Methods: The subjects enrolled in this study were systemically healthy with at least 16 natural teeth and had had no periodontal or antibiotic therapy in the last 6 months. The patients had moderate to severe periodontitis, with 20% or more sites with ≥4 mm probing depth (PD ≥4 mm) or more and ≥30% sites of alveolar bone loss. Clinical measurements (PD, bleeding on probing (BOP), gingival index (GI), and tooth mobility) and whole saliva samples for bacteriology were collected at the beginning of the study. The total number of bacteria and the number of Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans in the mouth were calculated using real-time polymerase chain reaction (PCR). All the subjects underwent initial preparation including scaling and root planing (SRP) at intervals of 7-10 days, and re-examination and saliva extraction were repeated 4 weeks after SRP. Subsequently, SRP was repeated for residual sites with PD ≥4 mm and re-examination and saliva extraction were repeated 4 weeks after this procedure. Subjects with ≥30% residual sites with BOP were enrolled into the treatment-resistant periodontitis group (azithromycin group), while subjects with <30% residual BOP sites were enrolled into the healing group. Results: Five of 31 subjects were enrolled into the azithromycin group. The values of PD, GI, and BOP revealed improvement after SRP in both groups; however, the improvement in the healing group was better than that in the azithromycin group. Following azithromycin administration, the BOP values revealed improvement, and the healing was better in the azithromycin group than in the healing group. Furthermore, the ratio of P. gingivalis number compared to total bacteria number was reduced even after re-SRP in the azithromycin group. Conclusion: Our results suggest that azithromycin administration could be a favorable treatment option for patients with treatment-resistant periodontitis.

Journal

  • The Japanese Journal of Conservative Dentistry

    The Japanese Journal of Conservative Dentistry 56(3), 239-251, 2013

    The Japanese Society of Conservative Dentistry

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