【作者】 陈铁；

【导师】 黄世光；

【作者基本信息】 暨南大学 ， 口腔临床医学， 2005， 硕士

【摘要】 目的:评估尼美舒利对牙周炎的治疗效果,探讨前列腺素与牙周炎发病的关系,为牙周炎治疗联合用药时的药物选择提供理论依据。 方法:动物实验研究部分:Sprague-Dawly大鼠120只,体重约200-250g,随机分成四组(1)正常对照组;(2)牙周炎组(periodontitis,P):用丝线结扎法复制牙周炎模型,并于术后即日起每日灌喂生理盐水;(3)尼美舒利预防组(nimesulide for prevention,NIMP):同上复制模型后,每日灌喂尼美舒利;(4)尼美舒利治疗组(nimesulide for treatment,NIMT):同上复制模型后,术后第5周开始每日灌喂尼美舒利。正常对照组及各实验组分别于4、5和8周末分批处死动物,每时间点每组处死的动物数为10只。在处死动物前测量各时间点的牙龈指数(gingival index,GI),通过石蜡切片和HE染色观察各组动物牙周组织的组织病理学改变,用Tiger细胞图像分析仪测量牙周附着丧失(attachment loss,AL)情况。 临床研究部分:选择136名慢性牙周炎(chronic periodontitis,CP)患者,所有患者均进行牙周基础治疗,然后分别用NIM和甲硝唑治疗2周,比较临床治疗效果。 结果:(1)SD大鼠经丝线结扎4周后成功复制出牙周炎模型。(2)实验性牙周炎组,4周时GI明显高于正常对照组(p<0.01);AL与正常对照组相比明显升高(p<0.01)。组织学观察到牙周组织出现明显的病理改变,并且牙周组织破坏程度随着时间的推移逐渐加重。(3)尼美舒利预防组GI和AL比牙周炎组明显下降(p<0.01),组织学观察到牙周组织的炎症减轻,牙槽骨未见明显吸收。(4)在实验性牙周炎形成后,尼美舒利治疗组自第5周开始给予尼美舒利治疗,5周和8周末时GI和AL明显低于牙周炎组(p<0.01),8周时GI和AL降低尤为明显。(5)在临床治疗中观察到:尼美舒利和甲硝唑均能有效改善牙周炎症程度,但尼美舒利能显著降低探诊深度(p<0.05)。尼美舒利治疗CP的显效率明显高于甲硝唑治疗组(p<0.05)。 结论:(1)预防性给予尼美舒利,可有效阻止实验性牙周炎的发展。(2)在牙周炎发生后,给予尼美舒利治疗,能有效降低牙周组织的炎症程度和破坏程度。(3)与甲硝唑比较,应用尼美舒利治疗慢性牙周炎临床治疗效果更显著。更多还原

【Abstract】 Objective: The pathogenic mechanism of periodontal disease is very complex and is still not well known. Studies have shown that COX-2(cyclooxygenase-2) and prostaglandin play important roles in the pathogenic mechanism of periodontitis, and they may lead to periodontal inflammation and alveolar bone absorption, and the level of prostaglandin in periodontal tissue is directly related to the severity of periodontitis. Recently nimesulide, which is one kind of COX-2 selective inhibitors, is clinically used for the treatment of rheumatoid arthritis and osteoarthritis. However there is no report about using nimesulide for the treatment of periodontitis .The animal experiment and clinical observation was designed in our study to observe the effect of the nimesulide on periodontitis.Methods: Part of one—animal experiment: (1) 120 Sprague-Dawly rats were randomly devided into four groups:(1) control group;(2) periodontitis group(P): periodontitis was induced in rats by placing a piece of 3/0 braided silk around the cervix of the lower incisors, and then the rats were subjected to intraperitoneal injection of normal saline(NS) after operation daily;(3) nimesulide for prevention (NIMP) group: the rats were subjected to intraperitoneal injection of NIM (15mg/kg)daily after the rats receiving the operation of periodontitis model;(4) nimesulide for treatment (NIMT) group: the rats were subjected to intraperitoneal injection of NIM daily after receiving the same operation four weeks later. The gingival index(GI) was measured before the rats were sacrificed at end of 4,5and 8 weeks. For histopathological examination, the mandibular incisors and the periodontal tissues were removed at 4,5 and 8 weeks after the ligature induction of periodontitis. The tissues were fixed in 10% neutral-buffered of formaldhyde for more than 48 hours, decalcified, embedded in paraffin and sectioned. The sections were stained with hematoxylin and eosin. Histological changes were observed by microscope. The periodontal attachment loss(AL) was measured by Tiger cell image analyzer. Part of two—clinical observation: 136 patients with chronic periodontitis(CP) werechosed for the comparative study. Following the scaling and root planning, nimesulide and metronidazole were respectively used in two groups. After 2 weeks of observation, the effect of clinical treatment was assessed. Results:(1) Experimental periodontitis was successfully induced in rats by placing a piece of 3/0 braided silk around the cervix of the lower incisors at week 4.(2) In ligature-induced periodontitis group, at week 4,the GI and AL were higher significantly than those in control group ( p<0.0\ ) .The histopathologic changes of periodontium in periodontitis group showed obviously inflammatory ,and the severity of destruction for periodontium was increased as time passed.(3) In the nimesulide prevention group, the GI and AL were significantly lower than those in periodontitis group (/K0.01 ) .The histopathologic examination showed less inflammatory responses, and no obvious alveolar bone resorption was observed.(4) In the nimesulide treatment group, the GI and AL were significantly lower than those in periodontitis group at the end of week 5 and 8 (/K0.01) especially at week 8.(5) In clinical observation, our results showed that both nimesulide and metronidazole could decreased the severity of periodontal inflammation. However, nimesulide was more effective in reducing the probing depth (PD) than metronidazole group (p<0.05 ) . Nimesulide also showed a higher efficient in treatment for chronic periodontitis than metronidazole.(p<0.05 ) . Conclusions:(1) In ligature-induced periodontitis, nimesulide could effectively inhibit itsprogress.(2) In the developing periodontitis, a significant improvement was observed in GI and AL following the treatment with nimesulide.(3) Nimesulide showed a significant effect on chronic periodontitis thanmetronidazole. A significant improvement was observed in PD following treatment with nimesulide.更多还原