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Головна Медицина. Медичні науки → Клініко-патогенетичне обгрунтування корекції порушень метаболізму кісткової тканини у хворих на генералізований пародонтит

Рукопись.

Диссертация на соискание ученой степени кандидата медицинских наук по специальности 14.01.22 – стоматология. Национальный медицинский университет им. А.А. Богомольца, Киев, 2001.

Проведенные исследования структурно-функционального состояния костной ткани челюстей и опорного скелета у 142 здоровых и 152 больных генерализованным пародонтитом, не подтвердили взаимообусловленности генерализованного пародонтита и системного остеопороза. По данным изучения кинетических показателей кальций-фосфорного гомеостаза и маркеров костного обмена у отобранных 30 здоровых и 84 больных генерализованным пародонтитом, не имевших системных нарушений метаболизма костной ткани, доказано, что в основе остеопоротических изменений в альвеолярной кости лежит повышенная резорбция, не компенсируемая нормальным костеобразованием. Предложено местное применение остеотропных средств в комплексном лечении генерализованного пародонтита. В качестве конкретной терапевтической схемы апробированы лечебная композиция остеогенного действия, содержащая хиноксидин, иприфлавон, гидроксиапатит, и ультрафонофорез препарата-антирезорбента ксидифона.

Ключевые слова: генерализованный пародонтит, структурно-функциональное состояние костной ткани, костный метаболизм, лечение.


ABSTRACT


Fastovets O.O. Clinical-pathogenetic bases of correction of bone metabolism disorders in patients with generalized parodontitis. - Manuscript.

Thesis for a candidate's degree by speciality 14.01.22 – stomatology.The National Medical University, Kyiv, 2001.

The thesis has been devoted to the question of the disorders of bone metabolism and their correction in patients with generalized parodontitis.

The results of the structural-functional investigation of bone tissue of jaws and skeleton in 142 healthy and 152 patients with the diagnosis of generalized parodontitis of various degrees aged 35-44, who had no diseases which were possible to have considerable influence on bone metabolism, demonstrated local character of dystrophical-destructive process in alveolar bone with parodontitis. The skeleton's status didn't differ in healthy and ill persons: the prevalance of total systemic bone pathology was equal 31,73,9% and 41,44,0% accordingly, the prevalance of systemic osteoporosis, diagnozed us as "middle aged persons' osteoporosis", made up 1,40,5% and 1,90,6% accordingly. The mean indices of ultrasonic osteometry and densitometry of peripheral skeleton also didn't differ (p>0,05). Their decrease in patients with generalised parodontitis of III degree (p<0,05) was accounted by the possibility of total dystrophical disorders to put over inflammatory-destructive changes in parodontium. The correlation between the structural-functional state of bone system and the periodontal status wasn't ascertained. Generalized parodontitis against the background of systemic osteopenia and osteoporosis had no clinical peculiarities. So that proved the absence of conditionality between these pathologies.

Findings of the biochemical studies of the kinetic indices of calcium and phosphoric homoestasis and the markers of bone exchange in elected 30 healthy and 84 patients suffered from generalized parodontitis, who had no systemic disturbances of bone tissue's metabolism, have allowed to insist that in the basis of osteoporotic changes in alveolar bone there was heightened osteoresorption which wasn't compensated by normal bone formation. It has been established that the most significant characteristics of the disorders of bone metabolism with generalized parodontitis were rise of calcium excretion by kidneys and salivary glands, increase of oxiproline excretion in urine, activation of tartratresistant acid phosphatase in serum. In one's turn the concentration of total calcium and inorganic phosphorus in serum and oral fluid didn't change with generalized parodontitis. At the same time use of pilocarpine made the index of calcium concentration in oral fluid more demonstrative concerning studied process. The dynamics of the inorganic phosphorus indices as a whole depended on the calcium metabolism. The levels of total and bonespecific alkaline phosphatases were the same in healthy and ill persons, only in patients with generalized parodontitis of III degree it rose owing to bonespecific isoenzyme.

Revealed changes of the structural-functional status and metabolism of bone tissue in patients with generalized parodontitis have allowed to verify changes in alveolar bone as a local (periarticulate) osteoporosis and shown the necessity to include the local measures of correction of resorption and stimulation of reparative osteogenesis determined us local osteotropic therapy as a new direction in the complex treatment of the disease under conditions of the absence of systemic bone pathology.

The medicinal composition of osteogenic effect contained chinoxidine, ipriflavone, hydroxiapatite in combination with ultraphonephoresis of remedy prevented resorption - xydifone have been suggested and approved as a concrete therapeutic scheme. 63 patients with generalized parodontitis of I-III degrees have been treated. Use of proposed therapy permitted to liquidate inflammation in parodontium in reduced time. In 6 month studies of the most informative biochemical indices in this group in contrast to control demonstrated normalization of metabolic process in alveolar bone tissue testified by reduction of calcium excretion in urine to 15,27,0%, oxyproline excretion in urine to 21,88,1%, speed of calcium excretion in oral fluid to 20,37,9%, activity of tartratresistant acid phosphatase in serum to 42,89,7% and increase of levels of total and bonespecific alkaline phosphatases in serum to 24,48,4% and 31,18,2% (p<0,05). In 12 month in these patients it was diagnosed radiological symptoms of lessening of resorptive activity, disappearance of osteoporosis, clearness of contours of destroyed bone, restoration of usual density and tracery of bone tissue. Besides it was registered increase of speed of ultrasound in mandible corresponded to consolidation of bone structure to 9,15,9%. So according to the data of clinical examination, radiological and ultrasonicosteometric investigation of alveolar bone it has been determined that such a treatment promoted more prolonged clinical-radiological stabilisation of the disease.

Key words: generalized parodontitis, structural-functional state of bone tissue, bone metabolism, therapy.