環孢素A導致牙齦增生患者治療前后齦溝液TH1/TH2/TH17細胞因子變化研究

柳惠榮

[摘要] 目的 研究環孢素A導致牙齦增生（CIGH）患者治療前后齦溝液（GCF）TH1/TH2/TH17細胞因子濃度變化及其意義。 方法 選取2014年7月～2019年11月就診于我院口腔科門診的21例CIGH患者，同期19名健康志愿者作為對照。記錄健康志愿組及CIGH組治療前后牙齦增生指數，收集齦溝液，采用流式微球技術（CBA）應用流式細胞儀測定健康志愿組及CIGH組辛伐他汀凝膠治療3個月前后齦溝液TH1/TH2/TH17細胞因子濃度。 結果 辛伐他汀凝膠治療總有效率為76.2%。治療前CIGH組齦溝液中IL-6和TNF-α濃度與健康志愿組比較，差異有統計學意義（P<0.05），而IL-2、IL-4、IL-10、IL-17A和 IFN-γ 5種細胞因子濃度與健康志愿組比較，差異無統計學意義（P>0.05）。7種細胞因子濃度在CIGH患者1級增生組與2級增生組比較，差異無統計學意義（P>0.05）。辛伐他汀凝膠治療前，有效組和無效組齦溝液中IL-6和TNF-α濃度與健康志愿組比較，差異有統計學意義（P<0.05），而IL-2、IL-4、IL-10、IL-17A和IFN-γ 5種細胞因子濃度與健康志愿組比較，差異無統計學意義（P>0.05）;有效組與無效組齦溝液中7種細胞因子濃度比較，差異無統計學意義（P>0.05）。有效組齦溝液中IL-6和TNF-α濃度治療前后比較，差異有統計學意義（P<0.05），與健康志愿組比較，差異無統計學意義（P>0.05）;無效組齦溝液中IL-6和TNF-α濃度治療前后比較，差異無統計學意義（P>0.05），治療后與健康志愿組比較，差異有統計學意義（P<0.05）;IL-2、IL-4、IL-10、IL-17A和IFN-γ 5種細胞因子濃度兩組治療前后比較，差異無統計學意義（P>0.05）。 結論 齦溝液中IL-6和TNF-α增高是促進CIGH發生的部分原因，局部給予辛伐他汀治療可以降低齦溝液IL-6和TNF-α濃度，改善患者牙齦增生狀況。

[關鍵詞] 牙齦增生;環孢素A;TH1/TH2/TH17細胞因子;流式微球技術;齦溝液

[中圖分類號] R781.42;R780.2? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-9701（2020）27-0005-05

[Abstract] Objective To study the changes and significance of TH1/TH2/TH17 cytokine concentration in gingival crevicular fluid （GCF） of patients with cyclosporin A-induced gingival hyperplasia（CIGH） before and after treatment. Methods A total of twenty-one patients with CIGH who were treated in the outpatient of the department of stomatology in our hospital from July 2014 to November 2019 were selected. Nineteen healthy volunteers were selected as the control in the same period. The gingival hyperplasia index of healthy volunteers and CIGH group before and after treatment was recorded. The gingival crevicular fluid was collected. The cytometric bead array（CBA） was used to measure 3 simvastatin gel treatments of healthy volunteer group and CIGH group using flow cytometry The concentration of TH1/TH2/TH17 cytokines in gingival crevicular fluid around month. Flow cytometric bead array（CBA） was used to measure the TH1/TH2/TH17 cytokine concentration in gingival crevicular fluid before and after 3 months of simvastatin gel treatment in healthy volunteer group and CIGH group. Results The total effective rate of simvastatin gel treatment was 76.2%. The concentration of IL-6 and TNF-α in the gingival crevicular fluid of the CIGH group before the treatment were significantly differentces from those of the healthy volunteer group（P<0.05）. While there were no statistically significant differences in the concentration of IL-2， IL-4， IL-10， IL-17A and IFN-γ between the CIGH group and the healthy volunteer group（P>0.05）. There was no significant difference in the concentration of 7 cytokines between grade 1 hyperplasia group and grade 2 hyperplasia group in CIGH patients（P>0.05）. Before simvastatin gel treatment， the concentration of IL-6 and TNF-α in the gingival crevicular fluid of the effective group and the ineffective group were statistically differentces from those of the healthy volunteer group（P<0.05）， while IL-2 and IL-4， IL-10， IL-17A and IFN-γ concentrations were not statistically differentces from those of the healthy volunteer group（P>0.05）. The difference was not statistically significant in 7 cytokine concentrations in gingival crevicular fluid between the effective group and the ineffective group（P>0.05）. After treatment， the differences in the concentration of IL-6 and TNF-α in gingival crevicular fluid of the effective group before and after treatment were statistically significant（P<0.05）. And the difference was not statistically significant compared with the healthy volunteer group（P>0.05）. The IL-6 and TNF-α concentrations in the gingival crevicular fluid of the non-effective group had no statistically significant differences before and after treatment（P>0.05）. There was a statistically significant difference after treatment of the non-effective group compared with the healthy volunteer group（P<0.05）. IL-2， IL-4， IL-10， IL-17A and IFN-γ concentrations of 5 cytokines before and after treatment had no significant differences between the two groups（P>0.05）. Conclusion The increase of IL-6 and TNF-α in gingival crevicular fluid is part of the reason for promoting the occurrence of CIGH. Local administration of simvastatin can reduce the concentration of IL-6 and TNF-α in gingival crevicular fluid and improve the gingival hyperplasia of patients.

[Key words] Gingival hyperplasia; Cyclosporin A; TH1/TH2/TH17 cytokines; Cytometric bead array; Gingival crevicular fluid

藥物性牙齦增生是指服用某些藥物為主要因素而誘發的牙齦體積增大，出現乳頭狀和牙齦緣增厚病變形成小葉，牙齦堅韌，呈分葉狀覆蓋牙面。在組織學特征方面主要為上皮細胞和固有層成纖維細胞增多、細胞外基質和膠原纖維成分增多，并伴有不同程度的炎癥浸潤[1]。環孢素A是臨……