The Clinical Analysis of Gingival Hyperplasia in Patients after Renal Transplantation_West China Medical Journal

Authors：

MA Xiaoping ¹ , LIU Yang ¹ , LI Yangbo ¹ ,  XU Yahong ¹ , LIN Tao ²

1. Department of Urology, The 452 Hospital of the People’s Liberation Army, Chengdu, Sichuan 610021, P. R. China; 2. Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

XU Yahong, Email: mxp5612@sina.com

Keywords：

腎移植; 環孢素A; 牙齦增生; 口腔衛生

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【摘要】　目的　探討腎移植術后藥物（環孢素A和鈣離子拮抗劑）、口腔衛生與牙齦增生的關系。　方法　隨訪2003年1月—2010年3月間321例腎移植患者，記錄患者術后藥物使用和口腔衛生情況，觀察牙齦增生程度。結果　〖HTSS〗口腔衛生水平與牙齦增生程度之間存在統計學相關性（rs=0.344，P=0.000），口腔衛生水平越差，牙齦增生越嚴重。服用環孢素A和鈣離子拮抗劑患者（A組）牙齦增生發生率為62.15%，高于單純服用環孢素A患者（B組）23.40%，二者比較，差異有統計學意義（χ2=39.220，P=0.000）。結論　〖HTSS〗腎移植術后環孢素A和鈣離子拮抗劑聯合應用明顯增加了牙齦增生的發病率。口腔衛生水平與牙齦增生程度之間存在重要關聯，口腔衛生差是牙齦增生的危險因素。
【Abstract】　Objective　 To investigate the correlation between drugs (cyclosporine A and calcium channel blocker), oral hygiene and gingival hyperplasia in patients after renal transplantation. 　Methods　 We continuously followed up 321 patients undergoing renal transplantation from January 2003 to July 2009 in our hospital. The levels of oral hygiene, medication and gingival hyperplasia were recorded. 　Results　 There was a close relationship between the level of oral hygiene and the degree of gingival hyperplasia (rs=0.344, P=0.000). Higher grades of gingival hyperplasia (grades Ⅱ and Ⅲ) were found exclusively in patients who did not have good oral hygiene. There was a higher tendency of developing gingival hyperplasia among patients who received cyclosporine A and calcium channel blocker than those who only received cyclosporine A (62.15% vs. 23.40%; χ2=39.220, P=0.000). 　Conclusion　 The prevalence of gingival hyperplasia is higher in renal transplant recipients taking cyclosporine A and calcium channel blockers. There is a significant relationship between the level of oral hygiene and the development of gingival hyperplasia. Poor oral hygiene is a risk factor of gingival hyperplasia.

Citation： MA Xiaoping,LIU Yang,LI Yangbo,XU Yahong,LIN Tao. The Clinical Analysis of Gingival Hyperplasia in Patients after Renal Transplantation. West China Medical Journal, 2011, 26(5): 695-697. doi: Copy

1.
2.	e transplanted patient[J]. Nephron, 1998, 80(3), 257-268.
3.	Butler RT, Kalkwarf KL, Kaldahl WB. Drug-induced gingival hyperplasia: phenytoin, cyclosporine, and nifedipine[J]. J Am Dent Assoc, 1987,114(1): 56-60.
4.	Garzini-Demo P, Carbone M, Carrozzo M, et al. An increase in gingival volume induced by drugs (phenytoin, cyclosporine and calcium antagonists). A review of the literature[J]. Minerva Stomatologica, 1998,47(9): 387-398.
5.	Spratt H, Boomer S, Irwin CR, et al. Cyclosporine associated gingival overgrowth in renal transplant recipients[J]. Oral Diseases, 1999,5(1): 27-31.
6.	Vescovi P, Savi A, Macaluso GM, et al. Gingival hypertrophy due to cyclosporine. A clinico-statistical study in 82 patients[J]. Minerva Stomatologica, 1997, 46(4): 155-164.
7.	O’Leary TJ, Drake RB, Naylord JE. The plaque control record[J]. J Periodontol, 1972, 43(1): 38.
8.	Silness J, Löe H. Periodontal disease in pregnancy. Ⅱ. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand, 1964, 22: 121-135.
9.	Rateitschak-Plüss EM, Hefti A, Lrtscher R, et al. Initial observation that cyclosporine-A induces gingival enlargement in man[J]. J Clin Periodontol, 1983, 10(3): 237-246.
10.	Wong W, Hodge MG, Lewis A, et al. Resolution of cyclosporine induced gingival hypertrophy with metronidazole[J]. Lancet, 1994, 343(8903): 986.
11.	Reali L, Zuliani E,Gabutti L,et al. Poor oral hygiene enhances gingival overgrowth caused by calcineurin inhibitors[J]. J Clin Pharm Ther, 2009, 34(3): 255-260.
12.	First MR, Neylan JF, Rocher LL, et al. Hypertension after renal transplantation[J]. J Am Soc Nephrol, 1994, 4(Suppl 8): s30-s36.
13.	Schwenger V, Zeier M, Ritz E, et al. Hypertension after renal transplantation[J]. Curr Hypertens Rep, 2001, 3(5): 434-439.
14.	Zeier M, Mandelbaum A, Ritz E, et al. Hypertension in th.
15.	Tutone VK, Mark PB, Stewart GA,et al. Hypertension, antihypertensive agents and outcomes following renal transplantation[J]. Clin Transplant, 2005, 19(2): 181-192.
16.	Morton RS, Dongari-Bagtzoglou AI. Regulation of gingival fibroblast interleukin-6 secretion by cyclosporine A[J]. J Periodontol, 1999, 70(12): 1464-1471.
17.	Trackman PC, Kantarci A. Connective tissue metabolism and gingival overgrowth[J]. Crit Rev Oral Biol Med, 2004, 15(3): 165-175.
18.	Bulut S, Ozdemir BH, Alaaddinoglu EE, et al. Effect of cyclosporin A on apoptosis and expression of p53 and bcl-2 proteins in the gingiva of renal transplant patients[J]. J Periodontol, 2005, 76(5): 691-695.
19.	鄭恒, 劉東, 方淑賢,等. 腎移植患者術后牙齦增生與環孢素A濃度的相關性[J]. 中國醫院藥學雜志, 2004, 24(11): 677-678.
20.	Mustapha IZ, Debrey S, Oladubu M, et al. Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis[J]. J Periodontol, 2007, 78(12): 2289-2302.
21.	Harikrishnan P, Harden PN. Tacrolimus can resolve cyclosporine-induced gingival hyperplasia[J]. Nephrol Dial Transplant, 1999, 14(7): 1805-1806.
22.	James JA, Boomer S, Maxwell AP,et al. Reduction in gingival overgrowth associated with conversion from cyclosporin A to tacrolimus[J]. J Clin Periodontol, 2000, 27(2): 144-148.
23.	Margreiter R, European Tacrolimus vs Ciclosporin Microemulsion Renal Transplantation Study Group. Efficacy and safety of tacrolimus compared with cyclosporin microemulsion in renal ransplantation: a randomised multicentre study[J]. Lancet, 2002, 359(9308): 741-746.
24.	Somacarrera ML, Lucas M, Scully C, et al. Effectiveness of periodontal treatments on cyclosporin-induced gingival overgrowth in transplant patients[J]. Br Dent J, 1997, 183(3): 89-94.
25.	Kantarci A, Cebeci I, Tuncer O, et al. Clinical effects of periodontal therapy on the severity of cyclosporin A-induced gingivalhyperplasia[J]. J Periodontol, 1999, 70(6): 587-593.
26.	范連慧,吳雄飛,吳曉倩,等.甲硝唑、阿奇霉素治療腎移植后環孢素致牙齦增生的療效觀察[J]. 重慶醫學,2003,32(3):370-371.

1.
2. e transplanted patient[J]. Nephron, 1998, 80(3), 257-268.
3. 　Butler RT, Kalkwarf KL, Kaldahl WB. Drug-induced gingival hyperplasia: phenytoin, cyclosporine, and nifedipine[J]. J Am Dent Assoc, 1987,114(1): 56-60.
4. 　Garzini-Demo P, Carbone M, Carrozzo M, et al. An increase in gingival volume induced by drugs (phenytoin, cyclosporine and calcium antagonists). A review of the literature[J]. Minerva Stomatologica, 1998,47(9): 387-398.
5. 　Spratt H, Boomer S, Irwin CR, et al. Cyclosporine associated gingival overgrowth in renal transplant recipients[J]. Oral Diseases, 1999,5(1): 27-31.
6. 　Vescovi P, Savi A, Macaluso GM, et al. Gingival hypertrophy due to cyclosporine. A clinico-statistical study in 82 patients[J]. Minerva Stomatologica, 1997, 46(4): 155-164.
7. 　O’Leary TJ, Drake RB, Naylord JE. The plaque control record[J]. J Periodontol, 1972, 43(1): 38.
8. 　Silness J, Löe H. Periodontal disease in pregnancy. Ⅱ. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand, 1964, 22: 121-135.
9. 　Rateitschak-Plüss EM, Hefti A, Lrtscher R, et al. Initial observation that cyclosporine-A induces gingival enlargement in man[J]. J Clin Periodontol, 1983, 10(3): 237-246.
10. 　Wong W, Hodge MG, Lewis A, et al. Resolution of cyclosporine induced gingival hypertrophy with metronidazole[J]. Lancet, 1994, 343(8903): 986.
11. 　Reali L, Zuliani E,Gabutti L,et al. Poor oral hygiene enhances gingival overgrowth caused by calcineurin inhibitors[J]. J Clin Pharm Ther, 2009, 34(3): 255-260.
12. 　First MR, Neylan JF, Rocher LL, et al. Hypertension after renal transplantation[J]. J Am Soc Nephrol, 1994, 4(Suppl 8): s30-s36.
13. 　Schwenger V, Zeier M, Ritz E, et al. Hypertension after renal transplantation[J]. Curr Hypertens Rep, 2001, 3(5): 434-439.
14. 　Zeier M, Mandelbaum A, Ritz E, et al. Hypertension in th.
15. 　Tutone VK, Mark PB, Stewart GA,et al. Hypertension, antihypertensive agents and outcomes following renal transplantation[J]. Clin Transplant, 2005, 19(2): 181-192.
16. 　Morton RS, Dongari-Bagtzoglou AI. Regulation of gingival fibroblast interleukin-6 secretion by cyclosporine A[J]. J Periodontol, 1999, 70(12): 1464-1471.
17. 　Trackman PC, Kantarci A. Connective tissue metabolism and gingival overgrowth[J]. Crit Rev Oral Biol Med, 2004, 15(3): 165-175.
18. 　Bulut S, Ozdemir BH, Alaaddinoglu EE, et al. Effect of cyclosporin A on apoptosis and expression of p53 and bcl-2 proteins in the gingiva of renal transplant patients[J]. J Periodontol, 2005, 76(5): 691-695.
19. 　鄭恒, 劉東, 方淑賢,等. 腎移植患者術后牙齦增生與環孢素A濃度的相關性[J]. 中國醫院藥學雜志, 2004, 24(11): 677-678.
20. 　Mustapha IZ, Debrey S, Oladubu M, et al. Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis[J]. J Periodontol, 2007, 78(12): 2289-2302.
21. 　Harikrishnan P, Harden PN. Tacrolimus can resolve cyclosporine-induced gingival hyperplasia[J]. Nephrol Dial Transplant, 1999, 14(7): 1805-1806.
22. 　James JA, Boomer S, Maxwell AP,et al. Reduction in gingival overgrowth associated with conversion from cyclosporin A to tacrolimus[J]. J Clin Periodontol, 2000, 27(2): 144-148.
23. 　Margreiter R, European Tacrolimus vs Ciclosporin Microemulsion Renal Transplantation Study Group. Efficacy and safety of tacrolimus compared with cyclosporin microemulsion in renal ransplantation: a randomised multicentre study[J]. Lancet, 2002, 359(9308): 741-746.
24. 　Somacarrera ML, Lucas M, Scully C, et al. Effectiveness of periodontal treatments on cyclosporin-induced gingival overgrowth in transplant patients[J]. Br Dent J, 1997, 183(3): 89-94.
25. 　Kantarci A, Cebeci I, Tuncer O, et al. Clinical effects of periodontal therapy on the severity of cyclosporin A-induced gingivalhyperplasia[J]. J Periodontol, 1999, 70(6): 587-593.
26. 　范連慧,吳雄飛,吳曉倩,等.甲硝唑、阿奇霉素治療腎移植后環孢素致牙齦增生的療效觀察[J]. 重慶醫學,2003,32(3):370-371.

West China Medical Journal

The Clinical Analysis of Gingival Hyperplasia in Patients after Renal Transplantation

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