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目的分析服用环孢素A(CsA)的肾移植患者相关临床因素与牙龈增生(GO)程度的关系,初步探讨血清亲环素(CyPA)浓度与CsA诱导的牙龈增生(CUGO)的关系。方法本研究以65例用CsA为主要免疫抑制剂抗排斥患者为研究对象,经牙龈增生指数(GOI)评价后将患者分为牙龈增生组(GO~+)和牙龈无增生组(GO)。比较两组患者年龄、性别、服药时间、服药剂量、血清CsA和CyPA服药浓度、尿素、肌酐、牙龈评价之间的差异,观察血清CyPA浓度与CIGO发生及严重程度的关系。结果 GO(GOI≥30)发生率为21.54%(14/65)。GO~+组和GO~-组间年龄、性别、服药时间、尿素、肌酐、服药剂量和血清CsA浓度差异均无统计学意义。GO~+组血清CyPA浓度低于GO~-组[0.23(0.16～0.30)ng/mL vs 0.34(0.22～0.54)ng/mL,P=0.04)];血清CyPA浓度与GO严重程度呈负相关(r=-0.264,P=0.03),但与CsA服药剂量和其血清浓度无关(r=-0.014,P=0.91;r=0.012,P=0.9 3);牙龈评价结果:GO~+组的菌斑指数和龈乳头出血指数均高于GO~-组(1.41±0.27 vs 1.15±0.34,P=0.01;0.49±0.30 vs 0.25±0.11,P=0.01)。结论 CIGO的发生可能是局部因素与系统因素共同作用的结果;血清CyPA浓度可能是独立于CsA服药剂量和血药浓度之外的CIGO风险因素,对其进行检测有助于临床医师预判GO的发生。
Objective To analyze the relationship between clinical factors and the degree of gingival hyperplasia (GO) in renal allograft recipients with cyclosporine A (CsA) and to investigate the relationship between cyclophilin (CyPA) and CUGO induced by CsA. Methods 65 patients with anti-rejection using CsA as the main immunosuppressive agent were divided into gingival hyperplasia group (GO ~ +) and gingival non-proliferation group (GO) after gingival hyperplasia index (GOI) evaluation. The differences of serum and serum levels of CsA and CyPA, urea, creatinine and gingiva were compared between the two groups in terms of age, sex, time of taking medicine, dosage of serum CsA and CyPA, and the relationship between serum CyPA concentration and the occurrence and severity of CIGO were observed. Results The incidence of GO (GOI≥30) was 21.54% (14/65). There was no significant difference in the age, sex, medication time, urea, creatinine, medication dose and serum CsA concentration between GO ~ + group and GO ~ - group. The level of serum CyPA in GO ~ + group was lower than that in GO ~ - group [0.23 (0.16-0.30) ng / mL vs 0.34 (0.22-0.54) ng / mL, P = 0.04) (r = -0.264, P = 0.03), but not with the dose of CsA and its serum concentration (r = -0.014, P = 0.91; r = 0.012, P = 0.9 3) The plaque index and the papillary hemorrhage index were higher than those in GO ~ - group (1.41 ± 0.27 vs 1.15 ± 0.34, P = 0.01; 0.49 ± 0.30 vs 0.25 ± 0.11, P = 0.01). Conclusions The occurrence of CIGO may be the result of the combination of local factors and systemic factors. Serum concentration of CyPA may be a risk factor of CIGO independent of dose of CsA and plasma concentration, and it is helpful for clinicians to predict GO occur.