心血管疾病背景下广泛性牙周炎患者管理方案的优化

O. V. Kopchak, H. F. Biloklytska, O. V. Asharenkova, K. A. Yanishevskyi
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摘要

许多研究者已经证实了牙周病和躯体病理之间的关系。对348例患者资料的分析显示,49岁以下的患者最常被诊断为各种形式的牙龈炎(36.3 - 51.65%)和全身性牙周炎(GP) I-II度(48.35 - 59.42%)。然而,在50-69岁的患者中,GP是主要疾病,占93.2%,56.03%的患者伴有心血管疾病(CVD)。我们的研究表明,尽管牙周病在心血管疾病患者中非常普遍,但他们并没有系统地去牙医那里接受治疗。我们的研究表明,自身免疫过程在慢性广泛性牙周病的形成和进展中具有重要作用,特别是在伴有心血管疾病的患者中。我们获得的数据表明,决定GP合并CVD的全身性炎症反应形式和局部和全身内皮功能障碍进展的重要自身抗原之一是热休克蛋白。考虑到这一点,基于新的发病机制概念,开发了一种新的区分治疗心血管疾病GP的方法。GP在CVD中的病理治疗是基于疾病的同时治疗(包括再生治疗方法),同时考虑到具有加重过程的病理过程的严重程度。考虑到躯体病理的存在和严重程度,牙医和心脏病专家的跨学科整合将优化管理方案,因此,将提高全科医生在合并症条件下的治疗质量。
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Optimization of protocols of management of patients with generalized periodontitis at the background of cardiovascular disease
Many researchers have proven the relationship between periodontal disease and somatic pathology. Analysis of the data obtained from 348 patients showed that patients under the age of 49 were most often diagnosed with various forms of gingivitis — 36.3–51.65 % and generalized periodontitis (GP) I–II degree — 48.35–59.42 %. However, in patients aged 50–69 years, GP was the predominant disease and accounted for 93.2 %, with 56.03 % of patients having concomitant cardiovascular disease (CVD). Our studies showed that despite the significant prevalence of periodontal disease in patients with CVD, they did not systema-tically visit dentists for treatment. Our studies demonstrated a significant role of autoimmune processes in the formation and progression of chronic generalized periodontal disease in patients with concomitant comorbid conditions, in particular with cardiovascular disease. The data obtained by us demonstrated that one of the important autoantigens that determine the forms of syste-mic inflammatory response and progression of local and systemic endothelial dysfunction in GP with CVD is heat shock proteins. Taking this into consideration, a new differentiated approach to the treatment of GP in CVD was developed based on a new concept of pathogenesis. Pathogenetic therapy of GP in CVD is based on the simultaneous treatment of diseases (including the regenerative method of therapy) taking into account the severity of pathological processes that have an aggravating course. Interdisciplinary integration of dentists and cardiologists will optimize management protocols considering the presence and severity of somatic pathology and, therefore, will improve the quality of GP treatment in conditions of comorbidity.
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