青少年结缔组织发育不良的表型征象

V. R. Shashmurina, O. L. Mishutina, M. Postnikov, A. Shashmurina, E. V. Dmitrieva, R. V. Parfenov
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It is important to improve the methodology of preventive examinations in relation to the early detection of phenotypic signs of CTD, including in the maxillofacial region. Substantiation of the connection of CTD with dental diseases will make it possible to develop examination and medical examination schemes, increase the effectiveness of comprehensive prevention of dental diseases and rehabilitation of adolescents with combined pathology.The aim is to study the incidence of CTD in adolescents and its relationship with dental diseases in order to develop a scheme of examinations and medical examinations, increase the effectiveness of comprehensive prevention of dental diseases and rehabilitation of adolescents with combined pathology.Materials and methods. A survey of 140 male adolescents aged 15–18 years, students of schools in Smolensk was conducted. When examining the somatic status, generally accepted markers of CTD were taken into account: bone (asthenic type of constitution, scoliotic deformity of the spine, hallux valgus, chest deformities), skin (increased skin extensibility of more than 3 cm), articular (hypermobility of joints) and visceral (changes from the cardiovascular system — prolapses of the heart valves, abnormally located chords; changes from the respiratory organs — polycystic lung disease, trachiobronchial dyskinesia; changes from the urinary system — nephroptosis, kidney doubling; changes from the gastrointestinal tract — visceroptosis, gallbladder anomaly; changes from the blood system — thrombocytopathy, hemoglobinopathy). When examining the dental status, the following generally accepted markers of CTD were taken into account: malocclusion (prognathia, deep bite, their combination), narrowing of the dentition, anomalies of the position of individual teeth, anomalies of soft tissue attachment, gum recession, chronic gingivitis. The diagnosis of CTD and the health group was established by a pediatrician on the basis of clinical recommendations and the order of the Ministry of Health of the Russian Federation № 621 dated 30.12.2003 «On a comprehensive assessment of the health status of children». Factor analysis was used to form a set of signs combining signs of CTD and dental diseases.Results. Of the phenotypic signs of СTD, bone and joint changes were diagnosed in 79,3 % (95 % CI 72,6– 86) of adolescents. In second place in frequency 35 % (95 % CI 27,1–42,9) were signs of СTD of the cardiovascular system and the organ of vision (myopia). 40 % (95 % CI 31,9–48,1) of the examined adolescents were diagnosed with chronic gingivitis, gum recession. Deep bite and prognathia were more common than other malocclusions: in 40,7 % (95 % CI 32,6–48,9) and 17,1 % (95 % CI 10,9–23,4), respectively. The use of factor analysis allowed us to identify four most informative factors (the fi rst of them is the most signifi cant) to characterize the relationship between the signs of CTD and its dental manifestations.Conclusion. The incidence of CTD in males in the age group of 15–18 years is 43 %. The most informative prognostic factor was the relationship of tracheobronchial dyskinesia with prognathia, deep bite, narrowing of the jaws, generalized gingivitis. 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引用次数: 0

摘要

介绍。结缔组织发育不良(СTD)是一组由遗传性或先天性胶原合成缺陷引起的多态病理状况,并伴有肌肉骨骼系统和内部器官功能的破坏,这被认为是儿童颌面区域病理发展的一个因素:牙周病的营养不良形式;形状、大小、出牙异常;颞下颌关节病理学。目前尚难以确定CTD与个体牙病的发病关系,这对确定儿童病程的预后和选择康复方法具有重要意义。重要的是要改进预防性检查的方法,以早期发现CTD的表型体征,包括在颌面区域。证实CTD与牙病的联系,将有助于制定检查和医学检查方案,提高综合预防牙病和综合病理青少年康复的有效性。目的是研究青少年CTD的发病率及其与牙病的关系,以制定检查和医学检查方案,提高综合预防牙病和综合病理青少年康复的效果。材料和方法。对斯摩棱斯克市学校的140名15-18岁男性青少年学生进行了调查。在检查躯体状态时,考虑到普遍接受的CTD标志物:骨骼(体质衰弱型,脊柱侧凸畸形,拇外翻,胸部畸形),皮肤(皮肤伸缩度增加超过3厘米),关节(关节活动过度)和内脏(心血管系统的变化-心脏瓣膜脱垂,异常定位的弦;来自呼吸器官的变化——多囊性肺疾病、气管支气管运动障碍;来自泌尿系统的变化——肾下垂,肾加倍;从胃肠道变化——内脏下垂、胆囊异常;从血液系统的变化-血小板病,血红蛋白病)。在检查牙齿状态时,考虑了以下普遍接受的CTD标记:错颌(前突、深咬及其组合)、牙列狭窄、单个牙齿位置异常、软组织附着异常、牙龈退缩、慢性牙龈炎。儿科医生根据临床建议和俄罗斯联邦卫生部2003年12月30日第621号“关于全面评估儿童健康状况”的命令确定了CTD的诊断和健康小组。采用因子分析方法,将CTD的体征与牙病相结合,形成一套体征。在СTD的表型体征中,79.3% (95% CI 72,6 - 86)的青少年被诊断为骨骼和关节改变。其次是35% (95% CI 27,1 - 42,9)的心血管系统和视觉器官(近视)СTD的迹象。40% (95% CI 31,9 - 48,1)的受访青少年被诊断为慢性牙龈炎、牙龈萎缩。深咬合和前颌畸形比其他错颌畸形更常见:分别占40.7% (95% CI 32,6 - 48,9)和17.1% (95% CI 10,9 - 23,4)。因子分析的使用使我们能够确定四个最具信息量的因素(其中第一个是最重要的)来表征CTD的体征与其牙齿表现之间的关系。15-18岁男性CTD发病率为43%。最重要的预后因素是气管支气管运动障碍与前颚畸形、深咬、下颌狭窄、全身性牙龈炎的关系。心血管系统СTD和骨关节变化的征象与牙龈萎缩、慢性牙龈炎、牙龈炎和深咬的相互关系也被揭示。
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Phenotypic signs of connective tissue dysplasia in adolescents
Introduction. Connective tissue dysplasia (СTD) is a group of polymorphic pathological conditions caused by hereditary or congenital defects in collagen synthesis and accompanied by a violation of the functions of the musculoskeletal system and internal organs, which is considered as a factor in the development of pathology of the maxillofacial region in children: dystrophic forms of periodontal diseases; anomalies of shape, size, teething; pathology of the temporomandibularthe mandibular joint. There are diffi culties in determining the pathogenetic relationship between CTD and individual nosological forms of dental diseases, which is important for determining the prognosis of their course and the choice of methods of rehabilitation of children. It is important to improve the methodology of preventive examinations in relation to the early detection of phenotypic signs of CTD, including in the maxillofacial region. Substantiation of the connection of CTD with dental diseases will make it possible to develop examination and medical examination schemes, increase the effectiveness of comprehensive prevention of dental diseases and rehabilitation of adolescents with combined pathology.The aim is to study the incidence of CTD in adolescents and its relationship with dental diseases in order to develop a scheme of examinations and medical examinations, increase the effectiveness of comprehensive prevention of dental diseases and rehabilitation of adolescents with combined pathology.Materials and methods. A survey of 140 male adolescents aged 15–18 years, students of schools in Smolensk was conducted. When examining the somatic status, generally accepted markers of CTD were taken into account: bone (asthenic type of constitution, scoliotic deformity of the spine, hallux valgus, chest deformities), skin (increased skin extensibility of more than 3 cm), articular (hypermobility of joints) and visceral (changes from the cardiovascular system — prolapses of the heart valves, abnormally located chords; changes from the respiratory organs — polycystic lung disease, trachiobronchial dyskinesia; changes from the urinary system — nephroptosis, kidney doubling; changes from the gastrointestinal tract — visceroptosis, gallbladder anomaly; changes from the blood system — thrombocytopathy, hemoglobinopathy). When examining the dental status, the following generally accepted markers of CTD were taken into account: malocclusion (prognathia, deep bite, their combination), narrowing of the dentition, anomalies of the position of individual teeth, anomalies of soft tissue attachment, gum recession, chronic gingivitis. The diagnosis of CTD and the health group was established by a pediatrician on the basis of clinical recommendations and the order of the Ministry of Health of the Russian Federation № 621 dated 30.12.2003 «On a comprehensive assessment of the health status of children». Factor analysis was used to form a set of signs combining signs of CTD and dental diseases.Results. Of the phenotypic signs of СTD, bone and joint changes were diagnosed in 79,3 % (95 % CI 72,6– 86) of adolescents. In second place in frequency 35 % (95 % CI 27,1–42,9) were signs of СTD of the cardiovascular system and the organ of vision (myopia). 40 % (95 % CI 31,9–48,1) of the examined adolescents were diagnosed with chronic gingivitis, gum recession. Deep bite and prognathia were more common than other malocclusions: in 40,7 % (95 % CI 32,6–48,9) and 17,1 % (95 % CI 10,9–23,4), respectively. The use of factor analysis allowed us to identify four most informative factors (the fi rst of them is the most signifi cant) to characterize the relationship between the signs of CTD and its dental manifestations.Conclusion. The incidence of CTD in males in the age group of 15–18 years is 43 %. The most informative prognostic factor was the relationship of tracheobronchial dyskinesia with prognathia, deep bite, narrowing of the jaws, generalized gingivitis. The interrelation of signs of СTD of the cardiovascular system and bone-joint changes with gum recession, chronic gingivitis, prognathia and deep bite was also revealed.
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