干燥综合征口腔疾病的治疗特点

doi:10.19723/j.issn.1671-167X.2023.05.023

摘要/Abstract

摘要：

目的: 深入了解(Sjögren’s syndrome, SS)干燥综合征相关口腔疾病治疗的临床特点, 为临床工作提供指导。方法: 回顾2015年1月至2021年9月于北京大学口腔医学院综合科进行口腔诊疗的部分SS患者, 分析其口腔疾病的诊断和治疗情况。对本研究纳入的SS患者, 进行全面的口腔检查, 包括腮腺区检查、口腔黏膜检查、牙列检查、牙体检查、牙周检查、静态唾液流率、念珠菌感染情况及影像学检查。根据检查结果, 按顺序给予患者氟化物治疗、抗真菌治疗、根管治疗、直接充填修复、间接修复治疗, 并记录治疗情况。结果: 共纳入9例SS患者, 其中4例原发性SS患者(primary SS, pSS), 5例继发性SS患者(secondary SS, sSS), 平均年龄(49.2±16.2)岁, 平均口干病程5年, 静态唾液流率均 < 1 mL/10 min。8例患者唾液念珠菌培养阳性(>200个/mL), 1例患者唾液念珠菌培养阴性。治疗前9例患者平均龋失补牙数(decay, missing, filling teeth, DMFT) (24.8±4.2)个, 平均龋失补牙面数(decay, missing, filling tooth surfaces, DMFS) (59.2±21.9)个, 平均切端龋(2.5±1.3)个, 平均冠修复体(4.5±3.6)个。9例SS患者均局部应用了氟化物治疗, 其中8例念珠菌感染者进行了抗真菌治疗。9例SS患者中6例患者人均3.2个全冠修复体由于继发龋而拆除。修复治疗阶段, 1例SS患者仅充填修复治疗, 1例SS患者进行了全口咬合重建治疗, 其余7例患者均进行直接充填联合固定修复治疗。9例SS患者中3例患者进行了种植义齿修复。结论: SS口腔疾病的治疗需要序列进行, 应先进行全面检查和诊断, 再控制感染, 然后进行口腔功能的恢复。

关键词: 干燥综合征, 口腔疾病, 龋病, 念珠菌

Abstract:

Objective: To understand the clinical characteristics about sequence diagnosis and treatment of oral complications in patients with Sjögren's syndrome (SS) through retrospective analysis, and to provide some guidance for clinical work. Methods: Some SS patients who underwent oral sequence management in the Department of General Dentistry, Peking University School and Hospital of Stomatology from January 2015 to September 2021 were enrolled. For the SS patients included in this study, a comprehensive oral examination was performed, including parotid region examination, oral mucosal exa-mination, dentition examination, dental examination, periodontal examination, unstimulated salivary flow rate, Candida infection and radiological imaging examination. According to the examination results, the patients were given fluoride application, antifungal treatment, root canal therapy, direct filling repair, and indirect repair treatment in sequence and the results recorded. Results: A total of 9 patients with SS, with 4 primary SS patients (pSS) and 5 secondary SS patients (sSS) were enrolled in the study. For all the 9 patients, the average age was (49.2±16.2) years and the median xerostomia duration 5 years. The unstimulated salivary flow rate of the 9 patients was all less than 1 mL/10 min. Eight of the 9 cases was diagnosed as oral Candidiasis, with positive salivary Candida culture result (>200 cfu/mL), and 1 of the 9 cases was not. The average decay, missing, filling teeth (DMFT) was 24.8±4.2; the average decay, missing, filling tooth surfaces (DMFS) was 59.2±21.9, the average incisal caries was 2.5±1.3, and the average number of crown restorations at baseline was 4.5±3.6. All the 9 SS patients were applied with topical fluoride usage, and 8 were prescribed with antifungal treatment. One sSS patient was conducted with filling restoration treatment, one pSS patient was conducted with full mouth rehabilitation, and the remaining 7 patients were conducted with direct filling combined with fixed repair treatment. The average 3.2 full crown restorations in 6 patients had to be removed and restored because of secondary caries, and 3 of the 9 patients underwent implant denture restorations finally. Conclusion: Management of oral complications in SS patients needs to be carried out in sequence. A comprehensive examination and diagnosis should be carried out first, followed by infection control, and then restoration of oral function at last.

Key words: Sjögren's syndrome, Oral complication, Caries, Candida

中图分类号:

R781.6

邢海霞,王琳,乔迪,刘畅,潘洁. 干燥综合征口腔疾病的治疗特点[J]. 北京大学学报（医学版）, 2023, 55(5): 929-933.

Hai-xia XING,Lin WANG,Di QIAO,Chang LIU,Jie PAN. Clinical features of oral management to oral complications of Sjögren's syndrome[J]. Journal of Peking University (Health Sciences), 2023, 55(5): 929-933.

图/表 2

表1

表2

参考文献 20

1	Serrano J , Lopez-Pintor RM , Fernandez-Castro M , et al. Oral lesions in patients with primary Sjögren's syndrome. A case-control cross-sectional study[J]. Med Oral Patol Oral Cir Bucal, 2020, 25 (1): e137- e143.
2	Gonzalez S , Sung H , Sepulveda D , et al. Oral manifestations and their treatment in Sjögren's syndrome[J]. Oral Dis, 2014, 20 (2): 153- 161. doi: 10.1111/odi.12105
3	闫志敏, 魏攀, 强璐, 等. 原发性干燥综合征国际分类标准中口腔诊断项目的临床评价[J]. 北京大学学报(医学版), 2012, 44 (1): 51- 54.
4	王中和. 呼吁建立我国的口干燥症分级标准[J]. 中华口腔医学杂志, 2010, 45 (8): 449- 452. doi: 10.3760/cma.j.issn.1002-0098.2010.08.001
5	Plemons JM , Al-Hashimi I , Marek CL , American Dental Association Council on Scientific A . Managing xerostomia and salivary gland hypofunction: Executive summary of a report from the Ameri-can Dental Association Council on Scientific Affairs[J]. J Am Dent Assoc, 2014, 145 (8): 867- 873. doi: 10.14219/jada.2014.44
6	Serrano J , Lopez-Pintor RM , Ramirez L , et al. Risk factors rela-ted to oral candidiasis in patients with primary Sjögren's syndrome[J]. Med Oral Patol Oral Cir Bucal, 2020, 25 (5): e700- e705.
7	吕晓慧, 王琨, 张凌琳. 白色念珠菌与龋病相关性的研究进展[J]. 中华口腔医学杂志, 2021, 56 (5): 491- 496. doi: 10.3760/cma.j.cn112144-20200609-00324
8	Linossier AG , Martinez B , Valenzuela CY . Quantitative interactions between Candida albicans and the mutans Streptococci in patients with Down syndrome[J]. Med Oral Patol Oral Cir Bucal, 2021, 26 (1): e1- e7.
9	Lyu X , Zhao C , Yan ZM , et al. Efficacy of nystatin for the treatment of oral candidiasis: A systematic review and meta-analysis[J]. Drug Des Devel Ther, 2016, 10, 1161- 1171.
10	Dawes C . Salivary flow patterns and the health of hard and soft oral tissues[J]. J Am Dent Assoc, 2008, 139 (Suppl 5): 18- 24.
11	刘晓丹, 金建秋, 韩莹, 等. 350例口腔黏膜病患者龋患及其增龄改变的病例对照研究[J]. 中华老年口腔医学杂志, 2017, 15 (14): 213- 220.
12	Maarse F , Jager DH , Forouzanfar T , et al. Tooth loss in Sjögren's syndrome patients compared to age and gender matched controls[J]. Med Oral Patol Oral Cir Bucal, 2018, 23 (5): e545- e551.
13	Zero DT , Brennan MT , Daniels TE , et al. Clinical practice guidelines for oral management of Sjögren disease: Dental caries prevention[J]. J Am Dent Assoc, 2016, 147 (4): 295- 305. doi: 10.1016/j.adaj.2015.11.008
14	Fisselier F , Comut AA . Contemporary management and full mouth rehabilitation of a patient with Sjögren syndrome[J]. J Prosthet Dent, 2018, 120 (1): 5- 8. doi: 10.1016/j.prosdent.2017.10.015
15	Mariette X , Criswell LA . Primary Sjögren's syndrome[J]. N Engl J Med, 2018, 378 (10): 931- 939. doi: 10.1056/NEJMcp1702514
16	Goodman SM , Springer B , Guyatt G , et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty[J]. Arthritis Care Res (Hoboken), 2017, 69 (8): 1111- 1124.
17	Chrcanovic BR , Kisch J , Wennerberg A . Dental implants in patients with Sjögren's syndrome: A case series and a systematic review[J]. Int J Oral Maxillofac Surg, 2019, 48 (9): 1250- 1259.
18	Barros AWP , Sales P , Carvalho AAT , et al. Is Sjögren's syndrome a risk factor/contraindication for dental implants? An umbrella review[J]. Spec Care Dentist, 2021, 41 (4): 453- 462.
19	Seo K , Kim HN . Effects of oral health programmes on xerostomia in community-dwelling elderly: A systematic review and meta-analysis[J]. Int J Dent Hyg, 2020, 18 (1): 52- 61.
20	邢海霞, 乔迪. 一例干燥综合征患者的序列口腔健康管理[J]. 中国口腔医学继续教育杂志, 2021, 24 (2): 42- 48.

相关文章 15

[1]	何梓玉, 张辉, 陈智滨, 邢海霞, 潘洁. 1例成年猛性龋患者龈上菌斑中小韦荣球菌的分离及代谢特性[J]. 北京大学学报（医学版）, 2026, 58(1): 50-59.
[2]	刘源, 石桂秀. 干燥综合征到干燥病的命名变迁[J]. 北京大学学报（医学版）, 2025, 57(6): 1015-1017.
[3]	林文灏, 谢阳, 王芳晴, 王淑盈, 刘香君, 胡凡磊, 贾园. 基于B细胞单细胞转录组测序的干燥综合征分子分型[J]. 北京大学学报（医学版）, 2025, 57(6): 1032-1041.
[4]	向钊, 杨莉, 杨静. 非靶向代谢组学揭示原发性干燥综合征血小板减少患者血清差异代谢物及代谢通路[J]. 北京大学学报（医学版）, 2025, 57(6): 1042-1050.
[5]	赵亚云, 倪梦凡, 李雪, 王蓓, 程功, 何菁, 金月波. 利妥昔单抗治疗原发性干燥综合征肾损害的临床疗效和安全性[J]. 北京大学学报（医学版）, 2025, 57(6): 1051-1060.
[6]	朱丽秀, 陈仁利, 周素娟, 林烨, 汤一榕, 叶桢. 水通道蛋白5对干燥综合征大鼠TLR4/MyD88/NF-κB信号的影响[J]. 北京大学学报（医学版）, 2025, 57(5): 875-883.
[7]	宁圆, 张晓盈, 李雪, 李原, 何菁, 金月波. 干燥综合征并发乳腺淋巴瘤1例[J]. 北京大学学报（医学版）, 2025, 57(4): 808-811.
[8]	陈心心, 唐哲, 乔艳春, 荣文笙. 北京市密云区4岁儿童患龋状况及其与龋活跃性检测的相关性[J]. 北京大学学报（医学版）, 2024, 56(5): 833-838.
[9]	杨玉淑, 齐晅, 丁萌, 王炜, 郭惠芳, 高丽霞. 抗唾液腺蛋白1抗体联合抗腮腺分泌蛋白抗体对干燥综合征的诊断价值[J]. 北京大学学报（医学版）, 2024, 56(5): 845-852.
[10]	韩艺钧,李常虹,陈秀英,赵金霞. 抗SSB抗体阳性和阴性的原发性干燥综合征患者临床及免疫学特征的比较[J]. 北京大学学报（医学版）, 2023, 55(6): 1000-1006.
[11]	李建斌,吕梦娜,池强,彭一琳,刘鹏程,吴锐. 干燥综合征患者发生重症新型冠状病毒肺炎的早期预测[J]. 北京大学学报（医学版）, 2023, 55(6): 1007-1012.
[12]	孟彦宏,陈怡帆,周培茹. CENP-B抗体阳性的原发性干燥综合征患者的临床和免疫学特征[J]. 北京大学学报（医学版）, 2023, 55(6): 1088-1096.
[13]	吴洁,张雯,梁舒,秦艺璐,范文强. 妊娠期原发性干燥综合征合并视神经脊髓炎谱系疾病危重症1例[J]. 北京大学学报（医学版）, 2023, 55(6): 1118-1124.
[14]	王丽芳,石连杰,宁武,高乃姝,王宽婷. 干燥综合征合并冷凝集素病1例[J]. 北京大学学报（医学版）, 2023, 55(6): 1130-1134.
[15]	刘杨,程昉,王艳玲,艾香艳,朱振航,赵福涛. 唾液腺超声对干燥综合征的诊断价值[J]. 北京大学学报（医学版）, 2022, 54(6): 1123-1127.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Case No.	Systemic medication	Filling surfaces, n	Remove crowns, n	Root canal treatment, n	Crowns restoration, n	Other restoration	Follow up/ months
1	Nifedipine	10	2	2	4	RPD	12
2	Glucocorticoid	22	1	1	2	Fixed bridge	72
3	Glucocorticoid	39	4	4	4	None	66
4	None	49	0	5	5	RPD	6
5	Glucocorticoid	24	0	3	3	None	24
6	None	18	2	2	3	2 implants	15
7	Hydroxychloroquine	0	8	1	24	Full mouth rehabilitation with 2 implants	12
8	Glucocorticoid	38	0	1	0	None	10
9	Hydroxychloroquine, leflunomide	26	2	6	3	4 implants, 2 fixed bridges	6