RU2637413C1 - Method for treatment of oral mucosa chronic inflammation with hyperkeratosis elements in young persons - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention is intended for treatment of oral mucosa chronic inflammation with hyperkeratosis elements (lichen acuminatus of erosive-ulcerous form, flat form of leukokeratosis). Injection of platelet-enriched plasma 0.1-0.5 ml per mm² is performed once a week, as a course of 3 procedures, and of placental drug "Laennek" 0.1-0.2 ml per mm², 1 injection with an interval of 2 days, as a course of 5-10 injections, the injections are carried out under the morphological elements located on the oral mucosa and "Laennec" is additionally injected intravenously, dropwise, in a dose of 4 ml dissolved in 250-500 ml of physiological solution, for the course of 10 procedures with an interval of 2 days.

EFFECT: application of the method provides long-term remission due to a complex effect on the main links of the disease pathogenesis, which is manifested in the reduction of inflammatory response, normalization of local immunity, microbial contamination of the oral fluid and stabilization of free-radical oxidation of the oral fluid.

2 ex

Description

The invention relates to medicine, namely to therapeutic dentistry and laboratory diagnostics, and is intended for the treatment of chronic inflammation of the oral mucosa with elements of hyperkeratosis (lichen planus erosive-ulcerative form, leukoplakia flat form) in young people, which allows to normalize free radical oxidation , microbial contamination and local immunity of the oral fluid.

Chronic inflammatory diseases of the oral mucosa (COP) are currently an urgent and complex problem of dentistry, due to the low knowledge of their etiopathogenesis, asymptomatic course, difficulty in making a diagnosis, due to the similarity of clinical manifestations, low effectiveness in treatment and prevention. One of the most common and often detected chronic inflammatory processes of the mucous membrane with elements of pathological keratinization is the process of hyperkeratotic type - flat leukoplakia with a morphological element stain, and recurrent dermatoses with pronounced morphological elements papules, erosions, ulcers - lichen planus (CPL).

Difficulties in diagnosing the pathology of the oral mucosa are caused by: the diversity and similarity of the clinical picture, dynamic change due to adverse environmental factors, both environmental and general: mucosal injury, microbial contamination, the presence of somatic pathology. Examination of COP is of great diagnostic value in a number of pathological conditions: chronic periodontal tissue diseases, chronic inflammatory diseases of the oral mucosa, infectious diseases, somatic diseases (diseases of the gastrointestinal tract, liver, pancreas). Diseases of the mucous membrane with a pronounced keratinization process tend to further malignancy due to the ability to transform from one form to another.

In diseases of the oral mucosa related to the “white manifestations”, changes in the color and general appearance of the mucosa do not have independent diagnostic value, however, in combination with other symptoms, they can support the clinical diagnosis. Hyperemia, swelling, plaque, hypertrophy or flattening of the papillae of the tongue, hyperkeratotic changes in the mucosa, foamy, thick saliva (oral fluid), bad breath, dry mucosa - all these changes are characteristic of many diseases of the oral mucosa.

A decrease in the immunological resistance of the oral cavity in chronic inflammatory diseases of the oral mucosa with elements of hyperkeratosis (leukoplakia of the flat shape, lichen planus erosive-ulcerative form) is caused by a violation of microbiocenosis with prevalence of yeast-like fungi of the genus Candida, which is accompanied by a breakdown of the adaptive mechanisms of local immunity of the oral fluid, which creates favorable background for exacerbating the manifestations of chronic inflammation of the oral mucosa.

One of the main links in the pathogenesis of chronic inflammatory diseases of the mucous membrane with elements of hyperkeratosis is a violation of free radical oxidation (SRO). An increase in the number of free radicals leads to the disintegration of connective tissue structures, enhances the permeability of the vascular walls, forms active chemotaxis factors [E. Gilmiyarov Dental and somatic status of the body in terms of oral fluid metabolism: abstract. dis. Dr. med. sciences. - Samara, 2002. 44 p.].

Cells with phagocytic activity produce oxygen radicals, which ensure their microbicidal activity. In acute and exacerbation of chronic inflammatory processes, the amount of ROS in biological fluids increases [Ivanyushko TP, Gankovskaya LV, Kovalchuk LV and others. A comprehensive study of the mechanisms of development of chronic inflammation in periodontitis. // Dentistry. - 2000. - No. 4. - S. 13-16]. In the oral cavity, the activity of enzymes that regulate the content of oxygen radicals changes.

An excess of free radicals causes depolymerization of hyaluronic acid and other components of connective tissue, promotes the formation of an active chemotaxis factor and neutrophil migration to the site of inflammation, increases capillary permeability, and lipid peroxidation processes are initiated [Vladimirov, Yu.A. Free radicals in biological systems / Yu.A. Vladimirov // Soros Educational Journal. - 2000. - No. 12. - S. 13-19]. Activation of free radical lipid peroxidation leads to disruption of tissue respiration in mitochondria and hydroxylation processes in microsomes, and the release of lysosomal enzymes. All this, ultimately, supports the inflammatory process and leads to damage to the oral mucosa.

The diagnostic difficulties of the clinical diagnosis and further treatment of chronic inflammatory lesions of the oral mucosa with elements of hyperkeratosis can also be caused by their frequent combination with the presence in the oral cavity of yeast-like fungi of the genus Candida, which aggravate the clinical course of lichen planus, leukoplakia and contribute to the appearance in their clinical a picture of new symptoms. Also, the leading mechanism of the occurrence of chronic inflammation is associated with metabolic disorders in tissues and individual cells.

Therefore, for the treatment of all pathological links of chronic diseases of the mucous membrane with the manifestations of hyperkeratosis, several basic and general therapy drugs are usually prescribed simultaneously (local antiseptics, synthetic antibacterial drugs and antibiotics, steroidal and non-steroidal anti-inflammatory and antihistamines, immunomodulators, antioxidants, hormones, keratoplastics, vitamins ) This usually increases the risk of allergic and adverse reactions, since in the aggregate the pharmacodynamics of all drugs significantly change with their longer circulation in the body and slow elimination.

Thus, an approach to the local and general treatment of chronic inflammation of the oral mucosa with elements of hyperkeratosis should be carried out to correct local immunity, the state of consolidated radical oxidation, and the degree of contamination of the oral fluid with Candida fungi, which, in our opinion, is especially promising for planning effective treatment prophylactic effects on the oral mucosa.

Despite some successes in solving the problem of local and general treatment of chronic inflammatory diseases of the oral mucosa with elements of hyperkeratosis, the search for new means and methods of therapy remains relevant.

A known method of treating inflammatory diseases of the oral mucosa, characterized in that they use a drug in the form of a gel of the following composition, wt. %: fir oil 0.1-0.3, sage oil 0.1-0.2, peppermint oil 0.1-0.3, glycerin 14.0-20.0, sodium alginate 4.0-5.0 , pectin 2.5-4.0, polyvinylpyrrolidone 2.0-3.0, lidocaine hydrochloride 1.7-2.5, dimexide 0.5-1.0, silver ions 0.001-0.004, methylene blue 0.01- 0.02, purified water to 100 [patent RU No. 2482859, 2013].

The closest analogue of the invention is a method of treating patients with a flat form of leukoplakia of the oral mucosa and the red border of the lips, which consists in the use of the Angiovit folate drug complex according to the following scheme: the first month, 1 tablet 3 times a day; the second month, 1 tablet 2 times a day; the third, fourth month, 1 tablet 1 time per day [application RU No. 2011108185, publ. September 10, 2012]. The disadvantage of this method is its inefficiency due to the lack of adequate pathogenetic local and general treatment.

The objective of the invention is to develop an adequate method for the treatment of chronic inflammation in inflammatory diseases of the oral mucosa with elements of hyperkeratosis, which allows to normalize indicators of free radical oxidation, microbial contamination and local immunity of the oral fluid.

The technical result when using the invention is to extend the remission due to the impact on the main links of the pathogenesis of the disease, which is expressed in a decrease in the inflammatory response, normalization of local immunity, microbial contamination of the oral fluid and stabilization of free radical oxidation of the oral fluid.

The proposed method for the treatment of chronic inflammation in inflammatory diseases of the oral mucosa with elements of hyperkeratosis is as follows. A comprehensive dental examination is carried out, the clinical condition of the oral mucosa is determined according to the WHO method, luminescent diagnostics of the lesion of the oral mucosa is carried out, morphological elements and size of the lesion are determined. A microbiological study of microflora is carried out for the presence of a pathogenic fungus of the genus Candida in yeast or mycelial form (smears from the oral cavity, oral fluid), a study of the local immunity of the oral cavity - secretory immunoglobulin A, lysozyme, oxidative stress (free radical oxidation) in the oral fluid. The complex of local effects on the chronic inflammatory process in the oral mucosa with elements of hyperkeratosis includes a plasmolifting procedure, i.e. the introduction of platelet-rich plasma (platelet autoplasm) as a highly effective biological stimulator of regeneration processes containing high growth factors, hormones, proteins and vitamins in a natural combination, which has regenerative, anti-inflammatory, immunotropic and microbicidal effects [R. Akhmerov, Ovechkina M.V., Tsyplakov D.E., Vorobyov A.A., Mansurova G.T. Technology “PlasmoliftingTM” - an injection form of platelet autoplasma for the treatment of chronic periodontitis I-II severity // Periodontology. 2013. No1. P. 45-52.], As well as the human placenta hydrolyzate “Laennec” [Registered in the Russian Federation as a hepatoprotector and immunomodulator, registration certificate No. 013851/01 of 10.24.2008] containing cytokines (interleukins 1 - 6, 8, 10 , 12), erythropoietin, interferon, amino acids (18), aminoglycosides (hyaluronic acid), vitamin B1, B2, B6, C, D, PP), growth factors (in particular, hepatocyte growth factor), which has immunomodulating properties due to the ability stimulate humoral immunity and increase the functional activity of phagocytes and natural ki lerov also increases the bactericidal activity of peripheral blood leukocytes, which is manifested in their ability to destroy the captured pathogen. The cytokines that make up the drug activate the metabolic and supervisory functions of cells, the biologically active substances contained in the hydrolyzate stimulate the regeneration (proliferation) of hepatocytes, exhibit detoxification properties, reduce the deposition of lipids and cholesterol in the liver cells, increase the activity of tissue respiration, and activate metabolism substances.

In case of diagnosed chronic inflammation of the oral mucosa with hyperkeratosis elements - flat leukoplakia and lichen planus erosive-ulcerative local treatment consists of a set of procedures, including injection under morphological elements located on the oral mucosa enriched with platelets of 0.1- 0.5 ml per mm ² - 1 procedure per week, for a course of 3 procedures, as well as for Laennec 0.1-0.2 ml per mm ² - 1 procedure with an interval of 2 days, for a course of 5-10 procedures. The course of local treatment is 4 weeks. In addition, the placental preparation “Laennec” is administered intravenously: 4 ml (224 mg of human placenta hydrolyzate) - 2 ampoules are dissolved in 250-500 ml of physiological saline and injected through the ulnar vein for 1.5-2 hours. Intravenous injections are carried out 3 once a week, a course of treatment of 10 sessions for 2-3 weeks.

After 14-21 days, the patient undergoes a repeated laboratory examination of the oral fluid for the presence of yeast-like fungi of the genus Candida microflora, local immunity and free radical oxidation.

A comprehensive dental examination of 102 young people aged 20 to 30 years living in a region with adverse environmental factors was carried out. Based on the results of a comprehensive clinical examination, the following groups were formed:

1. Patients with lichen planus erosive and ulcerative form - 27 patients;

2. Patients with leukoplakia of a flat form - 75 patients.

The treatment according to the proposed method. Further, the dynamics of the clinical condition of the oral mucosa, laboratory data of microbiological, immunological studies and determination of free radical oxidation of the oral fluid, depending on the group affiliation, are analyzed. The results of local treatment of chronic inflammation in young people with diseases of the mucous membrane with elements of hyperkeratosis - flat lichen of erosive-ulcerative form and flat leukoplakia were evaluated on the basis of dynamics of objective clinical data, data of luminescent diagnostics and monitoring of the state of laboratory research methods.

A significant improvement in the clinical picture was obtained in young people with chronic inflammation of the oral mucosa with hyperkeratosis elements — flat lichen, erosive-ulcerative form — mucous membrane of the cheeks of pale pink color with weakly expressed morphological elements (Wickham mesh), luminescent diagnosis — brown staining of erosion and whitish glow of keratinization sites.

A microbiological study determined the disappearance and a significant decrease in pathogenic flora, yeast-like fungi of the genus Candida towards the norm, stabilization of local immunity of the oral cavity and normalization of free radical oxidation of the oral fluid. The achieved clinical effect lasted for 12 months in 90% of young people.

A significant improvement in the clinical picture was obtained in young people with chronic inflammation of the oral mucosa with elements of hyperkeratosis - leukoplakia of a flat form - the disappearance of hyperemia of the mucous membrane of the cheeks along the closing line of the teeth, the mucous membrane of a pale pink color, the disappearance of keratinization of a grayish-white color, the disappearance of the lesion, luminescent diagnostics bluish-blue glow.

Microbiological examination determined the disappearance and significant reduction of Candida fungi towards the normal level, stabilization of local immunity of the oral cavity, and normalization of free radical oxidation of the oral fluid. The achieved clinical effect lasted for 12 months in 90% of young people.

Thus, the application of the proposed method for local and general treatment of chronic inflammation of the mucous membrane with elements of hyperkeratosis allows to increase the effectiveness of treatment of lichen planus erosive and ulcerative form, leukoplakia of a flat form, to prolong remission, prevent malignancy and dispense with traditional surgical treatment methods.

The proposed method is illustrated by the following clinical examples.

Example 1

Patient M., 22 years old.

Diagnosis: Flat leukoplakia. Candidiasis of the oral cavity.

No complaints.

Objectively: the mucous membrane of the oral cavity is not changed, on the mucous membrane of the cheeks along the closing line of the teeth a hyperkeratotic spot is whitish-gray in color with clear edges, is not removed during scraping, does not protrude above the level of the surrounding areas of the healthy oral mucosa, is taken into a fold, painlessly on palpation , luminescent diagnosis - a bright bluish glow of the affected area. Swelling of the lateral surface, lining of the tongue, the presence of foamy oral fluid in the oral cavity (unstimulated saliva).

The obtained data of complex laboratory research methods before treatment: representatives of opportunistic and pathogenic microflora, facultative and obligate anaerobes, gram microflora and yeast-like fungi of the genus Candida in the amount of 10 ³ 10 ⁴ CFU / ml, and data on the state of free radical oxidation of the oral cavity were microbiologically identified in the oral fluid liquids: maximum flash - 8.4 conventional units, light sum - 47.7 conventional units, SIgA 0.7 ± 0.02 g / l, lysozyme 7.01 ± 0.84 μg / ml, indicating a high activity of free radical oxidation and low activity of local immunity.

The treatment was carried out as follows: local treatment consists of a set of successive injection procedures: plasmolifting - 1 procedure per week, for a course of 3 procedures for 3 weeks, for which plasma enriched with platelets is injected under morphological elements located on the oral mucosa, 0.1 -0.5 ml per mm ² , and injections "Laennec" according to 1 procedure with an interval of 2 days, 0.1-0.2 ml per course of 5 procedures for 3 weeks. Additionally, the placental preparation “Laennec” is administered intravenously: 4 ml (224 mg of human placenta hydrolyzate) - 2 ampoules are dissolved in 250-500 ml of physiological saline and injected through the ulnar vein for 1.5-2 hours. Intravenous injections are carried out 3 times in week, a course of treatment of 10 sessions for 2-3 weeks.

After the treatment, the patient does not complain.

Objectively: the mucous membrane of the oral cavity and cheeks along the closing line of the teeth is pale pink without pathological changes, moderately moistened, shiny, luminescent diagnosis - a bluish-blue glow.

Oral fluid: yeast-like fungi of the genus Candida - 10 ² 10 ³ CFU / ml, CFU / swab. SIgA 0.35 ± 0.03 g / l, lysozyme 6.9 ± 1.35 μg / ml, free radical oxidation state data: maximum flash - 1.76 conventional units, light sum - 22.44 conventional units, indicating an antioxidant the action of this local and general therapy with the normalization of indicators of local immunity of the oral fluid and persistent clinical remission.

The achieved treatment result lasted for 12 months.

Example 2

Patient M., 25 years old.

Diagnosis: Red lichen planus of the mucous membrane of the cheeks along the closing line of the teeth. Candidiasis of the oral cavity. Concomitant diseases: chronic cholecystitis, pancreatitis.

Complaints: pain when taking annoying food, burning sensation, painful rashes of the oral mucosa.

Objectively: on the mucous membrane of the cheeks against a hyperemic background of irregular shape, painful erosion of various sizes, covered with a dense fibrinous coating, against the background of a characteristic papular pattern. Tongue obstruction, the presence of foamy oral fluid in the oral cavity (unstimulated saliva), luminescent diagnosis - a whitish-blue glow of the affected area (Wickham mesh).

Obtained data of complex laboratory research methods before treatment: representatives of opportunistic and pathogenic microflora, facultative and obligate anaerobes, gram-microflora and yeast-like fungi of the genus Candida in the amount of 10 ³ -10 ⁴ CFU / ml, free radical oxidation state data were revealed microbiologically in the oral fluid oral fluid: maximum flash - 8.7 conventional units, light sum - 46.7 conventional units, SIgA 0.7 ± 0.08 g / l, lysozyme 12.5 ± 0.84 μg / ml, indicating a high activity of free oradical oxidation and low activity of local immunity. The treatment was carried out as follows: local treatment consists of a set of successive injection procedures: plasmolifting - 1 procedure per week, for a course of 3 procedures for 3 weeks, for which plasma enriched with platelets is injected under morphological elements located on the oral mucosa, 0.1 -0.5 ml per mm, and Laenec injections for 1 procedure with an interval of 2 days, 0.1-0.2 ml per course of 10 procedures for 3 weeks. Additionally, the placental preparation “Laennec” is administered intravenously: 4 ml (224 mg of human placenta hydrolyzate) - 2 ampoules are dissolved in 250-500 ml of physiological saline and injected through the ulnar vein for 1.5-2 hours. Intravenous injections are carried out 3 times in week, a course of treatment of 10 sessions for 2-3 weeks.

After the treatment, the patient does not complain.

Objectively: the mucous membrane of the cheeks is pale pink with weakly expressed morphological elements (Wickham mesh), luminescent diagnostics - brown staining of erosion and whitish glow of keratinization sites.

Oral fluid: yeast-like fungi of the genus Candida - 10 ² 10 ³ CFU / ml, CFU / swab. SIgA 0.35 ± 0.03 g / l, lysozyme 6.9 ± 1.35 μg / ml, Data on the state of free radical oxidation: maximum flash - 1.76 conventional units, light sum - 22.44 conventional units, which indicated an antioxidant the action of this local and general therapy with the normalization of indicators of local immunity of the oral fluid and persistent clinical remission.

The achieved treatment result lasted for 12 months.

Thus, the proposed method allows to increase the effectiveness of local and general treatment of chronic inflammation of diseases of the mucous membrane with elements of hyperkeratosis in young people, to prolong remission due to the complex effect on all pathogenesis links of these diseases. The advantages of the proposed method for local and general treatment of chronic inflammation of the oral mucosa with elements of hyperkeratosis - lichen planus erosive-ulcer form, leukoplakia flat form in young people is reproducibility with a high degree of significance and reliability of the results.

Claims (1)

A method for the treatment of chronic inflammation in inflammatory diseases of the oral mucosa with elements of hyperkeratosis, characterized in that they administer 0.1-0.5 ml plasma enriched with platelets per mm ² - 1 times a week, with a course of 3 procedures, and a placental preparation Laennec "0.1-0.2 ml per mm ² for 1 injection with an interval of 2 days, a course of 5-10 injections, and the injections are carried out under the morphological elements located on the mucous membrane of the mouth, and, in addition, additionally administered" Laennec "intravenously in doses e 4 ml, which is dissolved in 250-500 ml of physiological saline, for a course of treatment of 10 procedures with an interval of 2 days.