标题：PRF联合GTR治疗牙周牙髓联合病变的临床价值

      作者：陈颖 1，岳二丽 2，李蓓蕾 1，王云燕 1    郑州大学第一附属医院牙体牙髓科 1、牙周科 2，河南 郑州 450000

      卷次： 2024年35卷6期

      【摘要】 目的 观察富血小板纤维蛋白(PRF)联合引导组织再生术(GTR)治疗牙周牙髓联合病变的疗效，并探讨其对患者牙周状况、炎症因子和组织再生指标的影响。方法 将2020年9月至2022年9月郑州大学第一附属医院收治的190例牙周牙髓联合病变患者按电脑随机数表法分为GTR组和联合组，每组95例。两组患者均予以常规治疗，在此基础上，GTR组予以GTR治疗，联合组予以PRF+GTR治疗。治疗2个月后评估两组患者临床疗效，比较两组患者治疗前、治疗1个月后和治疗2个月后的龈沟液炎症因子[白细胞介素-1 (IL-1)、白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)]、组织再生指标[骨形态发生蛋白-2 (BMP-2)、转化生长因子-β1 (TGF-β1)、血管内皮生长因子(VEGF)]水平，比较两组治疗前、治疗6个月后和治疗12个月后的患牙探诊深度(PD)、附着丧失水平(AL)、牙龈退缩松动度(GR)、出血指数(BI)、牙槽骨密度、牙周袋深度，同时比较两组患者的不良反应发生情况。结果 联合组患者的治疗总有效率为95.79%，明显高于GTR组的86.32%，差异有统计学意义(P<0.05)；治疗1个月和2个月后，联合组患者的 IL-1、IL-6和TNF-α水平明显低于GTR组，差异均有统计学意义(P<0.05)；治疗1个月和2个月后，联合组患者的BMP-2、TGF-β1和VEGF水平明显高于GTR组，差异均有统计学意义(P<0.05)；治疗6个月和12个月后，联合组患者的AL、PD、BI和牙周袋深度明显低于GTR组，而GR和牙槽骨密度明显高于GTR组，差异均有统计学意义(P<0.05)；术后门诊随访3个月，两组患者均未见其他不良反应。结论 PRF联合GTR治疗牙周牙髓联合病变可减轻炎症反应，改善牙周状况，提高牙槽骨密度，降低牙周袋深度，促进牙髓组织再生，其疗效确切且安全性较高。
      【关键词】 牙周牙髓联合病变；富血小板纤维蛋白；引导组织再生术；炎症因子；疗效；牙周状况；牙髓组织
      【中图分类号】 R781.3 【文献标识码】 A 【文章编号】 1003—6350（2024）06—0834—05

Clinical value of PRF combined with GTR in the treatment of combined periodontal-endodontic lesions.
CHENYing 1, YUE Er-li 2, LI Bei-lei 1, WANG Yun-yan 1. Dental and Dental Pulp Department 1, Periodontal Department 2, the FirstAffiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, CHINA
【Abstract】 Objective To observe the efficacy of platelet-rich fibrin (PRF) combined with guided tissue regen-eration (GTR) in the treatment of combined periodontal-endodontic lesions, and to explore the effects of PRF on peri-odontal status, inflammatory factors, and tissue regeneration indexes. Methods A total of 190 patients with combinedperiodontal-endodontic lesions admitted to the First Affiliated Hospital of Zhengzhou University from September 2020to September 2022 were divided into GTR group and combined group according to random number table method, with95 cases in each group. Based on conventional treatment, the GTR group was given GTR treatment, and the combinedgroup was given PRF+GTR treatment. The clinical efficacy of the two groups was evaluated after 2 months of treatment.Gingival crevicular fluid inflammatory factors [interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α)], tissue regeneration indexes [bone morphogenetic protein-2 (BMP-2), transforming growth factor-β1 (TGF-β1),and vascular endothelium growth factor (VEGF)] levels were compared between the two groups before treatment, 1month after treatment, and 2 months after treatment. The depth of probing (PD), the level of attachment loss (AL), gingi-val recession and looseness (GR), bleeding index (BI), alveolar bone density, and periodontal pocket depth were com-pared between the two groups before treatment, 6 months after treatment and 12 months after treatment. The occurrenceof adverse reactions was also compared. Results The total effective rate of combined group was 95.79%, which wassignificantly higher than 86.32% of GTR group (P<0.05). After 1 and 2 months of treatment, the levels of IL-1, IL-6,and TNF-α in combined group were significantly lower than those in GTR group (P<0.05). After 1 month and 2 monthsof treatment, the levels of BMP-2, TGF-β 1, and VEGF in combined group were significantly higher than those in GTRgroup (P<0.05). After 6 and 12 months of treatment, AL, PD, BI, and periodontal pocket depth in combined group were sig-nificantly lower than those in GTR group, while GR and alveolar bone density were significantly higher than those in GTRgroup (P<0.05). The patients were followed up for 3 months, and no other adverse reactions were observed in both groups.Conclusion PRF combined with GTR can reduce inflammatory response, improve periodontal status, increase alveolarbone density, reduce periodontal pocket depth, and promote pulp tissue regeneration, with definite efficacy and good safety.
      【Key words】 Combined periodontal-endodontic lesions; Platelet-rich fibrin; Guided tissue regeneration; Inflam-matory factors; Curative effect; Periodontal status; Pulp tissue