全身性重度慢性歯周炎に対するアジスロマイシンの併用療法：臨床的、微生物的、生化学的パラメーター

Azithromycin as an adjunctive treatment of generalized severe chronic periodontitis: clinical, microbiologic, and biochemical parameters.

抄録

背景:

本研究では，重症の全身性慢性歯周炎（CP）患者を対象に，非外科的歯周治療とアジスロマイシンの併用による 6 ヵ月間の臨床・微生物学的パラメータおよび歯肉溝液（GCF）MMP-8 値に対する有効性を検証した．

BACKGROUND: This study examines the efficacy of azithromycin in combination with non-surgical periodontal therapy on clinical and microbiologic parameters and gingival crevicular fluid (GCF) matrix metalloproteinases-8 (MMP-8) levels over 6 months in patients with severe generalized chronic periodontitis (CP).

方法:

この無作為化二重盲検プラセボ対照並行群間比較試験には，重症の全身性 CP 患者 36 例中 28 例が組み入れられた．患者はアジスロマイシン群とプラセボ群に無作為に割り付けられた（500 mg、1日1回、3日間）。プロービングデプス（PD）、臨床的付着レベル、歯肉縁上プラーク蓄積の有無、およびプロービング時の出血を2値で記録した。GCFサンプルはPD≥6 mmの片根歯1本から，微生物学的サンプルはPD≥6 mmの片根歯2本から採取された．微生物学的パラメータは，Aggregatibacter actinomycetemcomitans，Porphyromonas gingivalis，Tannerella forsythia，Fusobacterium nucleatum，Prevotella intermediaおよび全菌について定量リアルタイムPCRで分析した．GCFのMMP-8濃度は，免疫蛍光法で測定した．

METHODS: Twenty-eight of 36 patients with severe generalized CP were included in this randomized, double-masked, placebo-controlled, parallel-arm study. They were randomly assigned to azithromycin or placebo groups (500 mg, once daily for 3 days). Probing depth (PD), clinical attachment level, dichotomous presence or absence of supragingival plaque accumulation, and bleeding on probing were recorded. GCF samples were obtained from one single-rooted tooth with PD ≥ 6 mm, whereas microbiologic samples were collected from two single-rooted teeth with PD ≥ 6 mm. Microbiologic parameters were analyzed by quantitative real-time polymerase chain reaction for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, and total bacteria. GCF MMP-8 levels were determined by immunofluorescence assay.

結果:

アジスロマイシン群とプラセボ群は、すべての臨床パラメータにおいて同程度だが有意な改善を示した（P <0.05）。A. actinomycetemcomitans，P. gingivalis，T. forsythia，P. intermediaおよび総菌数は両群とも6カ月間で有意に減少したが，F. nucleatumはアジスロマイシン群のすべての診察で有意に減少し，プラセボ群と比べてもその値は低かった（p＜0.05）．アジスロマイシン群とプラセボ群では、治療後と2週間後のGCF MMP-8レベルが有意に減少した（P <0.05）。

RESULTS: Azithromycin and placebo groups demonstrated similar but significant improvements in all clinical parameters (P <0.05). A. actinomycetemcomitans, P. gingivalis, T. forsythia, P. intermedia, and total bacteria significantly decreased over the 6-month period in both groups, whereas F. nucleatum was significantly reduced in all visits in the azithromycin group, with the levels also being lower compared with those of the placebo group (P <0.05). The azithromycin and placebo groups exhibited significant reduction in GCF MMP-8 levels at the post-treatment visit and at 2 weeks (P <0.05).

結論:

以上の結果より，重症の CP 患者において，アジスロマイシンを併用しても，非外科的歯周治療に対する追加的な効果は得られないと結論づけられる．

CONCLUSION: On the basis of the present findings, it can be concluded that adjunctive azithromycin provides no additional benefit over non-surgical periodontal treatment on parameters investigated in patients with severe generalized CP.