口腔内微生物の比較検討 -周術期管理合併症の潜在的要因として

Comparative assessment of selected intraoral microorganisms – potential factors for peri-surgical management complications.

抄録

本研究では、口腔内の健康と口腔内細菌叢の種構成との関連について、異なるヒト集団を対象とした調査結果の比較分析について報告する。この解析の目的は、歯科的問題に関連した外科的管理を必要とする新生物患者において、健康上の合併症を引き起こす可能性のある微生物を特定し、評価することであった。口腔癌を外科的に治療した患者と新生物のない患者を対象に，口腔内の健康状態（歯，歯肉，歯周組織の状態，炎症過程の発生状況）を評価した．各患者の歯周組織，歯垢，歯周ポケットのスワブから分離された微生物を湿式および染色顕微鏡で同定し，真菌と細菌の標準的なin vitro技術を適用して，菌株を決定した．顕微鏡観察およびin vitro培養の結果を比較検討した結果，真菌，口腔内寄生原虫および細菌群の有病率に患者群間で有意差が認められた．口腔癌患者の93.75%でCandida属の酵母様真菌（主にC. albicans）が検出され，非癌患者の25%ではC. albicans属の酵母様真菌が検出された．E. gingivalisアメーバは12.5％の重症患者でのみ検出され，トリコモナスは全例で検出されなかった．細菌種では，口腔がん患者において，病原性を有する可能性のある腸内細菌科細菌が検出された．口腔癌で長期間の治療が必要な患者では，健常者と比較して微生物相が大きく変化していることが示唆された．

In this research, a comparative analysis of results of investigations involving different human populations, in terms of a relation between the oral cavity health and the species composition of mouth microbiota is reported. The purpose of this analysis was to identify and assess microorganisms that could cause health complications in patients with neoplasm requiring dental problem-related surgical management. The patients with the oral cancer surgically treated and those without neoplasm were assessed for their oral health: status of teeth, gingiva, periodontium, and occurrence of inflammatory processes. From each patient, microorganisms isolated of periodontium, dental plaque, and dental pocket swabs were identified in wet and stained microscopic preparations; standard microbiology in vitro techniques were also applied to determine the fungal and bacterial strains. The comparative analysis of results of direct microscopic examinations and in vitro cultures assessment indicated significant differences in prevalences of fungi, parasitic oral protozoans and bacteriae in particular patient’s groups. Yeast-like fungi belonging to Candida genus, mostly of C. albicans group, were identified in 93.75% patients with the oral cancer, while in 25% of individuals assessed without neoplasm. E. gingivalis amoebae were only found in 12.5% patients with the serious disease; no trichomonads were detected in all patients analyzed. Among bacteria species, potentially pathogenic Enterobacteriaceae were found in the patients with oral cancer. The pronounced shift in the microbiota species composition in the patients who needed prolonged treatment due to oral cavity cancer, compared to other generally healthy persons has been showed in this analysis.