デジタルパノラマラジオグラフィーにおける血液透析および腹膜透析患者と健常者の歯と骨格の指標の比較

Comparison of dental and skeletal indices between patients under haemodialysis and peritoneal dialysis with healthy individuals in digital panoramic radiography.

抄録

目的:

血液透析、腹膜透析を受けている患者と、年齢・性別をマッチさせた対照群との間で、パノラマX線写真における歯と骨格の指標を比較することを目的とした。

OBJECTIVE: The aim was to compare dental and skeletal indices in panoramic radiography between patients undergoing haemodialysis, peritoneal dialysis and age- and sex-matched control group.

方法:

この比較横断研究では、血液透析患者32名、腹膜透析患者14名、健常者52名のパノラマ画像において、Antegonial Index (AI), Mental Index (MI), Panoramic Mandibular Index (PMI) を含む定量的指標、Mandibular Cortical Index (MCI) と Trabecular Pattern (TP) を含む定性的指標を評価した。また、歯根管石灰化、歯髄結石、軟組織石灰化、硬膜の変化や消失、褐色腫瘍に伴う放射線透過、歯根吸収の有無も調査された。これらの指標を3群間で比較し，患者の血液検査値および慢性腎不全（CRF）の原因となる疾患との関連性を検討した．2週間の評価間隔における観察者内一致度を算出した。

METHODS: In this comparative cross-sectional study, quantitative Indices including Antegonial Index (AI), Mental Index (MI), Panoramic Mandibular Index (PMI) and qualitative indices including Mandibular Cortical Index (MCI) and Trabecular Pattern (TP) were evaluated in panoramic images of 32 haemodialysis patients, 14 patients under peritoneal dialysis and 52 healthy individuals. The images were also investigated for pulp canal calcification, pulp stones, soft tissue calcification, changes in or loss of lamina dura, radiolucencies associated with brown tumour and ridge resorption. The indices were compared between the three groups and were investigated for association with the patients' blood test parameters and their diseases causing chronic renal failure (CRF). Intraobserver agreement for the 2-week interval of assessment was calculated for the indices.

結果:

MI（＝0.574）およびPMI（＝0.100）は有意差を認めなかったが，AI（＝0.01），MCI（＜0.001）およびTP（＝0.002）は対照群との間に有意差を認めた．歯髄石灰化（＝0.03），歯根吸収（＝0.005）の有病率は血液透析群で高かった．軟組織石灰化（＝0.85）と硬膜の変化（＝0.9）には有意差はなかった。褐色腫瘍は血液透析群の1例のみに認められた。

RESULTS: MI ( = 0.574) and PMI ( = 0.100) were not significantly different, but AI ( = 0.01), MCI ( < 0.001) and TP ( = 0.002) were significantly different between the two case groups and the control group. The prevalence of pulp calcification ( = 0.03) and ridge resorption ( = 0.005) was higher in the haemodialysis group. Soft tissue calcification ( = 0.85) and lamina dura changes ( = 0.9) showed no significant difference. Brown tumours were observed in only one case in the haemodialysis group.

結論:

CRF患者においてAI、MCI、TPは皮質骨と海綿骨のミネラル密度の減少を示し、腹膜透析患者よりも血液透析患者でより重篤となった。

CONCLUSIONS: AI, MCI and TP showed a reduction in mineral density of the cortical and trabecular bone in CRF patients and more severely in patients under haemodialysis than those under peritoneal dialysis.