37
Литература
1. Бекжанова О.Е., Юльбарсова Н.А. Показатели
функциональной активности эндотелия у паци -
ентов с хронической рецидивирующей тре-
щи ной губ // Клин. стоматол. – 2019. –
№ 2. – С. 24–26.
2. Бекжанова О.Е., Юльбарсова Н.А. Клини ческие
критерии оценки тяжести клинического течения
хронической рецидивирующей, тре щины губ //
Мед. журн. Узбекистана. – 2019. – № 6. – С. 14–
17.
3. Макеева И.М., Матавкина М.В. Онкологи ческая
настороженность при заболеваниях губ» // Сто-
матология для всех. – 2012. – № 2. – С. 54–58.
4. Матавкина М.В. Комплексная терапия у па-
ци ентов с хронической рецидивирующей тре-
щиной губ с применением психотропных
препаратов: Автореф. дис. … канд. мед. наук. –
М., 2012. – 22 с.
5. Матавкина М.В. Роль неврогенного фак тора в
возникновении хронической рециди вирующей
трещины губы // Стоматология. – 2012. – Т. 91,
№3. – С. 76–79.
Резюме
Цель
:
оценка психологического статуса у
пациентов с различной тяжестью кли ничес кого
течения хронической рецидивирующей трещины
губ (ХРТГ). Материал и методы: исследование
проводилось на базе кафед ры факультетской
терапевтической стома то логии с 2017 г. Были
обследованы 75 пациентов с
ХРТГ,
средний возраст
45,64± 2,11 года. Мужчины составляли 65,00±-
7,54%, женщины – 35,00±7,54%. В кон троль ную
группу вошли 40 человек, не имеющих заболеваний
красной каймы губ, средний возраст 45,22±1,82
года, мужчины составляли 66,67±5,44%, жен щины
– 33,33±5,44%. Результаты: у пациентов с ХРТГ
преобладали тревожно-фобические расстройства
и депрессия. Их проявления варьировали от
отсутствия при легком течении заболевания до
субклинических форм при течении средней тя-
жести, также определяется депрессивные состо-
яния, про текающие тяжелее. Выводы: паци ентам
с ХРТГ необходима пси хологическая по мощь,
адаптированная к тяжести клинического течения
патологии губ.
Ключевые слова
: красная кайма губ, хрони -
ческая рецидивирующая трещина губ, тре вожно-
депрессивные расстройства, госпиталь ная шкала
тревоги и депрессии HADS.
ANNOTATION
. A study in patients with CHRLC
revealed a predominance of anxiety-phobic disorders
and depression. Its manifestations vary from absence
in the mild course of the disease to subclinical forms in
the course of moderate severity, and depressive states
that are more severe are also determined. Research
results prove the need for psychological assistance to
patients with CHRLC, adapted to the severity of the
clinical course of lip pathology.
Key words:
red border of lips. chronik relapsing
crack of lips. Anxiety and depressive disorders, hospital
anxiety scale and depression, HADS.
UDK: 616.31-002.157.2-08:[611.31-579.262
ANALYSIS OF THE MICROFLORA OF THE ORAL CAVITY IN THE CLINICAL COURSE OF
THE CHRONIC RECURRENT ARTHOSIS OF STOMATITIS
Alimova D.M., Bahramova F.N.
Tashkent State Dental Institute
Chronic recurrent aphthous stomatitis (CPAS) is
one of the most common inflammatory diseases of
the oral mucosa (MOP), characterized by recurrent
rash of aphthae with a prolonged course and periodic
exacerbations. The study of chronic recurrent aphthous
stomatitis for many years does not lose its relevance and
continues to be a priority in modern dentistry [1,2,6].
One of the complex issues of the pathology of
the oral mucosa (COP) is the treatment of chronic
recurrent aphthous stomatitis. The reason for the lack
of effectiveness of therapy is the lack of a complete
picture of the pathogenesis of CPAS.
In recent years, interest in the role of microorganisms
in the etiology and pathogenesis of various diseases of
the oral mucosa has increased [1–3,6].
However, the vast majority of studies devoted to
the study of CPAS were carried out without taking
into account the severity of the clinical course of
ТЕРАПЕВТИЧЕСКАЯ СТОМАТОЛОГИЯ
38
STOMATOLOGIYA
CPAS. Assessment of microbiocenosis was carried
out according to the data of oral swabs without
a detailed study of the number of microbioce -
no sis [4,7].
The significance of pathogenic microorganisms that
make up the most important biotopes of the div in
the persistence of the process and the recurrence of the
disease has not been determined.
In recent years, there has been reason to consider
the oral cavity and intestines as an essential part of
the div’s immune system. The microflora of these
biotopes contributes to the formation of general
div immunity due to the induction of antibodies of
interferons, lysozyme, cytokines, immunoglobulins,
complement [2,3,5,8,9].
Promising in this regard is the conduct of
comprehensive studies to study the clinical and
pathogenetic features of the development of CPAS,
assess the nature of the disorders of the microbiocenosis
of the oral cavity and large intestine, their role in the
development of the disease.
It can be assumed that a comprehensive solution to
this issue will reveal some pathogenetic mechanisms
of recurrence of the pathological process, evaluate the
role of microbiocenosis disorders in the main biotopes
of the div.
Objective
To study the state of microbiocenoses of the main
biotopes of the oral cavity in patients with various
clinical course of HRAS.
Materials and methods
Research on the study of ASD was carried out at
the Department of Hospital Therapeutic Dentistry and
Therapeutic Dental Clinic TGSI.
The material for analysis and conclusions were
the results of a survey of 43 patients with recurrent
aphthous stomatitis. As a norm, data were taken from
a survey of 10 people of the corresponding gender and
age of the patient.
In the oral fluid, not only a qualitative microbial
landscape was determined, but also a quantitative
content of representatives of the normocenosis,
conditionally and pathogenic microflora, which made
it possible to determine dysbiotic changes in the oral
cavity.
For this, test tubes with oral liquid were delivered
to the laboratory for 1 hour, where a series of serial
dilutions were prepared with culture on the appropriate
differential diagnostic media, incubation of cultures for
29–72 ches and study of the cultural, morphological
and biochemical characteristics of the isolated
microorganisms. The results were expressed in Ig
CFU/ml.
Results
Communicating with the external environment, the
oral cavity is populated by microorganisms representing
a complex and stable ecosystem. From a wide variety of
species inhabiting the oral cavity, we studied resident,
pathogenic, and conditionally pathogenic species that
determine the colonial resistance of this biotope. An
analysis of the microflora composition showed that
healthy people (control group) were dominated by
representatives of normal microflora, representatives
of opportunistic microorganisms were present in
insignificant titers. The presence of CPAS on oral
mucosa was accompanied by impaired microbiocenosis,
while the severity of dysbiotic changes progressively
increased with an increase in the severity of the process
on SOP.
The oral cavity is often colonized by lactobacilli.
These microorganisms are capable of producing
proteases, peptidases and bacteriocytes, performing
a physiologically important function of maintaining
the constancy of the internal environment of the div.
These microorganisms are involved in providing non-
specific resistance and become part of the environmental
barrier. In this case, lactobacilli have an antagonistic
effect on pathogenic microorganisms, blocking the
receptors of epithelial cells, protecting themselves
from the adhesion of pathogens [2,3,5].
As can be seen from table 1, the titers of lactobacilli
of the oral fluid were lowered relative to the control
(р<0.05) already in patients with mild XPA – 2.0±0.09
CFU/ml; moderate severity – 1.62±0.07 (р<0.01) and
severe course – 1.23±0.04 (р<0.01) versus 2.42±0.11
CFU / ml in the control group. Against this background,
the number of bacteriocides sharply increased,
amounting to 2.51±0.12 (р<0.01); 3.02±0.14 (р<0.01)
and 4.00±0.19 CFU/ml (р<0.01) versus 2.01±0.09 CFU/
ml in the control group; the corresponding dynamics of
clostridia was 1.23±0.06 (р<0.05); 2.0±0.08 (р<0.05)
and 2.73±0.12 (р<0.01) CFU/ml vs. 0.92±0.03 CFU/
ml in the control.
An indicator of microbiological distress is the
detection of various variants of E. coli, a microorganism
of an unusual oral biotope. Thus, the total concentration
of E. coli progressively increased from 1.0±0.04 CFU/
ml in patients with mild ASD to 1.32±0.05 – 3.25±0.14
CFU/ml, respectively, with an average and severe
severity; the concentration of E. coli with hemolytic
activity was 0.63±0.02, respectively; 0.88±0.03 and
1.32±0.04 CFU/ml.
39
Table
Oral microbiocenosis (in Ig КOE/ml) of oral fluid in patients with various clinical courses of CPAS
Icroorganisms
Control
Clinical course of ASD
light
medium
heavy
Lactobacillus spp.
2,42±0,11
2,00±0,09
а
1,62±0,07
ав
1,23±0,04
авс
Bacteroides spp.
2,01±0,09
2,51±0,12
а
3,03±0,4
ав
4,00±0,19
авс
Clostridium
0,92±0,03
1,23±0,06
а
2,00±0,08
ав
2,73±0,12
авс
Entero-bacillus
-
0,62±0,03
а
0,81±0,03
ав
1,25±0,05
авс
E.coli (lac+/hem-)
-
0,25±0,01
а
0,48±0,02
ав
0,83±0,04
авс
E coli (lac+/hem+)
-
0,32±0,01
а
0,92±0,04
ав
1,26±0,05
авс
E coli (lac-/hem-)
-
-
0,26±0,01
ав
0,91±0,03
авс
E coli (lac-/hem+)
-
-
0,44±0,02
ав
1,23±0,06
авс
E coli (only hem+)
-
0,63±0,02
а
0,88±0,03
ав
1,32±0,04
авс
E coli (amount)
-
1,0±0,04
а
1,32±0,05
ав
3,25±0,14
авс
Klebsiella (amount)
1,82±0,07
2,32±0,10
а
2,62±0,11
ав
2,88±0,12
авс
Proteus vulgaris
1,10±0,04
1,52±0,07
а
2,03±0,03
ав
2,42±0,11
авс
Staph. aureus
3,12±0,12
4,00±0,15
а
4,25±0,21
ав
4,82±0,23
авс
Staph. spp.
3,26±0,15
3,82±0,17
а
4,42±0,20
ав
4,95±0,25
авс
Entero-coccus
-
0,52±0,02
а
0,61±0,02
ав
1,23±0,05
авс
Candida
1,32±0,06
1,88±0,07
а
2,13±0,10
ав
3,16±0,14
авс
Note. а – р<0.05 with respect to control; в – р<0.05
to the mild course of XPA; с – р<0.05 with respect to
moderate chronic pain.
Against the background of a decrease in the activity
of resident microflora, the release of opportunistic
microorganisms sharply increased. Thus, Klebsiella
titers in mild ASD were 2.32±0.10 (р<0.05); moderate
severity – 2.62±0.11 (р<0.05) and severe course of
2.88±0.12 CFU/ml (р<0.05) versus 1.82±0.07 CFU/
ml in the control; the corresponding dynamics of the
protea was 1.52±0.07 (р<0.01); 2.03±0.09 (р<0.01)
and 2.42±0.11 (р<0.01) CFU/ml versus 1.10±0.04
CFU/ml.
Against the background of an increase in the
severity of the clinical course of ASD, pathogenic
and conditionally pathogenic coccal microflora were
activated. So, the titer of Staphylococcus aureus
in patients with mild ASD was 4.0±0.15 (р<0.05);
moderate severity – 4.25±0.21 (р<0.05) and severe
severity – 4.82±0.23 (р<0.05) CFU/ml vs. 3.21±0.12
CFU/ml control group; the corresponding dynamics
of pathogenic staphylococcus and enterococci was
3.82±0.17 (р<0.05); 4.42±0.20 (р<0.01) and 4.95±0.25
(р<0.01) versus 3.26±0.15 CFU/ml in the control; and
0.52±0.02; 0.61±0.02 and 1.23±0.05 against lack of
control.
The growth of Candida genus was noted, while in
patients with mild CPAS, the average titer of fungi
was 1.88±0.10 (р<0.05) CFU/ml, and medium and
heavy, respectively, 2.13±0.10 (р<0.05) and 3.16±0.14
(р<0.05) versus 1.32±0.08 COC/ml in the control
(table).
Microbial imbalance leads to the activation of
lipid peroxidation processes, a change in non-specific
resistance and exacerbation of inflammatory mucosal
lesions.
In recent years, an opinion has been established
that microbiocenosis disorders are considered not
as a reflection of the pathological process, but as
a pathogenetic mechanism in the development of
a particular disease, and in some cases, the trigger
mechanism of the disease [2,8,9].
Thus, dysbiosis can act as an etiological factor
or accompany the disease. Changes in the microbial
balance in the oral cavity are closed by a vicious
circle: pathogenic microflora reduces the resistance of
the tissues of MOP, impaired adhesion of neutrophils,
chemotaxis and phagocytosis, and multiplication and
persistence of microflora increase.
Conclusions
An increase in the severity of the clinical course of
CPAS is associated with an increase in the number of
ТЕРАПЕВТИЧЕСКАЯ СТОМАТОЛОГИЯ
40
STOMATOLOGIYA
bacteria in the oral cavity, mainly due to opportunistic
pathogens. The level of gram-negative bacteria
increases in proportion to the severity of the clinical
course of CHRAS, which can lead to an aggravation of
the course of the disease.
Literature
1. Абрамова Е.Р. Сравнительная оценка эффек-
тивности комплексной терапии у больных с
дисбактериозом слизистой оболочки полости
рта: Автореф. дис. ... канд. мед. наук. – М., 2013.
– 25 с.
2. Алимова Д.М., Камилов Х.П. Повышение
эффективности лечения рецидивирующего
афтозного стоматита с применением озона:
Автореф. дис. ... канд. мед. наук. – Ташкент,
2018. – 38 с.
3. Алимова Д.М., Камилов Х.П., Бекжано ва О.Е.
Роль про и противовоспалительных ци токинов
в патогенезе рецидивирующего афтозного
стоматита // Клин. стоматол. – 2017. – №1. – С.
20–24.
4. Евстигнеев И.В. Исследование микрофлоры
полости рта и оценка местного иммунитета //
Клiнiчна iмунологiя. Алергологiя. Iнфек тологiя.
– 2013. – Т. 4 (63). – С. 26–31.
5. Камилов Х.П., Алимова Д.М. Современные
аспекты клиники и этиопатогенеза рециди-
вирующего афтозного стоматита // Ўзбекистон
тиббиёт журнали. – 2015. – №3. – С. 86–90.
6. Успенская О.А., Шевченко Е.А., Болтенко С.А.
Cовременные методы лечения хронического
рецидивирующего афтозного стоматита у
женщин с урогенитальной инфекцией и без нее
// Соврем. пробл. науки и образования. – 2015.
– №1–1.
7. Рабинович О.Ф., Рабинович И.М., Гусева
А.В., Абрамова В.С. Лечение больных с
рецидивирующим афтозным стоматитом, ос-
лож ненным дисбактериозом полости рта //
Клин. стоматол. – 2010. – №3. – С. 18–20.
8. Царев В.Н. Микробиология, вирусология и
иммунология полости рта. – М.: ГЭОТАР-
Медиа, 2013. – 576 с.
9. Sookkhee S., Chulasiri M., Prachyabrand W. Lactic
acid bacteria from healthy oral cavity of Thai
volunteers: inhibition of oral pathogens // J. App.
Microbiоl. – 2010. – Vol. 90, № 2. – P. 172–179.
Summary
Communicating with the external environment, the
oral cavity is populated by microorganisms representing
a complex and stable ecosystem. From a wide variety of
species inhabiting the oral cavity, resident, pathogenic,
and conditionally pathogenic species that determine
the colonial resistance of this biotope were studied. An
analysis of the composition of microflora showed that
the titers of pathogenic microorganisms progressively
increased with an increase in the severity of the process
in oral mucosa.
Key words:
aphthous stomatitis, microbiocinosis,
pathogenic microorganisms, conditionally patho genic
microorganisms.
Rezumesi
Tashqi muhit bilan aloqa qilganda, og’iz bo’sh-
lig’ida murakkab va barqaror ekotizimni ifodalovchi
mikroorganizmlar yashaydi. Ushbu biotopning
rezistentligini ifodalovchi og’iz bo’sh lig’ida ko’plab
turlardan biri rezident, patogen va shartli patogen
microorganizmlar o’rganildi. Mikroflora tarkibining
tahlili shuni ko’rsatdiki, patogen mikroorganizmlarning
titrlari OBSHQ dagi jarayonning og’irligi oshishi bilan
asta-sekin o’sib boradi.
Резюме
Сообщаясь с внешней средой, полость рта
заселяется микроорганизмами, представля ю щими
сложную и стабильную экосистему. Из большого
разнообразия видов, заселяющих полость рта,
авторами были изучены резиден тные, патогенные
и условно-патогенные ви ды, определяющие
колониальную резистен тность этого биотопа.
Анализ состава микро ф лоры показал, что титры
патогенных
микро организмов
прогрессивно
увеличивались с уве личением тяжести процесса на
слизистую оболочку полости рта.
Ключевые слова:
полость рта, резидентные,
патогенные и условно-патогенные виды микро-
флоры.
