Greenberg Katja V, Armitage Gary C, Shiboski Caroline H
Division of Periodontology, Department of Stomatology, School of Dentistry, University of California-San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA.
J Periodontol. 2008 Mar;79(3):453-60. doi: 10.1902/jop.2008.070434.
Tacrolimus is a new-generation immunosuppressant as successful as cyclosporin in suppressing organ transplant rejection. Although cyclosporin is known to cause gingival enlargement (GE), tacrolimus has not been associated with this condition. We sought to explore the prevalence of GE among renal transplant recipients (RTRs) in relation to cyclosporin and tacrolimus while controlling for the effect of calcium channel blockers (CCBs) and supragingival plaque.
RTRs were recruited from our institution's Kidney Transplant Unit. Participants completed a standardized questionnaire and received a complete oral examination, including a soft tissue examination and a periodontal examination measuring probing depth, recession, bleeding on probing, plaque index (PI), and GE.
Among 115 RTRs, 39 (34%) presented with GE, with the highest prevalence among those taking cyclosporin and CCBs (76%) and the lowest among tacrolimus users not on a CCB (15%). Tacrolimus was not found to be associated with GE. Cyclosporin was found to be associated with GE in a univariate analysis stratified by the use of CCBs, but multivariate analysis revealed that the only significant risk factors for GE were the use of CCBs and the widespread presence of abundant supragingival plaque (PI > or =2 on >40% of tooth surfaces).
This study confirmed that tacrolimus is not associated with GE. Cyclosporin taken at the currently recommended low dosage and not in combination with a CCB may not be associated with a significant risk for GE in individuals with good oral hygiene. CCBs should be avoided among patients taking cyclosporin and those with poor oral hygiene.
他克莫司是一种新一代免疫抑制剂，在抑制器官移植排斥反应方面与环孢素一样成功。虽然已知环孢素会导致牙龈增生（GE），但他克莫司与这种情况并无关联。我们试图探讨肾移植受者（RTRs）中GE的患病率与环孢素和他克莫司的关系，同时控制钙通道阻滞剂（CCBs）和龈上菌斑的影响。
从我们机构的肾脏移植科招募RTRs。参与者完成一份标准化问卷，并接受全面的口腔检查，包括软组织检查和牙周检查，测量探诊深度、退缩、探诊出血、菌斑指数（PI）和GE。
在115名RTRs中，39名（34%）出现GE，服用环孢素和CCBs的患者中患病率最高（76%），未服用CCB的他克莫司使用者中患病率最低（15%）。未发现他克莫司与GE有关。在按CCB使用情况分层的单因素分析中，发现环孢素与GE有关，但多因素分析显示，GE的唯一显著危险因素是CCB的使用和龈上大量菌斑的广泛存在（在>40%的牙面上PI≥2）。
本研究证实他克莫司与GE无关。以目前推荐的低剂量服用且不与CCB联合使用的环孢素，对于口腔卫生良好的个体，可能与GE的显著风险无关。服用环孢素的患者以及口腔卫生较差的患者应避免使用CCB。
