难治性根尖周炎根管内及根尖外菌群的研究现状

doi:10.7518/gjkq.2022047

摘要/Abstract

摘要：

难治性根尖周炎的致病因素包括根管内与根尖外的持续感染，两者的细菌种类既有联系又有差别。随着现代分子技术的发展，发现单一取样方式与传统细菌检测方法难以洞察根管中的所有细菌种类，而多种取样及检测方式的结合可更好地提高检测细菌的种类与数量。本文通过对近十年来难治性根尖周炎根管内及根尖外菌群研究文献的回顾，对不同取样方法及检测技术获得的难治性根尖周炎根管内外优势菌群的种类的比较，以及难治性根尖周炎的感染细菌来源等作一综述。

关键词: 难治性根尖周炎, 菌群, 根管内感染, 根尖外感染

Abstract:

The pathogenic factors of refractory apical periodontitis include persistent intraradicular infection and extraradicular infection, both connectedly and differentially. With the development of modern molecular technology, it is found that the use of single sampling method and traditional bacterial detection methods makes it difficult to offer clear insight into all the bacterial species in the root canal. However, the combination of multiple sampling and detection methods can better improve the detection of species and populations of detected bacteria. Based on the review of literature on the intraradicular and extraradicular bacterial communities of refractory apical periodontitis in the last 10 years, this paper discus-ses the comparison of predominant microbial flora in and outside of the root canal of refractory apical periodontitis obtained by different sampling methods and detection techniques as well as the sources of infection microorganisms in refractory apical periodontitis.

Key words: refractory apical periodontitis, microflora, intraradicular infection, extraradicular infection

中图分类号:

R 781.34+1

朱嘉妮,苏勤. 难治性根尖周炎根管内及根尖外菌群的研究现状[J]. 国际口腔医学杂志, 2022, 49(3): 283-289.

Zhu Jiani,Su Qin. Research status of the use of root canal and periapical microflora in refractory periapical periodontitis[J]. Int J Stomatol, 2022, 49(3): 283-289.

图/表 1

表　1

RAP根管内和根尖外检出的微生物对比"

取样方法	检测方法	研究者及年份	检测结果
根管内：根管再治疗去除根管充填物后纸尖取样	培养法	Medina-Palacios等^[5]，2021	共鉴定出26种菌，粪肠球菌、链球菌、气球菌属和梭菌属最常见。88.5%兼性厌氧，11.5%严格厌氧
	非培养法	王娟等^[11]，2014	厚壁菌门、变形菌门、放线菌门、拟杆菌门、梭杆菌门和螺旋体门
		张富华等^[7]，2014	共发现 15 种细菌，分属厚壁菌门、变形菌门、拟杆菌门、放线菌门。其中粪肠球菌、微小单胞菌最多
		Sánchez-Sanhueza等^[2]，2018	细菌最丰富的家族是假单胞菌科。细菌数量最多的是变形菌门，其次是拟杆菌门
	二者结合	Endo等^[14]，2013	细菌培养中最常见的细菌为葡萄球菌、放线菌、孪生球菌、嗜血杆菌和肠球菌。PCR检出最多的菌种为微小单胞菌、变黑普雷沃氏菌、粪肠球菌和麻疹芽胞菌
		Karygianni等^[4]，2015	在根管充填材料和根管标本中均检测到厚壁菌门、放线菌门和拟杆菌门。从根管感染后的根管中恢复了5个新类群（嗜盐梭菌、意大利肠球菌、酸丙酸杆菌、茶肠球菌、解糖肠球菌）
		Zargar等^[17]，2019	粪肠球菌感染率最高，淡色普雷沃氏菌感染率最低
		Dioguardi等^[20]，2020	粪肠球菌和牙龈卟啉单胞菌在根管治疗的所有阶段都被高度检测到
根管内：根尖手术切根尖后纸尖取样	非培养法	Bouillaguet等^[3]，2018	经过与未经过根管治疗的牙中：厚壁菌门、拟杆菌门、放线菌门、梭形菌门和协同菌门均超过90%。细胞核梭杆菌数量最多。经过根管治疗的牙中：放线菌门显著富集，粪肠球菌含量最高，显著高于未经根管治疗的牙
根尖外：拔牙或显微根尖手术中根尖或根尖周组织取样	培养法	Signoretti等^[25]，2013	根尖病变中G+菌存活率最高
	非培养法	周耀等^[31]，2014	口腔放线菌属（84.6%）、口腔丙酸菌属（61.5%）。包括兼性厌氧菌、专性厌氧菌和需氧菌
		Ping等^[16]，2015	厚壁菌门、变形菌门、拟杆菌门、梭杆菌门、放线菌门、协同菌门和螺旋体
		Zhang等^[29]，2021	根外感染细菌数量最多的是厚壁菌门。链球菌、巨型球菌、放线菌、丙酸杆菌、坦纳菌和奈瑟菌仅在根外生物膜组中检出。变形杆菌、柠檬酸杆菌和细小单胞菌仅在根尖周病变中检出
		Pereira等^[26]，2017	在根端和根尖周标本中，有具核梭杆菌、害肺杆菌、福赛斯坦纳菌、伴放线放线杆菌、齿垢密螺旋体、中间普雷沃氏菌、牙龈卟啉单胞菌、粪肠球菌、牙髓卟啉单胞菌、变黑普雷沃氏菌
		周焱等^[30]，2019	检测出9个菌门，厚壁菌门、变形菌门、拟杆菌门、未培养菌、具核梭杆菌、隐蔽小杆菌、纤细弯曲菌、轻型链球菌、血链球菌
	二者结合	秦彦涛等^[27]，2016	丙酸菌属和放线菌属。以兼性厌氧菌、专性厌氧菌、需氧菌为主

表　1

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