国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (2): 266-273.doi: 10.7518/gjkq.2026108

• 综述 • 上一篇    

慢性肝病患者口腔种植治疗的研究进展

郭雪琪1,2(),满毅1()   

  1. 1.口腔疾病防治全国重点实验室;国家口腔医学中心 口腔疾病国家临床医学研究中心;四川大学华西口腔医院种植科 成都 610041
    2.广州医科大学口腔医学院种植学教研室 广州医科大学附属口腔医院种植科 广东省口腔组织修复与重建工程技术研究中心 广州市口腔再生医学基础与应用研究重点实验室 广州 510182
  • 收稿日期:2024-09-01 修回日期:2025-07-22 出版日期:2026-03-01 发布日期:2026-02-13
  • 通讯作者: 满毅
  • 作者简介:郭雪琪，主治医师，硕士，Email：drguoxueqi77@126.com
  • 基金资助:
    国家重点研发计划(2023YFC3605600);四川大学华西口腔医院资助临床研究项目(LCYJ-ZD-202303)

Research progress on dental implants in patients with chronic liver diseases

Xueqi Guo1,2(),Yi Man1()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.Dept. of Implantology, School and Hospital of Stomatology, Guangzhou Medical University, Guangdong Enginee-ring Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou 510182, China
  • Received:2024-09-01 Revised:2025-07-22 Online:2026-03-01 Published:2026-02-13
  • Contact: Yi Man
  • Supported by:
    National Key Research and Development Program of China(2023YFC3605600);Clinical Research Pro-ject of West China Hospital of Stomatology, Sichuan University(LCYJ-ZD-202303)

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摘要：

随着公共卫生条件的日益改善，病毒性肝炎发病率在全球范围呈下降趋势，但中国仍有超过1/5的人群正面临乙型肝炎、丙型肝炎、肝硬化、肝癌等慢性肝病（CLD）的威胁。针对CLD患者的口腔种植治疗不仅要考虑原发疾病本身及并发症对种植体骨结合的影响，还需要关注相关治疗药物对骨代谢的影响。本文将对上述因素进行讨论，并就CLD患者的种植体成功率/存留率及围手术期准备等种植治疗流程进行综述，拟为口腔种植医生提供临床参考。

关键词: 慢性肝病, 口腔种植, 骨结合, 免疫抑制剂

Abstract:

Despite the global decline in the incidence of viral hepatitis due to improved public health conditions, over one-fifth of the population in China continues to suffer from chronic liver diseases (CLDs), including hepatitis B, hepatitis C, cirrhosis, and liver cancer. In selecting appropriate oral implant treatments for these patients, the effects of the primary disease and its complications on implant osseointegration and the influence of relevant therapeutic medications on bone metabolism must be considered. This work aims to explore these factors and review the implant treatment process, success and survival rates, and perioperative preparations for patients with CLDs to provide valuable clinical insights for oral implant practitioners.

Key words: chronic liver disease, oral implant, osseointegration, immunosuppressant

中图分类号: 

  • R783.4

图 1

肝移植患者26牙位点种植修复a：术前口内观（正颊侧）；b：术前口内观（??面）；c：术前锥形束计算机断层扫描（cone-beam computed tomography，CBCT）（矢状面）；d：修复后口内观（正颊侧）；e：修复后口内观（??面）；f：修复后根尖片。"

表 1

CLD治疗药物对种植修复的影响及应对措施"

药物种类代表药物影响应对措施
抗病毒药物NA恩替卡韦、替诺福韦酯肾脏损伤→低磷血症→骨质疏松风险↑监测骨密度；补充磷制剂及维生素D；必要时更换药物（需咨询内科医生）
IFN＿甲状腺功能障碍→骨代谢紊乱→骨质疏松风险↑术前筛查甲状腺功能（尤其高龄女性）；调整治疗方案
免疫抑制剂GC泼尼松抑制成骨细胞活性→骨量减少；增加破骨细胞活性→骨吸收↑；诱发骨质疏松若每日服用泼尼松≥5 mg，建议暂缓种植手术
CNI环孢霉素、他克莫司甲状旁腺激素分泌↑→骨密度↓；诱发胰岛素抵抗→肝移植后糖尿病监测血糖及骨代谢指标；延长愈合时间，采用渐进性负荷
抗骨质疏松药物雌激素受体调节剂雷洛昔芬选择性雌激素调节→骨转化率↓缺乏长期临床证据，谨慎评估骨代谢状态
BP—长期使用→颌骨坏死风险↑用药史<4年者可行简单手术；>4年者需停药≥2个月，采用微创手术；静脉注射应暂缓种植
单克隆抗体地舒单抗抑制破骨细胞分化→骨代谢紊乱→颌骨坏死风险↑尚无明确共识，高剂量者尽量采用保守修复策略
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