牙齦異常出血與肝硬化─病例報告

Gingival Bleeding Disorders and Liver Cirrhosis-Cases Report

李佳霖(Jia-Lin Li) ； 翁肇嶸(Chao-Jung Weng) ； 林益弘(Yi-Hung Lin) ； 盧俊泰(Chun-Tai Lu)

《臺灣牙周病醫學會雜誌》 16卷3期 (2011/09) Pp. 175-183

摘要

肝硬化會造成牙齦異常出血，若再加上患者原本有牙周炎存在，則臨床上常見牙齦流血不止現象。患者A為51歲男子，99年3月因全口牙齦出血不止經肝膽胃腸科轉診至牙周病科，自述肝硬化(C型肝炎)多年，於三年前開始接受干擾素治療，臨床檢視可見多處牙結石沉積與牙銀腫脹。抽血撿查發現: Platelet count=29x 1 0^3/μ1 (175.5-387.4 x10^3/μ1)， PT=14.7(9.9-11.2 secs)。由於，患者特殊病史，在口腔衛教後，遂建議術前了輸血Platelet Conc. MPL，之後使用超音波洗牙機(ultrasonic device)將全口牙結石徹底清除並在術後投予口服Transamine。患者B為60歲婦人，98 年11月診斷出肝硬化(B肝帶原) ，12月因牙齦出血問題就診，臨床檢查可見牙銀腫脹化膿及多處結石沉積。抽血檢查發現：Platelet count=87x10^3/μ1 , PT=l3.8s，aPTT=41.6 (21.2-35 secs)。由於血液檢查仍在可接受範園，於口腔衛教後，遂分次分象限牙周病治療。對於伴隨有全身性疾病而牙齦異常出血患者，牙周治療前務必詳問病史，並安排抽血檢查作為術前參考，必要時會診血液腫瘤科。而口腔衛生維護對這類型思考更是首要之務。(台灣牙周醫誌16: 175-183, 2011 )

關鍵字

牙齦異常出血 ； 肝硬化 ； 肝炎

並列摘要

An abnormal gingival bleeding can be caused by liver cirrhosis, especially in patients with existing periodontitis. A 51-year-old man was transferred from Gastroenterology & Hepatology department to periodontal department due to continues gingival bleeding. He has been diagnosed with liver cirrhosis due to chronic hepatitis C infection. He has been treated with Interferon for three years. Upon his dental examination, he was presenting with full mouth gingivitis and calculus deposition. His blood test result showed: platelet count=29x 10^3/μ1 (referemce value= 175.5~387.4x10^3/μ1, PT= 14.7s (referemce value=9.9~11.2s). Due to the patient's medical condition, he was given an oral hygiene education first. Then he received Platelet Conc. MPL blood transfusion prior to full mouth ultrasonic scaling, followed by an oral dose of Transamine. Another 60-year-old woman who was diagnosed with Iiver cirrhosis, a hepatitis B carrier, in November 2009. She visited our department in December due to gingival bleeding. She presented with swollen gingiva, purulent discharge, and calculus deposition. The platelet count=87x10^3/μ, PT= 13.8s , aPTT=41.6s(referemce value=21.2~35s) . The data was within an acceptable range, so she received the routine periodontal treatment procedures. A complete medical history and blood clotting results should be considered when treating patients with abnormal gingival bleeding, especially if they also have other medical conditions. Hematologists may also be involved in the management of patient 's abnormal gingival bleeding. Nevertheless, maintaining a good oral hygiene is still the most important management strategy in these patients. (J Taiwan Periodontol 16: 175-183, 2011 )

並列關鍵字

abnormal gingival bleeding ； liver cirrhosis ； hepatitis