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Рецензент: к.мед.н., доц. С.Ю. Труфанов
Харківський національний медичний університет
Харьковский национальный медицинский университет
Kharkiv National Medical University
The goal of the research consisted in the grounding of algorithm of patients stratification with inflammatory diseases of maxillofacial area after the index of integral risk of paradontium pathology.
Patients (n1=147) with odontogenic ID MFA took part in the research. They were previously arranged into two sub-groups: the first one (1n1=69 persons) consisted of patients that in the remote post-operative period had an indicator of the generalized needs index in treatment of paradontium CPITN≥2; the second one (2n1=78 persons) - CPITN<2. The analysis of requirement in treatment of paradontium was conducted after the generalized index CPITN. While developing of stratification algorithm it was applied the successive Wald's analysis in modification of Hubler E.V.
The research of risk factors of paradontium pathology forming has revealed that from more than 30 possible factors, 20 are considerable and prognostic valuable for patients with the diseases of MFA. So, the most informing occurred to be the presence of ССT in anamnesis of patients; ССT took place among (62,3±5,8)% patients with CPITN≥2 and only among (9,0±3,2)% patients with CPITN<2 in the remote post-operative period (р≤0,0001); the level of relative risk of paradontium pathology forming under condition of CCT presence was practically in 12 times. The factor of presence of comorbid with the disease of MFA cardiovascular pathology appeared to be highly informative (І=1,680 bits), its frequency among patients with CPITN≥2 for certain (р≤0,0001) was higher than among patients with CPITN<2 in the remote post-operative period (accordingly (63,8±5,8)% and (21,8±4,7)%.The level of relative risk of paradontium pathology forming under condition of CVP presence is practically in 7 times higher. It is revealed that the high level of informativity in relation to forming of paradontium pathology for patients with the diseases of MFA has such factor (η2=14,0%) as drug addiction (I=1,701 bits). In particular, the relative risk of paradontium pathology for drug addict patients grows practically in 11 times in comparison with other patients (р<0,0001). The factor of alcohol abuse was characterized by analogical regularity of influence (η2=13,0%) that took place among (30,4±5,5)% patients with CPITN≥2 and only among (23,1±4,8)% patients with CPITN<2 in the remote post-operative period (р≤0,0001).
According to the data of comparative study of anamnestic, behavioural and clinical technological factors applying the standardized procedure of determination of its diagnostic value and prognostic significance is worked out the algorithm of prognostication of risk of paradontium pathology forming for patients with ID MFA. Clinical verification of the mentioned algorithm is executed among 91 patients of the specialized in-patient department (the 1st sub-group consists of patients with odontogenic ID MFA for that also in the remote post-operative period are registered the levels of requirement in treatment of paradontium pathology at CPITN≥2; the 2nd one consists of patients for that in the remote post-operative period the levels of requirement in treatment of paradontium pathology at CPITN<2) are registered and it is well-proven that frequency of errors of the first class (α) is 4,2% (for 2 from 47 patients of the 1st sub-group) and errors (β) of the second class - 6,8% (for 2 from 44 patients of the 2nd sub-group). Thus, specificity of prognostic algorithm is 95,8% and its sensitivity is 93,2% that allows to recommend it as the previous stage during the preoperative stratification of patients into the high-risk groups of paradontium pathology development at ID MFA in the remote post-operative period.
Conclusions. It is studied frequency, diagnostic value and prognostic significance of separate risk factors of paradontium pathology forming for patients with ID MFA and it is executed ranking of these factors. It is grounded the algorithm of stratification of patients with ID MFA after the risk of paradontium pathology forming, application of that allows to individualize curatively-rehabilitation tactics beginning from the preoperative period. It is executed clinical verification of algorithm and it is proved that its specificity and sensitivity are satisfactory for application as the previous stage at forming of high-risk groups of paradontium pathology development on the preoperative stage among the patients with ID MFA.
The prospects of further researches are related to development and approbation of analogical algorithm of necessity prognostication at treatment of paradontium among patients with the damages of ССT.
Keywords: odontogenic inflammatory diseases of maxillofacial area, stratification, pathology of paradontium, treatment, rehabilitation.
1. Аболмасов Н.Н. Стратегия и тактика профилактики заболеваний пародонта / Н.Н. Аболмасов // Стоматология. - 2003. - № 4. - С. 34-39.
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