Authors
Vinogradova N.G.1, 2, Epifanov S.A.3, Kharitonova M.P.2, Lvov K.V.1
1 Central City Clinical Hospital №23, Yekaterinburg
2 Ural State Medical University, Yekaterinburg
3 Pirogov National Medical and Surgical Center, Moscow
Abstract
The relevance of the topic is due to the widespread use of bone-modifying agents and the prevalence of osteonecrosis of the jaw.
The aim of the study was to identify a laboratory prognostic criterion for the probability of development and recurrence of medication-related osteonecrosis of the jaw.
Materials and methods. A non-randomized comparative cohort study was performed. The main group included 39 patients treated in the Department of Maxillofacial Surgery of the Central City Clinical Hospital No. 23 of Yekaterinburg with a diagnosis of medication-related osteonecrosis of the jaw, among them 23 women (60.5%), 15 men (39.5%), the mean age of patients was 66.2±10.1 years. The comparison group included patients receiving chemotherapy, including bone-modifying agents, for malignant neoplasms of various localization in the day hospital of the Central City Clinical Hospital No. 23 of Yekaterinburg without clinical manifestations of medication-related osteonecrosis of the jaw, among the examined there were 20 women (58.8%) and 14 men (41.2%), mean age was 65.7±9.4 years. The concentration of D-dimer in blood plasma was determined by three-phase enzyme-linked immunosorbent assay using “Vector-Best” reagents, Novosibirsk, Russia. Performance status was assessed using the scale of the general condition of the oncological patient (ECOG), as well as by laboratory general clinical indicators.
Calculations for statistical analysis were performed using the MS Excel 10 analysis package. The mean (M), median (Me), and standard deviation (σ) were determined.
Normality of the distribution was assessed by the indices of skewness and kurtosis. The Pearson correlation coefficient was calculated to reveal the dependence between the factors. To evaluate the statistical difference between the groups, Student’s t-test and Pearson’s chi-squared test were used. The reliability level was 95% (p≤0.5).
Results. In the main group, the average level of D-dimer was 677.82±845.4 (394.78; 960.86) ng/ml; correlation analysis revealed an average positive relationship between the level of D-dimer and the period of taking bone-modifying agents (Pearson’s coefficient = 0.3). In the comparison group, the average level of D-dimer was 267.93±177.56 (204.98; 330.9). In a comparative analysis, the average level of D-dimer in the main group exceeded that in the comparison group by 2.5 times (calculated t-test (2.68)>tabular t-test (1.99), which indicates significant statistical differences in the groups).
Conclusions. Thus, our study at this stage is a laboratory confirmation of the previous stage, where laser Doppler flowmetry of the alveolar mucosa, both in the lesion and in clinically healthy areas, revealed a systemic lesion of the microvasculature. Based on the obtained results, it can be regarded that the level of D-dimer can be a prognostic sign of the probability of development and recurrence of medication-related osteonecrosis, and it is also necessary to take this indicator into account in the drug therapy of the disease.
Keywords: osteonecrosis of the jaw, D-dimer, bone-modifying agents.
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