采用龈沟血筛查糖尿病的初步研究

[摘要] 目的 评估在牙周检查中,检测龈沟血的血糖水平以代替手指末梢血筛查糖尿病的可靠性,从而寻求一种迅速、安全以及无创的椅旁筛查糖尿病的方法。方法 选取30例慢性牙周炎患者（男性13例,女性17例）,血糖仪分别检测龈沟血和手指末梢血的血糖水平。结果 龈沟血的血糖值范围为4.8~16.7 mmol/L,平均值为（7.77±3.43）mmol/L,手指末梢血的血糖值范围为5.0~17.0 mmol/L,平均值为（7.94±3.67）mmol/L,配对t检验分析两者无显著性差异,皮尔森相关系数分析两者高度相关。结论 在牙周检查过程中,检测龈沟血的血糖水平可能用来筛查糖尿病。     

龈沟血糖化血红蛋白筛查糖尿病的应用研究

目的:评估在牙周探诊中获得的龈沟血(gingival crevicular blood,GCB)的糖化血红蛋白(HbAlc)是否可以代替手指末梢血(finger stick capillary blood,FSB)来筛查糖尿病(diabetes mellitus,DM)的可靠性,为DM筛查提供新渠道。方法:选取中重度慢性牙周炎患者,血糖仪检测GCB和FSB的血糖,Bio-rad D10全自动糖化血红蛋白分析仪检测GCB和FSB的HbAlc,Pearson相关系数分析GCB和FSB血糖以及HbAlc的相关性,受试者工作特征( receiver operating characteristic,ROC)曲线确定GCB HbAlc对DM的最佳诊断界值。结果:本研究收集了60例中重度慢性牙周炎患者,根据有无DM史、FSB血糖以及HbAlc的结果,发现18例有DM、42例无DM的牙周炎患者,两组GCB和FSB血糖的相关性分别为r=0.993和r=0.926;HbAlc的相关性分别为r=0.977和r=0.829;ROC曲线确定GCB HbAlc对DM的最佳诊断界值为HbAlc=5.7%,灵敏度为100%,特异度为95.2%。结论:与FSB HbA1c相比,牙周探诊获得的GCB进行HbA1c检测同样准确,最佳诊断界值为GCB HbAlc=5.7%,可能用于筛查DM患者。     

糖尿病牙周炎病人龈沟液TNF-α水平及其与HbA1c的相关性分析

目的:研究依赖胰岛索治疗的糖尿病(IDDM)伴牙周炎病人、单纯牙周炎病人和牙周健康者龈沟液(gingival cervicular fluid,GCF)TNF-α水平及其与糖代谢状况的关系.方法:用ELISA法检测GCF中TNF-α的水平,同时检测受试者的糖化血红蛋白(HbAlc)百分比.结果:IDDM牙周炎组病人GCF中TNF-α水平明显高于单纯牙周炎组及对照组.GCF中TNF-α水平与反映糖代谢控制状况的糖化血红蛋白无相关性.结论:糖尿病可使牙周炎病人龈沟液TNF-α水平显著增高.     

龈沟液研究的方法学

对龈沟液(GCF)研究的方法学,如GCF的收集方法及定量,混合和单个样本的分析,取样时间及重复多次取样对GCF内容物的影响,GCF中成分的表达方式以及GCF的处理和贮存等问题进行了综述。     

2型糖尿病合并慢性牙周炎患者血清与龈沟液瘦素水平的研究

目的 探讨2型糖尿病合并慢性牙周炎患者血清、龈沟液瘦素水平与临床指标的相关性。方法将60名受试者分成三组：DMCP组：2型糖尿病合并慢性牙周炎患者20人;CP组：慢性牙周炎患者20人;HC组：健康对照者20人。对所有受试者进行健康体检,同时用酶联免疫吸附测定法分别对所有受试者血清及龈沟液中的瘦素水平进行检测。结果 血清瘦素水平DMCP组最高[(4946.42±244.82) pg/ml],HC组最低[(3731.62±166.39) pg/ml],但三组之间血清的瘦素水平无显著差异（P> 0.05）。龈沟液瘦素水平DMCP组水平最低[(1554.37±161.28) pg/ml],HC组最高[(3868.87±128.99) pg/ml],同时三组龈沟液瘦素水平有显著差异（P<0.01）。血清瘦素水平与性别、BMI密切相关,龈沟液瘦素水平与多个牙周临床指标显著相关。结论 2型糖尿病合并慢性牙周炎患者血清瘦素水平与龈沟液瘦素水平呈现相反的变化趋势。血清瘦素水平与性别、BMI密切相关,龈沟液中的瘦素水平与牙周临床指标密切相关。     

2型糖尿病合并慢性牙周炎患者血清与龈沟液中抵抗素水平的研究

目的:探讨2型糖尿病合并慢性牙周炎患者血清、龈沟液抵抗素水平以及与牙周临床指标的相关性.方法:将60名受试者分成三组,1组:2型糖尿病伴慢性牙周炎患者20人,2组:慢性牙周炎患者20人,3组:健康对照者20人.对所有受试者进行牙周临床检查,检测指标包括:菌斑指数,牙龈指数,出血指数,探诊深度,附着丧失.同时用酶联免疫吸...     

龈沟液生物标志物在慢性牙周炎诊疗中的研究进展

慢性牙周炎(chronic periodontitis,CP)是以牙周软、硬组织破坏为特点的慢性炎症性疾病,局部炎症微环境贯穿慢性牙周炎病损的各个阶段。目前,临床上常用的CP诊断评价指标包括牙周探诊深度、探诊出血和通过影像学检查评估牙槽骨水平等,但在明确牙周疾病进程、精确评估炎症状态等方面有所欠缺。通过生物标志物进行疾病的快速、精准筛查,提供准确的检测信息并可靠地评估CP的疾病状态,是研究的热点。龈沟液(gingival crevicular fluid,GCF)是牙周组织的血清渗出物或炎性渗出物,其中的生物标志物与炎症发展、结缔组织和骨组织破坏的关系密切,因此经常被用作检测CP病损程度的有效指标,对CP治疗效果的评价和预后的评估也有一定的帮助。该文就GCF生物标志物在CP非手术治疗前后的评估价值及研究进展作一综述。     

糖尿病对牙周炎病人龈沟液白介素-1β、前列腺素E2水平的影响

目的：探讨Ⅱ型糖尿病对牙周炎病人龈沟液白介素-1β（IL-1β）、前列腺素E2（PGE2）水平的影响及其与糖脂代谢情况的关系。方法：选择Ⅱ型糖尿病伴发牙周炎病人18例（DM组）、单纯牙周炎病人18例（PD组）和全身、牙周健康者18例（H组）为研究对象。分别测定各组糖化血红蛋白（HbA1C）、血脂水平以及龈沟液（gingival cervicular fluid GCF）中IL-1β、PGE2水平,并同时测定牙周龈沟出血指数、探诊深度、附着丧失等指标。结果：DM、PD组龈沟出血指数（SBI）、探诊深度（PD）、附着丧失（AL）、龈沟液PGE2水平明显高于H组（P〈0．05）,DM与PD组无明显差异;DM组病人糖化血红蛋白、龈沟液IL-1B指标均明显高于PD、H组（P〈0．05）;龈沟液IL-1β水平与HbA1C含量正相关。结论：糖尿病伴发牙周炎病人龈沟液IL-1β水平升高可能受全身因素影响,进一步促进牙周病变发展。     

龈沟产线菌与牙周炎关系的研究进展

随着高通量测序技术的发展,牙周致病菌除使用传统培养方法鉴定出的红色复合体外,许多新的与牙周炎存在较强相关性的微生物种属也相继被发现。其中,龈沟产线菌（ Filifactor alocis,Fa）作为一种专性厌氧的革兰阳性菌,其与牙周炎的发生发展密切相关。Fa不仅可以破坏宿主细胞、诱发免疫逃逸反应,促进牙周炎...     

龈沟液成分及含量变化与糖尿病及心血管疾病的关系

牙周病与多种系统性疾病相关。其中与糖尿病和心血管疾病之间的关系是近年来的研究热点。龈沟液成分的种类和含量可受到糖尿病、心血管疾病的影响而发生变化。分析龈沟液有关成分的变化可提示疾病的进展,并且可以了解这些疾病如何影响牙周病的进展。本文就牙周病患者龈沟液成分与糖尿病及心血管疾病的相关性做一综述。     

In-dental-office screening for diabetes mellitus using gingival crevicular blood

BACKGROUND: Diabetes mellitus (DM) is undiagnosed in approximately 1/2 of the patients actually suffering from the disease. In addition, the prevalence of DM is more than 2x as high in patients with periodontitis when compared to periodontally healthy subjects. Thus, a high number of patients with periodontitis may have undiagnosed DM. AIM: The purpose of this pilot study was to evaluate, whether blood oozing from gingival tissues during routine periodontal examination can be used for determining glucose levels. 32 non-diabetic and 13 diabetic patients with moderate to severe periodontitis were enrolled and subjected to routine clinical periodontal examination. Periodontal pocket probing was performed using a standard force. Blood oozing from gingival tissues of anterior teeth following periodontal pocket probing was collected with the stick of a glucose self-monitoring device (Elite(R) 2000, Bayer Diagnostics GmbH, Munich). As control, fingerstick capillary blood was taken. Statistical analysis was performed by Pearson's correlation coefficient. RESULTS: The patient blood glucose levels ranged from 3.57 mmol/l to 18.01 mmol/l and the values of blood samples taken from gingiva or finger tip showed a very high intrapatient correlation (r=0.98; p<0.0001). CONCLUSION: The results suggested that blood oozing during routine periodontal examination may be used for diabetes mellitus screening in a dental office setting.     

Screening for type 2 diabetes mellitus using gingival crevicular blood

Abstract:  This study was conducted to assess the usefulness of the gingival crevicular blood for estimating the glucose level during routine periodontal examination using Xitux Diagnostics Smart-X self-monitoring blood glucose device among Jordanian patients attending dental teaching clinics. A total of 34 type 2 diabetic patients (18 males and 16 females) and 26 non-diabetic patients (14 males and 12 females) participated in this study. Glucose level was measured in a sample of gingival crevicular blood and in another sample obtained by finger puncture using a self-monitoring device. Glucose measurements from gingival crevicular blood samples, ranged from 57 to 250 mg dl⁻¹ with a mean of 125.4 ± 60.7 mg dl⁻¹ (±SD) and glucose measurements obtained by finger puncture, ranged from 62 to 263 mg dl⁻¹ with a mean of 131.9 ± 61.1 mg dl⁻¹. Pearson's correlation coefficient was performed to assess the correlation between the glucose measurements in these two samples. Pearson's correlation coefficient showed an almost perfect positive correlation between the gingival readings and finger-puncture readings ( r  = 0.997, P  < 0.0001). In conclusion, gingival crevicular blood can provide an acceptable source for measuring blood glucose level. However, the technique to obtain an acceptable blood sample from gingival crevices is not always feasible which would limit its application as a clinical practice. Additional studies that refine this technique and use larger sample size are recommended.     

Cellular source and tetracycline-inhibition of gingival crevicular fluid collagenase of patients with labile diabetes mellitus

Accelerated periodontal tissue destruction in patients with labile insulin-dependent diabetes mellitus (DM) and localized juvenile periodontitis (LJP) has been suggested to be related to functional abnormalities of neutrophils. We have recently found that collagenase in gingival crevicular fluid (GCF) of adult periodontitis patients is primarily derived from neutrophils and that neutrophil collagenase activity is more sensitive to inhibition by tetracyclines than collagenase produced by fibroblasts. This study is to characterize the cellular sources, activation and inhibition of collagenase in GCF of DM patients and to compare it with collagenase in LJP GCF. We found differences which may have therapeutic implications. Specific doxycycline inhibition tests revealed that GCF collagenase in DM is derived from neutrophils, whereas the enzyme in LJP originates primarily from fibroblasts. Oxidant, sodium hypochlorite, activated efficiently GCF collagenase of DM but not LJP patients. In contrast, plasmin activated LJP GCF collagenase but not that of DM patients. In GCF of DM patients 50-60% of collagenase existed in an active form, whereas in LJP GCF, the enzyme was almost completely in a latent form. The results suggest that collagenase in GCF of periodontitis patients with labile DM is primarily derived from neutrophils and that tetracycline therapy may be an effective adjunct in treatment aimed at controlling the periodontal breakdown in these patients. On the other hand, in LJP the anti-collagenase property of tetracyclines may be less important for control of periodontal tissue destruction because of the tetracycline-resistance of fibroblast collagenase.     

Cytokine profile in the gingival crevicular fluid of periodontitis patients with and without type 2 diabetes: a literature review

Background: Periodontitis may occur in patients with and without type 2 diabetes (T2D). It may be hypothesized that the gingival crevicular fluid (GCF) cytokine profile in patients with periodontitis with poorly controlled T2D may differ from the GCF cytokine profile in medically healthy individuals with periodontitis. The aim was to review the cytokine profiles in the GCF of patients with periodontitis with and without T2D. Methods: Databases were searched from 1988 to August 2011 using different combinations of various keywords. Titles and abstracts of articles that satisfied the eligibility criteria were screened by the authors and checked for agreement. Only articles published in English were included. Results: Ten studies were included. Two studies reported GCF concentrations of interleukin (IL)‐6 to be higher in patients with periodontitis with T2D compared to medically healthy patients with periodontitis. Two studies showed GCF IL‐6 levels to be higher in periodontitis with T2D compared to medically healthy subjects without periodontitis. In one study GCF levels of IL‐17, IL‐23, and interferon‐γ were higher in patients with periodontitis with T2D compared to medically healthy patients with periodontitis. In one study, GCF concentrations of IL‐8 were significantly higher in patients with periodontitis with T2D compared to medically healthy individuals with periodontitis. Three studies reported GCF levels of IL‐1α to be significantly higher in patients with periodontitis with T2D compared to medically healthy individuals with periodontitis. Conclusion: The GCF cytokine profile in patients with and without T2D seems to be governed by the intensity of periodontal inflammation and the role of T2D in this regard is rather secondary.     

Intracytoplasmic enzymes in gingival crevicular fluid of patients with aggressive periodontitis

Castro CE, Koss MA, López ME. Intracytoplasmic enzymes in gingival crevicular fluid of patients with aggressive periodontitis. J Periodont Res 2011; 46: 522–527. © 2011 John Wiley & Sons A/S Background and Objective: Biochemical parameters of crevicular fluid could provide evidence of periodontal tissue disease. The aim of this study was to analyze enzymes in crevicular fluid in aggressive localized and generalized periodontitis. Material and Methods: One hundred and twenty‐four subjects were classified as having localized (n = 36) or generalized aggressive periodontitis (n = 38) and subclassified into moderate and severe groups. Controls were 50 periodontitis‐free subjects. Activities of the enzymes lactate dehydrogenase, neutrophil elastase, alkaline phosphatase and aspartate aminotransferase were determined. Data were analyzed using one‐way ANOVA and Tukey’s test. Results: Among the subjects with localized aggressive periodontitis, values of lactate dehydrogenase and alkaline phosphatase increased notably in moderate and severe periodontitis compared with control subjects. Values for aspartate aminotransferase increased with the severity of the disease, and neutrophil elastase was increased in the moderate and severe states. In generalized aggressive periodontitis, lactate dehydrogenase showed higher values than in control subjects in both periodontal subgroups. Alkaline phosphatase and neutrophil elastase showed higher significant differences between moderate and severe periodontitis compared with the control group. Aspartate aminotransferase showed differences between the severe and moderate periodontitis groups compared with the control group. Of all the enzymes analyzed, only lactate dehydrogenase showed higher values in localized than in generalized aggressive periodontitis. Conclusion: Lactate dehydrogenase may distinguish localized and generalized aggressive periodontitis. Alkaline phosphatase increases from moderate to severe states in both types of periodontitis. Aspartate aminotransferase and neutrophil elastase only increase with strong evidence of periodontal destruction.