结构化治疗与教育课程对血液透析患者慢性牙周炎的作用

目的开发血液透析患者慢性牙周炎结构化治疗与教育课程(STEP)，探讨其对患者牙周健康状态、口腔保健自我效能、牙科畏惧和焦虑、以及全身炎症水平的作用。 方法选取2020年9月至2021年3月北京市某三甲医院的96例确诊为慢性牙周炎的老年血液透析(HD)患者，随机分为对照组和干预组。对于患者的口腔宣教，对照组(48例)使用传统方法，干预组(48例)则使用STEP方法。7个月后分析患者的菌斑指数(PLI)、龈沟出血指数(SBI)、牙周袋探诊深度(PD)、口腔保健自我效能量表(SESS)、牙科焦虑量表(DAS)、牙科畏惧量表(DFS)评分，以及超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和转化生长因子β(TGF-β)的变化。 结果与对照组比较，干预组患者的PLI、SBI、PD、SESS、DAS、DFS评分均改善(P<0.05)，且hs-CRP、TNF-α水平显著降低(P<0.001)，而IL-6、TGF-β指标改善不具有统计学意义。 结论STEP方法显著改善了血液透析合并慢性牙周炎患者的口腔健康状况、自我保健意识、焦虑和畏惧情绪、以及全身炎症水平。

Effect of structured treatment and education program on chronic periodontitis in hemodialysis patients

ObjectiveTo develop a structured treatment and education program (STEP) for chronic periodontitis of hemodialysis patients, and explore its impact on the patients′ periodontal health status, self-efficacy for oral care, dental fear and anxiety, and systemic inflammation level. MethodsA total of 96 elderly hemodialysis patients with chronic periodontitis from a tertiary hospital in Beijing from September 2020 to March 2021 were selected and randomly divided into a control group and an intervention group. The control group (48 cases) was given the oral education with the traditional method, and the intervention group (48 cases) was given the oral education with the STEP method. After 7 months, the patients were analyzed for plaque index (PLI), sulcus bleeding index (SBI), probing depth of periodontal pocket (PD), self-efficacy scale for self-care (SESS), dental anxiety scale (DAS), and dental fear scale (DFS) score, as well as high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), and transforming growth factor β (TGF-β) levels. ResultsCompared with the control group, the intervention group showed that the scores of PLI, SBI, PD, SESS, DAS, and DFS were all improved (P<0.05), and that the hs-CRP and TNF-α levels were significantly decreased (P<0.001), while the changes of IL-6 and TGF-β levels were not statistically significant. ConclusionThe STEP method significantly improved the oral health status, self-care awareness, anxiety and fear, and systemic inflammation level of the hemodialysis patients with chronic periodontitis.