快速进展性牙周炎患者龈沟液中的弹性蛋白酶活性

目的探讨中性多形核白细胞与快速进展性牙周炎的关系。方法检测２例快速进展性牙周炎患者共１０２个位点（其中２８个位点进行治疗前后的对比）的龈沟液弹性蛋白酶活性，将人多形核白细胞弹性蛋白酶特异底物———Ｓ２４８４与龈沟液反应，测吸光度值，以反映龈沟液弹性蛋白酶活性。结果快速进展性牙周炎龈沟液中的弹性蛋白酶活性［（０．６３±０．３８）Ａｂｓ／位点］明显高于健康对照组［（０．０７±０．０５）Ａｂｓ／位点］，差异有显著性；弹性蛋白酶活性的高低与龈沟液体积、探诊深度、附着丧失和出血指数呈正相关关系；治疗后龈沟液体积和各临床指数显著降低，弹性蛋白酶活性也从治疗前的（０．７３±０．３６）Ａｂｓ／位点下降为（０．１±０．１７）Ａｂｓ／位点，差异有显著性。结论快速进展性牙周炎患者的中性多形核白细胞并不是趋化反应不足，而是过度浸润与释放溶酶体酶，起协同致炎作用。

The elastase activity in gingival crevicular fluid from rapidly progressive periodontitis

OBJECTIVE: It is now generally accepted that polymorphonuclear neutrophil (PMN) chemotactic defect increases the patient's susceptibility to early-onset periodontitis. However, some reports including ours have failed to show defective PMN chemotaxis in rapidly progressive periodontitis(RPP) patients. The purpose of the study was to survey the role of PMN in the progression of RPP. METHODS: The elastase activity in gingival crevicular fluid from 22 RPP patients and 11 healthy controls were studied. For the control group and 12 RPP patients, 30 s GCF and clinical data were obtained at the first visit. For other 10 RPP patients, 30 s GCF and clinical data were collected prior to treatment and 4 weeks after scaling and root-planing. The elastase activity was measured with a low molecular weight substrate (L-Pyroglutamyl-L-prolyl-L-valine-p-nitroaniline, S2484) specific for granulocyte elastase. RESULTS: The pre-treatment elastase activity was much higher (0.63 +/- 0.38, Abs/site) in RPP patients than that in control subjects (0.07 +/- 0.05, Abs/site). The elastase activity was positively correlated with GCF volume, probing depth, attachment loss and gingival bleeding. Scaling and root-planing resulted in decrease of both clinical data and elastase activity. CONCLUSION: These results suggested that PMN with the increased accumulation or the increased release of lysosomal enzymes may play a role in the pathogenesis of RPP.