伴2型糖尿病的慢性牙周炎牙周可疑致病菌的检测

目的 检测伴2型糖尿病(diabetes mellitus,DM)的慢性牙周炎(chronic periodontitis,CP)患者龈下菌斑中牙周可疑致病菌的种类和构成,从微生物学角度探讨牙周炎与DM的相互作用机制.方法 采集伴2型DM的CP患者154例(DM组)、不伴DM的单纯CP患者120例(CP组)及40名全身及牙周健康者(N组)的龈下集合菌斑,传统酚-氯仿法提取菌斑DNA,以牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg),伴放线放线杆菌(Actinobacillus actinomycetemcomitans,Aa),具核梭杆菌(Fusobacterium nucleatum,Fn),中间普氏菌(Prevotella intermedia,Pi),福塞坦氏菌(Tannerella forsythia,Tf),齿垢密螺旋体(Treponema denticola,Td)为目标菌,应用以16SrRNA为基础的聚合酶链反应(PCR)技术对龈下菌群进行检测.结果 Pg、Aa、Fn、Pi、Tf、Td在DM组中均可检出;与CP组相比,在性别、年龄、牙周状况基本一致的情况下,轻度牙周炎者DM组Pi的检出率为35%(8/23),CP组为65%(13/20),两组间差异有统计学意义(P<0.05);重度牙周炎者DM组Pg、Aa、Tf的检出率分别为78%(72/92)、27%(25/92)、67%(62/92),CP组分别为58%(35/60)、17%(10/60)、43%(26/60),DM组均显著高于CP组,差异有统计学意义(P<0.05).同时,DM组Aa、Tf PCR产物的平均灰度值(average gradation,AVG)比值显著高于CP组,Pi的AVG比值明显低于CP组,P<0.05.结论 与单纯CP相比,伴2型DM的牙周炎患者龈下菌斑中Pg、Aa、Tf的数量增多,Pi的数量减少.     

伴2型糖尿病的慢性牙周炎牙周可疑致病菌的检测

目的 检测伴2型糖尿病(diabetes mellitus,DM)的慢性牙周炎(chronic periodontitis,CP)患者龈下菌斑中牙周可疑致病菌的种类和构成,从微生物学角度探讨牙周炎与DM的相互作用机制.方法 采集伴2型DM的CP患者154例(DM组)、不伴DM的单纯CP患者120例(CP组)及40名全身及牙周健康者(N组)的龈下集合菌斑,传统酚-氯仿法提取菌斑DNA,以牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg),伴放线放线杆菌(Actinobacillus actinomycetemcomitans,Aa),具核梭杆菌(Fusobacterium nucleatum,Fn),中间普氏菌(Prevotella intermedia,Pi),福塞坦氏菌(Tannerella forsythia,Tf),齿垢密螺旋体(Treponema denticola,Td)为目标菌,应用以16SrRNA为基础的聚合酶链反应(PCR)技术对龈下菌群进行检测.结果 Pg、Aa、Fn、Pi、Tf、Td在DM组中均可检出;与CP组相比,在性别、年龄、牙周状况基本一致的情况下,轻度牙周炎者DM组Pi的检出率为35%(8/23),CP组为65%(13/20),两组间差异有统计学意义(P<0.05);重度牙周炎者DM组Pg、Aa、Tf的检出率分别为78%(72/92)、27%(25/92)、67%(62/92),CP组分别为58%(35/60)、17%(10/60)、43%(26/60),DM组均显著高于CP组,差异有统计学意义(P<0.05).同时,DM组Aa、Tf PCR产物的平均灰度值(average gradation,AVG)比值显著高于CP组,Pi的AVG比值明显低于CP组,P<0.05.结论 与单纯CP相比,伴2型DM的牙周炎患者龈下菌斑中Pg、Aa、Tf的数量增多,Pi的数量减少.     

2型糖尿病伴慢性牙周炎患者牙周可疑致病菌的定植研究

目的:研究2型糖尿病伴慢性牙周炎患者龈下菌群的定植,进一步探讨牙周可疑致病菌在慢性牙周炎与2型糖尿病关系中的作用.方法:采集90例重度慢性牙周炎及30例牙周健康的2型糖尿病患者的龈下集合菌斑,以牙周可疑致病菌牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)、放线共生放线杆菌(Aggregatibacer actinomycetemcomitans,Aa)、具核梭杆菌(Fusobacterium nucleatum,Fn)、中间普氏菌(Prevotella intermedi,Pi)、福塞坦氏菌(Tannerella forsythia,Tf)、牙垢密螺旋体(Treponema denticola,Td)为目标菌,应用以16S rRNA为基础的聚合酶链反应(PCR)技术对龈下菌群进行检测,并测定PCR产物电泳条带的灰度值,以计算各种细菌在菌斑中所占的比例.采用t检验、x2检验、Pearson相关等统计方法,分析患者空腹(FBG)及糖耐量实验2h血糖(OGTT 2h BG)水平,血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平与细菌种类和细菌在菌斑中所占比例的关系.结果:Tf阳性患者的TC水平显著高于阴性患者,Tf在菌斑中所占比例与空腹血糖水平显著正相关,P=0.002;Pg在菌斑中所占比例与TC显著正相关,P=0.035;Pi在菌斑中所占比例与空腹血糖和血浆总胆固醇(TC)水平显著负相关,P分别为0.003、0.041.结论:2型糖尿病对某些牙周可疑致病菌的定植有一定影响.     

牙周可疑致病菌的传播性研究进展

现代分子生物学的快速进展为微生物的分类学研究提供了多种高敏感度的方法,使研究各类细菌的传播途径成为可能。近年来研究表明牙周可疑致病菌可交互传播,本文着重就其中与牙周疾病关系密切的相关细菌在人群中传播的可能性及途径的研究进展进行综述。     

慢性牙周炎龈下菌斑中五种牙周可疑致病微生物的分布

目的研究五种牙周可疑致病微生物在慢性牙周炎患者龈下菌斑的分布。方法选择27例慢性牙周炎患者,每位患者选取牙周袋最深的两个位点作为观察位点,采集龈下微生物样本,采用多重聚合酶链反应和反杂交的方法对伴放线菌嗜血菌、牙龈卟啉单胞菌、福赛斯坦纳菌、中间普雷沃菌和齿垢密螺旋体五种微生物进行半定量检测。结果在所检测的54个位点中,牙龈卟啉单胞菌、中间普雷沃菌、福赛斯坦纳菌和齿垢密螺旋体均有较高的检出率,分别为98.15%、92.59%、100%和98.15%;伴放线菌嗜血菌检出率较低,为20.37%。牙龈卟啉单胞菌和福赛斯坦纳菌的检出量明显高于其他三种微生物,其差异有统计学意义（P<0.05）。结论慢性牙周炎患者多存在牙龈卟啉单胞菌、福赛斯坦纳菌、中间普雷沃菌和齿垢密螺旋体的同时感染,且牙龈卟啉单胞菌和福赛斯坦纳菌的感染量较高。     

牙周炎可疑致病菌对慢性肾脏病的影响及可能机制

慢性肾脏病发病率高、病死率高,已逐步成为严重威胁人类身体健康的全球公共卫生问题。牙周炎作为常见的口腔慢性感染性疾病,与慢性肾脏病具有相关性。牙周可疑致病菌是牙周炎的始动因子,在慢性肾脏病的发生、发展中可能起到重要作用。文章就牙周可疑致病菌对慢性肾脏病的影响及可能机制做一综述。     

2型糖尿病伴慢性牙周炎牙周基础治疗的疗效观察

目的观察牙周基础治疗对2型糖尿病伴慢性牙周炎患者在临床指标及血糖控制方面的影响。方法选取52例2型糖尿病伴慢性牙周炎患者并随机分为2组。实验组行牙周基础治疗和药物治疗，对照组仅给予药物治疗。治疗前后分别记录患者各项临床指标和糖化血红蛋白水平。结果治疗后16周实验组菌斑指数（PLI）及出血指数显著减少，且PLI与对照组差异有统计学意义（P〈0.001）：两组患者其他各项临床指标和糖化血红蛋白水平在治疗后有一定改善，但差异无统计学意义。结论牙周基础治疗有利于2型糖尿病伴慢性牙周炎患者减轻牙周炎症及在一定程度上改善代谢状况。     

未获培养微生物与牙周可疑致病菌的牙周共生状态

目的：探索未获培养微生物与牙周可疑致病菌的共生关系。方法：使用基于16SrRNA基因检测的PCR法，对慢性牙周炎患者龈下菌斑中牙周可疑致病微生物和代表性未获培养微生物进行检测，通过KAPPA检验分析任意两种细菌对间的关系。结果：在56个细菌对中发现6对细菌的KAPPA值具有显著性。结论：Pg／T.d、B．f/T．d、B．f／F.n细菌组合的共生关系与文献报道一致，AU126／P．n、AU126／F．n、AU126／X112细菌对间的共生关系显示了未获培养微生物在龈下菌群中扮演的角色。     

牙周可疑致病菌的传播性研究进展

现代分子生物学的快速进展为微生物的分类学研究提供了多种高敏感度的方法，使研究各类细菌的传播途径成为可能。近年来研究表明牙周可疑致病菌可交互传播，本文着重就其中与牙周疾病关系密切的相关细菌在人群中传播的可能性及途径的研究进展进行综述。     

牙周非手术治疗对2型糖尿病伴慢性牙周炎患者血糖代谢水平的影响

目的探讨牙周非手术治疗对2型糖尿病伴慢性牙周炎患者牙周状况和血糖代谢水平的影响。方法 2型糖尿病伴慢性牙周炎患者135例,糖化血红蛋白（glycosylated hemoglobin,HbA1c）平均值（7.33±1.42）%,随机分为治疗组和对照组。治疗组接受牙周非手术治疗,对照组暂不接受治疗,只接受口腔卫生宣教。观察2组干预前及干预后3个月、干预后6个月的牙周临床指标,包括探诊深度（probing depth,PD）、菌斑指数（plaque index,PLI）、探诊出血（bleeding on probing,BOP）和血糖代谢指标,包括空腹血糖（fasting plasma glucose,FPG）、HbA1c的变化情况。结果同治疗前相比,治疗组全口平均PD（F=89.956,P=0.000）、PLI（F=82.399,P=0.000）、BOP（F=169.535,P=0.000）随时间推移下降,差异有统计学意义。对照组全口平均PD随时间推移差异无统计学意义（F=3.002,P=0.076）;PLI（F=11.443,P=0.001）、BOP（F=6.537,P=0.008）下降有统计学意义。干预后6个月,组间比较PD（t=-3.318,P=0.001）、PLI（t=-4.354,P=0.000）、BOP（t=-5.868,P=0.000）差异有统计学意义。治疗组FPG（F=4.325,P=0.015）和HbA1c（F=6.654,P=0.003）随时间推移下降,差异有统计学意义;对照组FPG（F=0.215,P=0.756）和HbA1c（F=1.767,P=0.184）随时间推移变化无统计学意义;干预后6个月,两组间FPG（t=-1.386,P=0.171）和HbA1c（t=-1.065,P=0.289）差异无统计学意义。结论牙周非手术治疗能有效控制2型糖尿病伴牙周炎患者的牙周炎症;尚不能认为牙周非手术治疗可以改善糖尿病患者的血糖代谢。     

牙周病伴2型糖尿病248例种植义齿治疗总结

目的 探讨牙周病伴2型糖尿病患者实施种植义齿治疗的风险和处理对策.方法 回顾分析2000至2008年在成都华西牙种植医院、华西口腔深圳门诊部、华西口腔重庆门诊部接受种植义齿治疗的248例牙周病伴2型糖尿病患者,以种植体存留率为评价指标,对数据进行统计分析.结果 248例患者选用Nobel Replace和CDIC两个种植系统,采用不翻瓣和骨膨胀的微创植入术,共植入牙种植体1190枚(Nobel Replace 333枚、CDIC 857枚).6枚(0.5％)种植体在术后6个月愈合期内脱落,术后1年种植体存留率为98.4％ (1165/1184)、5年存留率为95.3％ (487/511)、8年存留率为89.2％ (91/102).结论 严格掌握适应证和控制风险的情况下,牙周病伴2型糖尿病患者种植修复可获得较高的满意度.     

Investigation and quantification of key periodontal pathogens in patients with type 2 diabetes

Field CA, Gidley MD, Preshaw PM, Jakubovics N. Investigation and quantification of key periodontal pathogens in patients with type 2 diabetes. J Periodont Res 2012; 47: 470–478. © 2012 John Wiley & Sons A/S Background and Objective: Diabetes is a recognized risk factor for periodontitis. There are conflicting data regarding whether healthy diabetic patients or diabetic patients with chronic periodontitis have an altered subgingival microbiota compared with nondiabetic individuals. The aim of the present study was to detect quantitative differences in selected periodontopathogens in the subgingival plaque of diabetic patients using TaqMan quantitative PCR. Material and Methods:  Type 2 diabetes mellitus patients with (n = 9) or without chronic periodontal disease (n = 15) were recruited and matched to nondiabetic control subjects (n = 12 periodontally healthy, n = 12 chronic periodontitis). Subgingival plaque samples were collected from deep (> 4 mm probing depth) and shallow sites (≤ 3 mm probing depth) using paper points, and Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Porphyromonas gingivalis were quantified. Results: Forty‐eight subjects (69 samples) were recruited. Marked differences were seen in the levels of all three bacterial species, relative to the total bacterial population, according to periodontal health status. Using real‐time quantitative PCR, bacterial counts for P. gingivalis were significantly higher in deep pockets of diabetic and nondiabetic subjects compared with periodontally healthy subjects (p < 0.05) but did not differ significantly between diabetics and nondiabetics. A. actinomycetemcomitans was detected in all groups in low quantities, and counts did not differ significantly between groups (p > 0.05). F. nucleatum was abundant in all groups, with no clear significant differences between groups. P. gingivalis was found in higher quantities in periodontitis than in periodontally healthy subjects (p < 0.05). Statistically significant positive correlations were identified between pocket depth and counts for all three species tested (p < 0.05). Conclusion: A. actinomycetemcomitans, F. nucleatum and P. gingivalis were present in significantly different quantities and proportions in subgingival plaque, according to periodontal disease status. No significant differences were identified between the subgingival microbiota of type 2 diabetes mellitus patients compared with nondiabetic subjects.     

5种牙周龈下可疑致病微生物与慢性牙周炎局部不同牙周状态间的关系

目的 观察5种龈下微生物检出水平与慢性牙周炎局部牙周状态的关系。方法 选择20例慢性牙周炎患者的80个位点及10例牙周健康者的20个位点为观察位点,采集龈下微生物样本,记录牙周探诊深度（PD）,根据所测位点的PD进行分组。PD≤4 mm为A组,4 mm＜PD≤6 mm为B组,PD>6 mm为C组,健康对照组为H组。通过聚合酶链反应（PCR）和DNA探针反杂交技术半定量检测各组伴放线菌嗜血菌、牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体和中间普氏菌的检出率和检出水平。结果 B、C组牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体和中间普氏菌的检出率和检出水平均高于H组,A组牙龈卟啉单胞菌的检出率和检出水平也高于H组,C组福赛斯坦纳菌和齿垢密螺旋体检出水平高于B组,以上差异均有统计学意义（P<0.05）;伴放线菌嗜血菌在各组间的检出率及检出水平都无明显差异。结论 随着牙周袋的加深,牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体和中间普氏菌体的阳性检出率和检出水平都有随之增加的趋势;牙龈卟啉单胞菌与慢性牙周炎的早期炎症关系较为密切,而福赛斯坦纳菌和齿垢密螺旋体与中重度慢性牙周炎炎症位点的严重程度有关。     

Prevalence of periodontal pathogens with varying metabolic control of diabetes mellitus

Abstract. The purpose of this study was to determine the prevalence of 5 periodontal pathogens in individuals with diabetes mellitus. Subjects ( n = 107) 20–70 years of age with type 1 ( n = 60) or 2 ( n = 47) diabetes mellitus were studied for the occurrence of the periodontal pathogens A. actinomycetemcomitans, F. nude-alum, E. corrodens, P. gingivalis and P. intermedia. Subgingival plaque was sampled in each subject from a single site exhibiting the greatest inflammation. The evaluation of selected periodontal bacterial pathogens was based on an immunoassay utilizing bacterial specific monoclonal antibodies. 35% of the sites harbored P. gingivalis , 28% F. nucleatum and 21% E. corrodens. A. actinomycetemcomitans and P. intermedia were found in less than 10% of the sites. Subjects for whom the probing depth at the sampled site was 4 mm were more often found to have detectable pathogens than those with a probing depth 3 mm. Diabetic factors such as duration, type and metabolic control of the disease had no statistically significant effect on the prevalence of these bacteria.     

牙周非手术治疗对2型糖尿病伴牙周炎患者糖代谢及血清白细胞介素6的影响

目的 观察牙周非手术治疗对2型糖尿病伴慢性牙周炎(chronic periodontitis,CP)患者牙周状况、糖代谢及血清白细胞介素6(IL-6)的影响,探讨其可能的影响机制.方法 选取2型糖尿病伴慢性牙周炎(type 2 diabetes mellitus with chronic periodontitis,DMCP组)和不伴有全身系统性疾病的CP患者(CP组)各55例进行牙周非手术治疗,其中DMCP组中糖化血红蛋白(glycated hemoglobin,HbA1c)＜7.00%的患者为血糖控制较好组(A1组),HbAlc≥7.00%的为血糖控制较差组(A2组).在治疗前及治疗后6周、3个月时分别记录全口探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、出血指数(beeding index,BI)和菌斑指数(plaque index,PLI),并检测空腹血糖(fasting plasma glucose,FPG)、HbA1c及血清IL-6水平.结果 DMCP组和CP组PD、AL、BI、PLI和血清IL-6水平在治疗后6周及3个月时均显著降低(P＜0.05),其中DMCP组血清IL-6从(3.47±0.33)ng/L(治疗前)显著降至(3.21±0.66)ng/L(治疗后6周),再降至(3.03±0.54)ng/L(治疗后3个月).DMCP组治疗后3个月HbA1c水平[(6.80±1.21)%]与治疗前[(7.35±1.73)%]相比显著降低(P＜0.05),其中A2组HbA1c水平从治疗前的(8.72±1.51)%显著降至治疗后3个月的(7.59±1.28)%(P＜0.05),而A1组HbA1c水平则无明显变化(P＞0.05).结论 牙周非手术治疗能够降低DMCP患者血清IL-6水平,并在一定程度上改善患者糖代谢状况;该治疗能显著改善血糖控制较差者的糖代谢,而对血糖控制较好者的糖代谢则无明显影响.

Abstract：

Objective To evaluate the effect of non-surgical periodontal therapy on periodontal status, glycemic control and the level of serum interleukin(IL)-6 in type 2 diabetic patients with chronic periodontitis (DMCP). Methods Fifty-five DMCP and 55 systemically healthy patients with chronic periodontitis(CP) were recruited in this study. The diabetes were classified into two groups, the wellcontrolled group [glycated hemoglobin (HbA1c) ＜ 7.00%]and the poorly controlled group (HbA1c ≥7.00%). All subjects received non-surgical periodontal therapy. Periodontal clinical parameters including periodontal probing depth (PD), attachment loss (AL), bleeding index (BI) and plaque index (PLI) were recorded at baseline, 6 weeks and 3 months after the treatment. Fasting plasma glucose(FPG), HbA1c and the concentration of serum IL-6 were measured. Results At 6 weeks and 3 months after treatment, PD,AL, BI, PLI and the concentration of serum IL-6 of both groups significantly reduced(P ＜ 0. 05). The level of IL-6 in diabetic patients reduced significantly from (3.47 ±0.33) ng/L to (3.21 ±0.66) ng/L and to (3.03 ± 0. 54) ng/L. The HbA1c of diabetic patients reduced significantly 3 months after treatment [(6.80±1.21%]compared with the baseline[(7.35 ± 1.73)%, P ＜0.05]. HbA1c of the poorly controlled group reduced significantly(P ＜0. 05), while HbA1c of the well-controlled diabetes did not show any apparent reduction (P ＞ 0. 05). Conclusions Non-surgical periodontal therapy can effectively reduce the concentration of serum IL-6, thereby improving glycemic control in type 2 diabetes patients with chronic periodontitis. However, there was no any significant reduction of HbA1c in the well-controlled diabetes.