糖尿病前期和牙周炎的相互关系

糖尿病前期是从早期代谢异常到糖尿病的过渡期,牙周炎是发生在牙周组织的慢性感染性疾病.糖尿病前期和牙周炎之间存在着相关性,即糖尿病前期增加牙周炎的发病率及其严重程度,牙周炎亦加重糖尿病前期的严重程度,牙周炎治疗可以有效改善糖尿病前期患者的糖代谢.氧化应激和细胞因子,包括肿瘤坏死因子-α以及白细胞介素-1β和6,可能是影响这两种疾病发生发展的关键环节.肥胖和年龄是这两种疾病的共同危险因素,可促进这两种疾病同时发生发展.本文主要就糖尿病前期与牙周炎相关性及可能作用机制进行阐述.     

糖尿病与牙周炎的关系

糖尿病与牙周炎关系密切，糖尿病患者伴发重度牙周炎的风险比非糖尿病患者增高２￣３倍，而牙周慢性炎症又会促进患者血糖升高。二者有共同的遗传学基础，糖尿病还通过对牙周菌群、中性粒细胞功能，炎症反应强度，胶原代谢及组织愈合能力的影响促进牙周炎的发生。本文探讨了糖尿病和牙周炎的相互影响及糖尿病患者的牙周治疗有关注意事项。     

糖尿病与牙周炎的关系

糖尿病与牙周炎关系密切,糖尿病患者伴发重度牙周炎的风险比非糖尿病患者增高2～3倍,而牙周慢性炎症又会促进患者血糖升高。二者有共同的遗传学基础,糖尿病还通过对牙周菌群、中性粒细胞功能、炎症反应强度、胶原代谢及组织愈合能力的影响促进牙周炎的发生。本文探讨了糖尿病和牙周炎的相互影响及糖尿病患者的牙周治疗有关注意事项。     

C-反应蛋白及其与2型糖尿病和牙周炎间的相互关系

C-反应蛋白（CRP）是一种出现于炎症性疾病急性期的蛋白,与2型糖尿病和牙周炎密切相关。本文就CRP的生物学特征,CRP与2型糖尿病和牙周炎之间的相关性,CRP在2型糖尿病与牙周炎相互联系中的作用等研究进展作一综述。     

牙周炎伴发糖尿病的临床治疗

对牙周炎伴发糖尿病６８例病人的治疗进行观察，实验组牙周炎及糖尿病同时治疗，而对照组仅治疗牙周炎，观察３０天。结果为实验组中牙周炎显效３４例，占９１．９％，对照组牙周炎显效１１例，占２９．７％．ｘ＾２＝３２．８〉７．８８，Ｐ〈０．００５。结果表明，对于牙周炎伴发糖尿病病人，在治疗牙周炎的同时，治疗糖尿病，可以明显提高牙周炎的疗效。     

糖尿病性牙周炎与氧化应激的研究进展

糖尿病性牙周炎是糖尿病的并发症之一,由于糖尿病的存在,使得牙周炎病人牙周组织的破坏程度和病程进展速度都显著增高。近年来,氧化应激在糖尿病并发症中的作用机制日益得到重视,本文拟通过文献回顾对目前氧化应激在糖尿病性牙周炎中的的研究进展作一综述。     

武汉市公务员糖尿病与牙周炎相关性调查研究

目的：对武汉市国家公务员的牙周状况及血糖情况进行调查,探讨糖尿病与牙周炎的相关性。方法：2004.11～12月,对武汉市国家公务员以工作单位为抽样框进行随机整群抽样,对493人进行了血糖及牙周状况的横断面调查,其中458人符合纳入标准作为研究对象,再把研究对象分为中青年年龄段（30～59岁）与老年年龄段（60岁以上）分别进行研究。最终资料通过χ2检验及Logistic多因素回归分析进行统计学分析。结果：在单因素分析中,糖尿病与牙周炎具有相关性;在整个人群的多因素分析中,以年龄在30～39岁这一组作为对照时,年龄在40～49岁组,50～59岁、70岁以上组与之相比没有显著差异（P〉0.05）,而60～69岁组与之相比有统计学差异（P〈0.05）.说明在60～69岁这一年龄段患牙周炎的风险增加。老年组人群（60岁以上）血糖值与牙周炎在统计学上呈正相关。提示血糖超过7.0mmol/L（OR=6.906,CI1.274～37.424）是牙周炎的危险因素。结论：糖尿病为牙周炎患病的危险因素,对牙周炎患病的影响主要在老年阶段（60岁以上）。     

牙周炎伴发糖尿病的临床治疗

对牙周炎伴发糖尿病68例病人的治疗进行观察，实验组牙周炎及糖尿病同时治疗，而对照组仅治疗牙周炎，观察30天。结果为实验组中牙周炎显效34例，占91．9％，对照组牙周炎显效11例，占29．7％。x2＝32．8＞7．88，P＜0．005。结果表明，对于牙周炎伴发糖尿病病人，在治疗牙周炎的同时，治疗糖尿病，可以明显提高牙周炎的疗效。     

糖尿病在大鼠实验性牙周炎发生中的作用

以链脲佐菌素诱发的糖尿病大鼠和健康大鼠为地象，高糖食谱加自身粪便为致牙周病因子，显微镜下观察大鼠磨牙周组织的组织学改变，结果表明正常大鼠在高糖食谱加自身粪便的作用下，９周时方可出现上皮增生，上皮下结缔组织和越隔纤维表层炎细胞浸润，而糖尿病大鼠在同样的实验条件下，３周便出现类似的损害，９周时，出现深层组织的炎细胞浸润。牙槽骨吸收和深牙周袋形成，表明糖尿病具有缩短引起实验性牙周炎的时间和加重牙周组织破     

132例老年人糖尿病与牙周病相互关系的临床观察

糖尿病与牙周炎密切相关,具有双向相互作用,有共同的发病基础。近些年学者提出将牙周炎列为糖尿病的第六并发症,患有糖尿病的牙周炎患者,如血糖未能被很好的控制,牙周病变的发展有其特殊性。糖尿病患者的血糖控制情况、患病的年限与牙周病牙槽骨吸收破坏程度的比例关系,本研究旨在观察。     

慢性牙周炎与2型糖尿病的关系研究进展

慢性牙周炎（chronic periodontitis,CP）与糖尿病（diabetes mellitus,DM）关系密切,其相互影响是近年来牙周医学研究的热点。DM是CP的危险因素之一,可通过多种机制促进CP发生发展,同时CP也是DM的第6大并发症,可影响DM病程进展,约90%以上的DM为2型糖尿病（type 2 diabetes mellitus,T2DM）,本文就CP和T2DM相互影响的特点及机制等方面的研究进展作一综述。     

2型糖尿病患者牙周指标与糖化血红蛋白关系的研究

目的 :研究 2型糖尿病患者牙周指标与糖化血红蛋白间的相关关系。方法 :随机选择 3 0例 2型糖尿病伴牙周炎患者于牙周基础治疗前检测其体重 ,菌斑指数 ,牙龈指数 ,探诊出血指数 ,探诊深度 ,附着丧失 ,糖化血红蛋白值。结果 :糖化血红蛋白与附着丧失、年龄的密切相关。结论 :糖化血红蛋白是影响牙周破坏的重要指标。     

Long-term control of diabetes mellitus and periodontitis

Abstract The purpose of this study was to evaluate the association between long-term control of diabetes mellitus (DM) and periodontitis, A total of 75 diabetics (Type I or II) aged 20–70 years with long-term records of their diabetic control were selected for the study. The following periodontal variables were recorded in a randomized half-mouth examination: plaque, calculus (+/?), probing depth (pd) and attachment loss (al). The mean of glycosylated hemoglobin measurements (IIbAlc) over the past 2–5 years was used to indicate the long-term control of DM. The study participants were divided into well-, moderately- and poorly-controlled diabetics. An increase in the prevalence, severity and extent of periodontitis with poorer control of diabetes was observed. The extent of calculus also increased with poorer control. In a multiple regression analysis, calculus and long-term control of diabetes were significant variables when pd≥4 mm was used as the dependent variable. Age was a significant predictor for al > 3 mm but not for pd ≥4 mm. Sex, duration and type of DM were not significant variables in the regression models. Less than 2% of sites with no calculus demonstrated pd≥4mm. When calculus was present, the frequency of pd ≥4 mm increased from 6% in the well-controlled diabetics to 16% in the poorly-controlled ones. We conclude that periodontitis in diabetics is associated with long-term metabolic control and presence of calculus. Therefore, regular maintenance care, including patient motivation and instruction as well as professional calculus removal, is important for diabetic patients.     

Diabetes mellitus-associated periodontitis: differences between type 1 and type 2 diabetes mellitus

Aspriello SD, Zizzi A, Tirabassi G, Buldreghini E, Biscotti T, Faloia E, Stramazzotti D, Boscaro M, Piemontese M. Diabetes mellitus‐associated periodontitis: differences between type 1 and type 2 diabetes mellitus. J Periodont Res 2011; 46: 164–169. © 2010 John Wiley & Sons A/S Background and Objective: Although many studies have appeared about diabetes mellitus‐associated periodontitis, few have compared periodontitis inflammatory markers between type 1 (T1DM) and type 2 diabetes mellitus (T2DM), and information regarding this issue is scarce and contradictory. We evaluated the levels of plasma C‐reactive protein and of interleukin‐1β (IL‐1β), interleukin‐6 (IL‐6) and tumour necrosis factor‐α (TNF‐α) in gingival crevicular fluid in two groups of subjects affected by T1DM and T2DM, in order to identify possible differences between the two classes in the inflammatory mechanisms of diabetes mellitus‐associated periodontitis. Material and Methods: Plasma C‐reactive protein and gingival crevicular fluidIL‐1β, IL‐6 and TNF‐α were measured in periodontitis patients affected by type 1 (P‐T1DM, n = 24) and type 2 diabetes mellitus (P‐T2DM, n = 24). Results: Gingival crevicular fluid levels of IL‐1β and TNF‐α in P‐T1DM subjects were significantly higher than in P‐T2DM subjects. In P‐T1DM subjects, we found significant negative correlations between the duration of diabetes mellitus and IL‐1β and between the duration of diabetes mellitus and TNF‐α. Conclusion: This study shows that IL‐1β and TNF‐α levels in periodontitis patients with T1DM are affected by the duration of diabetes mellitus.     

RAGE基因多态性与2型糖尿病伴慢性牙周炎遗传易感性的相关研究

［摘要］ 目的 探讨晚期糖基化终产物受体(receptor for advanced glycation end products, RAGE)基因的5个SNP位点在2型糖尿病伴慢性牙周炎、单纯慢性牙周炎、健康对照北方汉族人群中分布的差异,从而研究RAGE基因是否为糖尿病和牙周炎可能的致病易感基因。方法 运用飞行时间质谱法检测19例2型糖尿病伴慢性牙周炎患者(DM组),22例单纯慢性牙周炎组(CP组)以及54例健康对照组(H组)全血基因组DNA中5个单核苷酸多态性(single nucleotide polymorphism, SNP)位点。结果 rs17846808、rs1800625、rs184003、rs2070600、rs3134940基因多态性在三组间分布无差异。DM组中的rs3134940 A/A（野生纯合子）基因型人群的龈沟出血指数(sulcus bleeding index,SBI)显著高于(A/G+G/G,杂合子和突变纯合子)基因型人群的SBI。CP组中的rs1800625 (T/C+C/C)和rs3134940 (A/G+G/G,杂合子和突变纯合子)基因型人群缺失牙数显著性增高。结论 RAGE基因并非2型糖尿病以及慢性牙周炎的易感基因。rs3134940 G等位基因可能在2型糖尿病伴慢性牙周炎进展过程中起到一定保护作用。     

脂联素基因多态性与慢性牙周炎及2型糖尿病的相关性研究

目的 了解牙周炎及糖尿病易感性与脂联素基因45位点和276位点多态性的关系,以期为进一步预防糖尿病伴慢性牙周炎的发生提供依据.方法 选取2008年1月至2010年12月四川大学华西口腔医学院就诊者、四川大学华西医院健康检查中心的体检者及四川大学华西口腔医学院病源库的患者共200例,按全身及牙周情况分为健康对照组、慢性牙周炎组、2型糖尿病组、慢性牙周炎伴2型糖尿病组,每组50例.分别收集颊黏膜拭子,提取DNA,再通过聚合酶链反应-限制性片段长度多态性检测脂联素基因45位点和276位点的基因型分布.对结果数据计量资料行方差分析,计数资料行x2检验,对性别、年龄、276位点和45位点基因多态性与慢性牙周炎和2型糖尿病的关系进行多因素Logistic回归分析,检验水准为双侧α=0.05.结果 健康对照组276位点基因型分布(GG:20例,GT:26例,TT:4例)与2型糖尿病组(GG:16例,GT:20例,TT:14例)差异有统计学意义(P=0.034);45位点基因型分布在健康对照组(GG:26例,TG:21例,TT:3例)与2型糖尿病组(GG:27例,TG:22例,TT:1例)差异无统计学意义(P =0.856);健康对照组276位点基因型分布与慢性牙周炎组(GG:14例,GT:30例,TT:6例)差异无统计学意义(P =0.418);45位点基因型在健康对照组及慢性牙周炎组(GG:30例,TG:18例,TT:2例)差异亦无统计学意义(P =0.699).多项Logistic回归分析表明仅在慢性牙周炎伴2型糖尿病组中性别与慢性牙周炎和2型糖尿病的共同发病有关(P=0.011,OR =2.938).结论 本项研究结果表明276位点基因多态性与2型糖尿病间存在着密切联系,而45位点基因多态性则与2型糖尿病无关;两者均与慢性牙周炎无关.     

内皮细胞型一氧化氮合成酶Glu298Asp基因多态性与牙周炎伴Ⅱ型糖尿病的相关性研究

目的研究内皮细胞型一氧化氮合成酶（eNOS）Glu298Asp基因多态性与牙周炎伴Ⅱ型糖尿病易感性的关系。方法收集慢性牙周炎患者、慢性牙周炎伴Ⅱ型糖尿病患者、Ⅱ型糖尿病患者和牙周健康者的颊黏膜拭子,提取DNA后应用聚合酶链反应-限制性片段长度多态性法检测eNOS Glu298Asp的基因型分布。结果慢性牙周炎组、 Ⅱ型糖尿病组、慢性牙周炎伴Ⅱ型糖尿病组、正常组eNOS Glu298Asp基因型的分布差异有统计学意义（掊2＝18.503, P＝0.005）,等位基因频率分布差异也有统计学意义（掊2＝8.243,P＝0.041）。慢性牙周炎伴Ⅱ型糖尿病组与正常组相比,T基因型的OR值为0.962,95%可信区间为0.737～1.256,说明T基因型可能为糖尿病和牙周炎的保护因素;G基因型的OR值为1.043,95%可信区间为0.781～1.391,说明G基因型可能为二者的危险因素,但差异无统计学意义。结论慢性牙周炎、慢性牙周炎伴Ⅱ型糖尿病、糖尿病的易感性可能与eNOS Glu298Asp多态性有关。     

Salivary human beta-defensins and cathelicidin levels in relation to periodontitis and type 2 diabetes mellitus

Abstract

Objective: Type 2 diabetes mellitus (T2DM) is a well-defined risk factor of periodontitis and it can affect expression of human beta-defensins (hBDs) and cathelicidin (LL-37) as well. The aim of the present study was to evaluate the impact of periodontitis and T2DM on salivary concentrations of these antimicrobial peptides.

Material and methods: Unstimulated saliva samples, together with full-mouth periodontal recordings were collected from 92 individuals with periodontitis (63 with T2DM and 21 smokers) and 86 periodontally healthy controls (58 with T2DM and 21 smokers). Salivary hBD-1, -2, -3, LL-37, and advanced glycalization end products (AGE) concentrations were measured by enzyme-linked immunosorbent assay.

Results: Among the periodontitis patients, T2DM group demonstrated lower levels of hBD-1 (p?=?.006), hBD-2 (p?<?.001) and hBD-3 (p?<?.001), and higher levels of LL-37 (p?<?.001) compared to systemically healthy controls. When only periodontally healthy controls were included into the analysis, higher hBD-1 (p?=?.002) and LL-37 (p?<?.001) levels were found in T2DM patients in comparison to systemically healthy controls. Salivary LL-37 levels were associated with HbA1c and periodontitis, while hBD-2, hBD-3 and levels associated only with HbA1c.

Conclusion: In the limits of this study, hyperglycaemia can be proposed as a regulator of salivary hBD and cathelicidin levels. Periodontitis, on the other hand, affects only salivary LL-37 levels.     

口腔卫生指导对2型糖尿病伴慢性牙周炎患者牙周炎症控制及血糖代谢水平的影响

目的探讨口腔卫生指导对2型糖尿病伴慢性牙周炎患者牙周状况和血糖水平的影响。方法 31例2型糖尿病伴慢性牙周炎患者,接受口腔卫生指导后,分别在基线、6周、3个月、6个月、12个月和18个月检测牙周临床指标和血糖代谢指标。牙周临床指标包括:探诊深度、附着丧失、探诊出血、菌斑指数;血糖代谢指标包括:空腹血糖、糖化血红蛋白。结果 31例患者基线、6周、3个月、6个月、12个月和18个月6个时间点的附着丧失量(P=0.003)和探诊出血阳性率(P=0.022)差异有统计学意义;其它指标如探诊深度(P=0.203)、菌斑指数(P=0.087)、空腹血糖(P=0.352)和糖化血红蛋白(P=0.071)的变化没有统计学意义。结论口腔卫生指导可以短期改善2型糖尿病伴慢性牙周炎患者的牙周炎症,但对牙周组织退缩没有更大的帮助,尚不能认为口腔卫生指导对血糖代谢有显著影响。