肥胖和／或2型糖尿病患者牙周病患病程度与中性粒细胞之间的关系

目的：肥胖和糖尿病是当今发达和发展中国家最常见的营养和内分泌失调疾病,并与免疫应答的变化密切相关。最近的研究发现牙周病发病与糖尿病和肥胖有关。本研究的目的在于衡量中性粒细胞的功能变化与2型糖尿病患者（伴或不伴有肥胖症）所患慢性牙周炎之间的关系。材料与方法：本研究共纳入了39名慢性牙周炎患者．根据体重和2型糖尿病患病情况将其分为4组：①8名患有肥胖和2型糖尿病的患者。②12名患2型糖尿病的患者。③8名肥胖患者。④11名无系统疾患的患者作为对照,衡量其中性粒细胞趋化性,吞噬作用和牙周情况。结果：各组中年龄、牙龈指数、菌斑指数、吞噬比例、吞噬细胞效能、胞内杀伤均无明显差异．但是患糖尿病的分组其中性粒细胞趋化性明显低于对照组,并且其探诊深度明显高于对照组。肥胖症对本研究探讨的因素影响不大。结论：与2型糖尿病患者不同．肥胖症患者其中性粒细胞功能和牙周病患病程度较之正常无明显变化。但是2型糖尿病患者其中性粒细胞趋化性改变与探诊深度水平密切相关。     

Cytokines and bone-related factors in systemically healthy patients with chronic periodontitis and patients with type 2 diabetes and chronic periodontitis

Background: This study compares the levels of cytokines and bone‐related factors in the gingival crevicular fluid (GCF) of systemically healthy patients with chronic periodontitis (CP); and better‐controlled, and poorly controlled patients with type 2 diabetes and CP. Methods: Thirty‐seven patients with type 2 diabetes and CP and 20 systemically healthy patients with CP were enrolled in this study. The patients with diabetes mellitus were categorized as better‐controlled (n = 17; HbA_1c levels ≤8%) or poorly controlled (n = 20; glycated hemoglobin values >8%). Levels of tumor necrosis factor‐α, interleukin (IL)‐4, interferon (IFN)‐γ, IL‐23, IL‐17, soluble receptor activator of nuclear factor‐kappa B ligand (sRANKL), and osteoprotegerin (OPG) in GCF of diseased sites were analyzed by enzyme‐linked immunosorbent assay. Results: Type 2 diabetes mellitus, as a whole, upregulates the levels of OPG, sRANKL, IFN‐γ, IL‐17, and IL‐23 and downregulates the production of IL‐4 in sites with CP (P <0.05). Better‐controlled individuals exhibited the highest levels of IFN‐γ, whereas poorly controlled patients presented the highest levels of IL‐17 (P <0.05). There were no differences in the levels of tumor necrosis factor‐α, OPG, and IL‐23 among systemically healthy, better‐controlled, and poorly controlled patients with diabetes (P >0.05). Conclusions: Increased levels of proinflammatory cytokines and RANKL were observed in the GCF of patients with type 2 diabetes with CP, compared to patients without diabetes. In addition, poor or good glycemic status seems to modulate osteo‐immunoinflammatory mediators in a different manner.     

慢性牙周炎患者治疗前、后血清降钙素基因相关肽水平检测的临床意义

目的:探讨慢性牙周炎患者治疗前、后血清中降钙素基因相关肽(calcitonin gene-related peptide,CGRP)水平的变化及意义.方法:随机选择2014年8月--2015年6月在我院牙周科就诊的健康对照组30例,轻度、中度、重度牙周炎患者各30例,抽取空腹外周静脉血,离心、分离上清液,运用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测CGRP浓度.慢性牙周炎患者轻度、中度、重度3组分别于基础治疗后3个月再次检测CGRP浓度.采用SPSS 22.0软件包对数据进行统计学分析.结果:ELISA检测结果显示,健康组静脉血中CGRP的含量显著高于牙周炎患者.随着牙周炎炎症程度加重,静脉血中CGRP的含量依次降低,重度牙周炎患者的含量最低,差异显著(P＜0.01);轻度、中度、重度牙周炎患者基础治疗3个月后,血清中CGRP含量相比同组治疗前显著升高(P＜0.05),治疗后牙周炎患者组间CGRP含量相比差异无显著性(P＞0.05).结论:静脉血中CGRP的含量与慢性牙周炎存在相关性,其含量随慢性牙周炎逐渐加重而降低,推测CGRP可能参与慢性牙周炎的发生、发展过程.慢性牙周炎治疗后血清中CGRP含量明显增加,CGRP可作为慢性牙周炎患者治疗效果的临床检测指标.     

牙周基础治疗对2型糖尿病相关性牙周炎患者血糖控制的Meta分析

目的系统评价牙周基础治疗对2型糖尿病相关性牙周炎患者血糖控制的影响,探讨牙周基础治疗在糖尿病治疗中的具体作用。方法计算机检索Cochrane图书馆对照试验注册中心、Medline、EMbase、SIGLE、GreyNet、NTIS、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库和万方数据库,查找有关牙周基础治疗对糖尿病血糖控制影响的研究。检索时限均为1991-2011年4月31日。均由2名评价者独立选择试验、提取资料和评估方法学质量,然后采用RevMan 5．1软件对资料进行Meta分析。纳入7个研究,共计471例受试患者。结果牙周基础治疗能明显降低2型糖尿病相关性牙周炎患者糖化血红蛋白的水平,组间差异有统计学意义（95％CI：-0．94—0．22,P=0．001）。治疗组牙周袋探诊深度低于对照组,组间差异也有统计学意义（95％CI：-2．26～0．69,P=0．0002）。结论牙周基础治疗有利于2型糖尿病相关性牙周炎患者总体血糖水平的控制。     

High prevalence of apical periodontitis amongst type 2 diabetic patients

AIM: To study the prevalence of AP in patients with and without type 2 diabetes mellitus. METHODOLOGY: In a retrospective cohort study, the records of 38 subjects with diabetes and 32 control subjects were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all teeth, excluding third molars, was examined. Periapical status was assessed using the periapical index score. Statistical analyses were conducted using the Cohen's kappa test, analysis of variance and logistic regression. RESULTS: Apical periodontitis in at least one tooth was found in 81.3% of diabetic patients and in 58% of control subjects (P = 0.040; OR = 3.2; 95% CI = 1.1-9.4). Amongst diabetic patients 7% of the teeth had AP, whereas in the control subjects 4% of teeth were affected (P = 0.007; OR = 1.8; 95% CI = 1.2-2.8). CONCLUSIONS: Type 2 diabetes mellitus is significantly associated with an increased prevalence of AP.     

慢性牙周炎伴Ⅱ型糖尿病患者牙周基础治疗的疗效分析

目的:研究中重度慢性牙周炎伴Ⅱ型糖尿病患者在常规糖尿病药物治疗的基础上,牙周基础治疗对患者牙周临床指标和血糖的影响.方法:将60例慢性牙周炎伴Ⅱ型糖尿病患者分为实验组(牙周基础治疗+常规糖尿病药物治疗)与对照组(单纯常规糖尿病药物治疗)各30例,在牙周基础治疗的第6周,第12周,第24周分别检测实验组和对照组的牙周临床...     

Immunoglobulin concentration in gingival tissue of type 2 diabetic patients with periodontitis.

BACKGROUND: Diabetes mellitus is considered as a risk factor for the initiation and progression of periodontal disease. The diabetic patients often exhibit decreased immune response and increased susceptibility to infection. In the present study, a quantitative estimation of the gingival tissue immunoglobulin concentrations in diabetic and non diabetic subjects with periodontitis was assessed and compared with that of clinically healthy gingiva. METHOD: 40 gingival tissue samples obtained from 20 diabetic (Type 2) and 20 non-diabetic subjects were subjected to quantitative estimation of immunoglobulins G, A, and M. The data thus obtained were compared to the level of immunoglobulin found in clinically healthy gingiva. RESULTS: The IgG and IgA level in the tissues of both diabetic and non-diabetic subjects with periodontitis were found to be significantly higher than that of healthy subjects. The diabetic group also showed a significantly higher IgG and IgA levels compared to the non-diabetic group with periodontitis. CONCLUSION: These findings support the concept that the humoral immune response plays an important role in the pathogenesis of periodontal disease in diabetics. The significantly higher levels of immunoglobulin in the gingival tissues might be a protective mechanism against the increased bacterial challenge in diabetic subjects.     

Vitapex治疗瘘管型慢性根尖周炎的临床观察

目的:观察Vitapex根充糊剂对瘘管型慢性根尖周炎临床效果.方法:应用Vitapex根充糊剂对35例瘘管型慢性根尖周炎,采用一次性根管充填治疗.结果:观察35例40个患牙经一次性治疗后,通过6个月至1年的临床随访观察,成功38个,失败2例(2个),成功率为95%,结论:Vitapex根充糊剂具有持续抗菌特性,有效抑制根管病菌繁殖,且有较强的组织渗透特性,能被组织吸收,置换肉芽组织,诱导新生骨组织,可加快根尖周病变组织愈合.     

Er: YAG激光对2型糖尿病相关性牙周炎患者龈下菌群动态变化的研究

目的 动态观察2型糖尿病相关性牙周炎患者经Er: YAG激光治疗前后龈下菌群的变化,并与不伴全身疾病的慢性牙周炎龈下菌群进行比较。方法 收集11例2型糖尿病相关性牙周炎患者的13对患牙（26个位点）作为试验组,分别进行Er: YAG激光治疗和超声治疗,采集治疗前及治疗后1、3个月的龈下菌斑;同时收集11例牙周状况相近的不伴全身疾病的中重度慢性牙周炎患者13个位点的龈下菌斑作为对照组,分析试验组是否有菌群种类变化。提取龈下菌斑DNA,进行变性梯度凝胶电泳分离及条带回收测序。结果 试验组与对照组患牙龈下菌斑的优势致病菌存在差异,分别为中间普雷沃菌和福赛斯坦纳菌。激光组治疗前后龈下菌群构成也发生改变,治疗后1个月,有的条带表达减弱或消失,并有新条带出现;测序结果表明,新出现的条带为放线菌的一种,减弱、消失的为福赛斯坦纳菌。结论 Er: YAG激光治疗前后龈下菌群的构成发生变化,治疗后1个月是关键时期;治疗后3个月,激光治疗在阻止细菌再定植方面可能更具优势。     

伴糖尿病的慢性牙周炎牙周基础治疗疗效观察二例

牙周炎和糖尿病(diabetes mellitus)都是严重危害人类健康的常见病,许多研究已经证实两者可以相互影响.目前,非手术治疗仍是牙周炎最基础、最有效的治疗方法.以控制菌斑为主的牙周基础治疗对伴有糖尿病的牙周炎患者能否取得同样的疗效,目前尚无明确结论.笔者在临床中曾收治两例伴糖尿病的慢性牙周炎患者,现报道如下,以期对牙周基础治疗对伴糖尿病的牙周炎患者牙周炎症及代谢改善的作用进行探讨.     

The changes in T lymphocyte subsets following periodontal treatment in patients with chronic periodontitis

Objective: The aim of this study was to determine whether there was any change in T‐lymphocyte subsets in patients with chronic periodontitis after applying different periodontal treatment methods. Patients and methods: Twenty‐four patients with chronic periodontitis were included in the study. In every phase of the treatment (pretreatment, initial treatment, curettage and flap operations) the biopsy samples were taken from the gingival tissues at sites of chronic periodontitis. Then CD4⁺ and CD8⁺ lymphocyte and CD4⁺/CD8⁺ ratio values were determined using flow cytometry in the biopsy samples. At the same time, gingival pocket depth, Löe–Silness gingival index, and Silness–Löe plaque index scores were recorded to assess the periodontal status in patients. To determine the correlation between the clinical measurements and the laboratory results obtained before the treatment, after initial treatment, after curettage and after flap operations, we conducted an analysis using a paired t‐test. Results: Flow cytometry findings in the patients with chronic periodontitis showed that CD4⁺ and CD8⁺ lymphocyte values before treatment were under the normal value and the CD4⁺/CD8⁺ ratio was within the normal distribution interval. The CD4⁺/CD8⁺ ratio decreased postcurettage and postflap operation. This decrease was statistically significant (p < 0.001). The CD4⁺ and CD8⁺ lymphocyte values were increased postcurettage and postflap operation. This increase was also statistically significant (p < 0.001). Conclusions: These findings suggest that local immune response was poor in the patients with chronic periodontitis. CD4⁺ and CD8⁺ T‐lymphocytes could play a significant role in chronic periodontitis pathobiology.     

Periodontal status and cytoplasmic enzyme activities in gingival crevicular fluid of type 2 diabetic and/or obese patients with chronic periodontitis

Type 2 diabetes mellitus and obesity are the most common nutritional disorders in developed and developing countries. Increased prevalence of periodontal disease is a well-known complication of type 2 diabetes mellitus (DM). As obesity is generally the first step toward type 2 diabetes mellitus, it is possible to find exacerbated periodontal disease in obese patients, also. The purpose of this cross-sectional study was to investigate the periodontal status and aspartate aminotransferase and lactate dehydrogenase enzyme activities in gingival crevicular fluid (GCF) of type 2 diabetic and/or obese chronic periodontitis patients. A total of 39 chronic periodontitis patients participated in the study. The study population was divided into four groups according to body mass index and type 2 DM status: 1) type 2 DM obese patients, n = 8; 2) type 2 DM patients, n = 12; 3) obese patients, n = 8; 4) systemically healthy control group, n = 11. Enzyme activities in gingival crevicular fluid and periodontal status were evaluated. No significant differences in age, gingival index, plaque index, aspartate aminotransferase and lactate dehydrogenase enzyme activities were observed, but probing depths were significantly higher in the DM groups than in the control group. Obesity did not seem to be a significant factor in any parameters evaluated. The present study showed increased probing depth values for the diabetic groups but failed to show any significant relation between obesity and enzyme activity or periodontal status. However, the slightly increased probing depth values in the obese groups might be a clue to an impaired immune response and predisposition to periodontitis in that patient group.     

牙周健康对2型糖尿病伴牙周炎患者口腔健康相关生活质量影响分析

目的 采用老年口腔健康评价指数(GOHAI)量表评估2型糖尿病伴牙周炎患者口腔健康相关生活质量状况.方法 对有2型糖尿病病史的患者进行牙周临床检查,将符合慢性牙周炎诊断、全口余留牙数在16颗以上,同时最近一年内未接受牙周治疗的个体,共80人作为研究对象.牙周临床检查包括采用Williams刻度探针检查全牙列菌斑指数、改...     

Plasma levels of tumour necrosis factor-alpha in patients with chronic periodontitis and type 2 diabetes

OBJECTIVES: Studies suggest that elevated circulating tumour necrosis factor-alpha (TNF-alpha) may contribute to insulin resistance in patients with type 2 diabetes. The source of plasma TNF has been thought to be adipocytes associated with obesity, but inflammation and infection result in TNF-alpha production as well. METHODS: We studied 46 patients with type 2 diabetes and chronic periodontitis to determine the relationship between plasma TNF-alpha levels and clinical measures of periodontitis, gingival crevicular fluid (GCF) interleukin-1beta (IL-1beta), plasma endotoxin, serum glucose, and glycated haemoglobin (HbA1c). TNF-alpha levels were measured using a high sensitivity enzyme-linked immunosorbent assay. RESULTS: TNF-alpha showed a significant positive correlation with attachment loss (r=0.40, p=0.009), plasma endotoxin (r=0.33, p=0.03), and GCF IL-1beta (r=0.33, p=0.035), but not probing depth (r=0.28, p=0.07), bleeding on probing (r=0.30, p=0.053), plaque index (r=0.22, p=0.17), serum glucose, HbA1c (r=0.10, p=0.50), or body mass index (r=0.077, p=0.62). A dose-response relationship was observed between periodontitis severity and TNF-alpha (p=0.012). CONCLUSION: The finding that chronic periodontitis is associated with plasma TNF-alpha levels in subjects with type 2 diabetes supports the hypothesis that periodontal infection and inflammation may contribute to insulin resistance.     

牙周干预对2型糖尿病伴慢性牙周炎患者血清炎症因子影响的Meta分析

目的:系统评价牙周干预对2型糖尿病伴慢性牙周炎患者血清炎症因子的作用.方法:检索中国期刊全文数据库、万方数据库、维普数据库、中国科技期刊数据库、中国生物医学文献数据库、Pubmed、Cochrane library、ScienceDirect和Embase等.统计分析采用Revman 5.3版软件.结果:共纳入12个R...     

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.     

慢性牙周炎基础治疗前后牙槽骨锥形束CT评价

目的 应用锥形束CT(CBCT)评价慢性牙周炎牙周基础治疗前后牙槽骨的改变.方法 选择重度慢性牙周炎患者30例,对牙周基础治疗前、后上颌前磨牙牙槽骨进行临床疗效观察及拍摄CBCT片,利用CBCT随机软件测量牙槽骨高度和相对骨密度变化.结果 重度慢性牙周炎基础治疗后,患者牙周袋探诊深度、附着丧失明显好转,较治疗前差异均有统计学意义(P＜0.05).牙槽骨密度升高差异有统计学意义(P＜0.05),牙槽骨吸收程度变化差异无统计学意义(P＞0.05).不同阅片者之间对牙槽骨密度及牙槽骨吸收状况的测量,一致性检测结果显示组内相关系数大于0.9,差异无统计学意义.结论 CBCT可用于重度慢性牙周炎牙周基础治疗前、后牙槽骨状态的评价,定点方法具有可行性和可重复性.