动脉粥样硬化斑块与龈下菌斑中牙周致病菌的关系研究

目的 分析动脉粥样硬化斑块与龈下菌斑中牙周致病菌的关系。方法 选取2014年8月—2015年10月于新疆医科大学第一附属医院心脏外科行冠状动脉旁路移植术的冠心病并牙周炎患者86例,收集其动脉粥样硬化斑块及龈下菌斑。采用Chelex-100法及聚合酶链反应(PCR)提取动脉粥样硬化斑块及龈下菌斑中福赛斯坦纳菌(Tf)DNA,计算动脉粥样硬化斑块和龈下菌斑中Tf DNA拷贝数,动脉粥样硬化斑块与龈下菌斑中Tf占比的相关性分析采用Pearson相关性分析。结果 动脉粥样硬化斑块和龈下菌斑中Tf阳性检出率分别为60.71%、80.21%。动脉粥样硬化斑块和龈下菌斑中Tf DNA测序结果符合Genbank数据库相应细菌标准序列,同源性达99%。动脉粥样硬化斑块中Tf DNA拷贝数为(2.24×102±1.52×102)拷贝/μl,Tf占比为(0.28±0.13)%;龈下菌斑中Tf DNA拷贝数为(2.06×103±1.18×104)拷贝/μl,Tf占比为(0.35±0.22)%;动脉粥样硬化斑块和龈下菌斑中Tf占比比较,差异有统计学意义(P0.05)。Pearson相关性分析结果显示,动脉粥样硬化斑块与龈下菌斑中Tf占比呈正相关(r=0.498,P0.05)。结论 动脉粥样硬化斑块和龈下菌斑中Tf阳性检出率均较高,动脉粥样硬化斑块和龈下菌斑中Tf具有同源性,且动脉粥样硬化斑块与龈下菌斑中Tf相关。     

颈动脉粥样硬化斑块中牙周可疑致病菌的检测

目的:检测颈动脉粥样硬化斑块中的主要牙周可疑致病菌。方法:选择颈动脉粥样硬化内膜剥脱术的病例,收集术中分离的含有颈动脉粥样硬化斑块的标本15例。提取斑块的组织DNA,分别用5种牙周可疑致病菌的特异引物采取聚合酶链式反应(PCR),扩增16S rDNA片段来鉴定细菌种类。结果:15例患者颈动脉粥样硬化斑块中4例样本检测到了具核梭杆菌(Fusobacterium nucleatum,Fn),2例样本检测到了牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)。其中1例同时检测到了Fn和Pg。未检测到伴放线聚生杆菌(Aggregatibacter actinom ycetemcomitans,Aa),福赛坦菌(Tannerella for-sythia,Tf),中间普氏菌(Prevotella intermedia,Pi)。结论:颈动脉粥样硬化的发生发展可能与牙周可疑致病菌有一定相关性。     

心脏移植患者龈上菌斑中五种牙周可疑致病菌的检测

目的:比较成人心脏移植患者和牙周健康者龈上菌斑中5种牙周可疑致病菌,具核梭杆菌(Fn)、中间普氏菌(Pi)、变黑普氏菌(Pn)、伴放线放线杆菌(Aa)及直肠弯曲菌(Cr)的分布,为进一步探讨牙周可疑致病菌对心脏移植患者牙周健康的影响提供理论依据。方法:32例HT患者和35例牙周健康对照者,选取16,26为受检牙位,进行牙周检查并采集龈上菌斑样本,应用以16S rRNA为基础的聚合酶链反应(PCR)技术,检测龈上菌斑中5种牙周病原微生物。结果:两组Fn、Cr、Pi检出率均高于Pn和Aa检出率,差异有统计学意义(P<0.01)。5种牙周可疑致病菌在两组间的分布差异无统计学意义(P>0.05)。结论:心脏移植患者龈上菌斑中牙周可疑致病菌Fn,Cr,Pi的检出率较高,这些细菌的共同定植可能增加了心脏移植患者感染牙周病的风险。     

感染负荷与粥样硬化形成及斑块性质的相关性

目的　探讨感染负荷与冠状动脉粥样硬化及其斑块性质的相关性。方法　2001年12月至2003年10月在本院接受介入检查的患者182例,血管内超声检测确定冠状动脉粥样硬化及其斑块性质;介入检查前抽静脉血,酶联免疫吸附检测法(ELISA)检测患者血清巨细胞病毒、幽门螺旋菌、肺炎衣原体、EB病毒、B型柯萨奇病毒、A型流感病毒、B型流感病毒、结核杆菌抗体IgG/IgA及乙肝病毒表面抗原。免疫散射比浊法检测高敏C反应蛋白(hs CRP)水平。结果　根据感染负荷将患者分为三组:A组:感染原n≤3种,B组:n=4~5种和C组:n≥6种。冠状动脉粥样硬化的检出率随感染负荷的增加而增加,各组冠状动脉粥样硬化阳性率分别为44. 4%, 70 .6%和76 .7% (P<0 .001);感染负荷与动脉粥样硬化阳性率呈正相关,r=0 .9396。血清hs- CRP水平升高者( >5 .0mg/L)冠状动脉粥样硬化阳性率升高更明显(43 .8%, 70. 0%, 70.8% )比(45 .5%, 63 .7%, 96 .8% )。A、B、C组易损斑块检出率分别为33 .3%、32 .4%、51. 7% (P<0. 05 ),感染原在5种以上者易损斑块检出率明显升高。结论　以往感染微生物数量与冠状动脉粥样硬化率相关,血清hs CRP水平升高者中两者的相关性更明显, 提示二者有协同作用。高水平的感染负荷与冠状动脉粥样硬化的易损斑块率相关。     

动脉粥样硬化斑块中TNF-α的表达与斑块稳定性的关系

目的研究动脉粥样硬化斑块中肿瘤坏死因子α(TNF-α)的表达与斑块稳定性的关系。方法选取2014年2月至2017年3月于郑州市第二人民医院行手术治疗的冠状动脉粥样硬化患者80例中获取患者冠脉粥样硬化斑块标本,经HE染色后在光学显微镜下观察,对冠脉粥样斑块面积、脂核面积和纤维帽厚度进行测量分析,将其分为正常对照组、稳定斑块组和不稳定斑块组。采用免疫组织化学检测技术检测冠脉斑块中巨噬细胞(CD68)、平滑肌细胞(α-actin)、TNF-α的表达情况。结果正常对照组无CD68的表达,α-actin的阳性率为100%,稳定斑块组与不稳定定斑块组阳性率分别为(60.71%,53.57%)和(96.77%,9.68%),每两组间比较差异均有统计学意义(P0.05);TNF-α在正常对照组中无表达,在稳定斑块组与不稳定斑块组的内膜与中膜阳性率分别为(64.28%,28.57%)和(93.54%,61.29%),每两组间差异均有统计学意义(P0.05)。结论 TNF-α的表达能促进动脉粥样硬化斑块的不稳定性,是动脉粥样硬化病变形成和发展的重要因素之一。     

乙酰肝素酶及新生血管在人颈动脉粥样硬化斑块中的表达

目的探讨乙酰肝素酶(Hpa)及新生血管在人颈动脉粥样硬化斑块中的表达特点。方法回顾性连续纳入2014年12月至2017年12月首都医科大学附属复兴医院神经外科接受颈动脉内膜切除术治疗的颈内动脉系统粥样硬化性狭窄患者55例(动脉粥样硬化组),经血管超声、CT血管成像和(或) DSA等影像学方法证实。根据美国心脏学会动脉粥样硬化组织病理学分型方法,筛选出结构清楚的晚期动脉粥样硬化斑块(Ⅳ～Ⅵ型)作为颈动脉粥样硬化斑块标本(共73个)。根据形态学分型标准,将73个颈动脉粥样硬化斑块标本分为易损斑块(42个)和移形斑块(31个)。选择同期于北京大学医学部病理学系行尸体解剖,并明确无动脉粥样硬化病变者15例为无动脉粥样硬化组(正常动脉段标本15个)。采用免疫组织化学、免疫荧光染色检测方法,分析颈动脉粥样硬化斑块内Hpa及新生血管的表达特点。结果 (1)正常颈动脉组织中无Hpa表达;颈动脉粥样硬化斑块内,Hpa阳性表达率为64. 4%(47/73)。(2)与移形斑块相比,易损斑块内Hpa阳性表达率增高[92. 9%(39/42)比25. 8%(8/31),χ~2=34. 968,P 0. 01]。(3)新生血管在颈动脉粥样硬化斑块内呈阳性表达,与移行斑块相比,易损斑块内新生血管阳性表达率更高[95. 2%(40/42)比22. 6%(7/31),χ~2=41. 060,P 0. 01]。(4)颈动脉粥样硬化斑块内,Hpa与新生血管表达主要位于斑块的纤维帽及肩部。结论 Hpa在颈动脉粥样硬化晚期病变进展过程中具有一定的作用,颈动脉粥样硬化斑块内Hpa与新生血管表达具有共区域性。     

超声检测缺血性脑卒中/短暂性脑缺血发作患者颈动脉粥样硬化与冠状动脉粥样硬化的相关性研究

目的探讨超声检测缺血性脑卒中/短暂性脑缺血发作患者颈动脉粥样硬化与冠状动脉粥样硬化的相关性。方法选取我院2014年4月~2016年3月收治的缺血性脑卒中/短暂性脑缺血发作患者122例为观察组,其中冠状动脉粥样硬化61例为A组,另选取120例同期健康体检者为对照组,均行颈动脉超声检测,观察比较颈动脉斑块发生率及斑块类型,观察对比A组不同病变支数间斑块积分、颈总动脉内径及颈动脉内-中膜厚度(intima-media thickness,IMT)。结果观察组斑块总发生率为88.52%,高于对照组33.33%,差异具有统计学意义(P0.05),其中软斑块最为常见,所占比例为37.36%,其次为混合斑块、硬斑块、扁平斑块;双支病变组及多支病变组斑块积分、颈动脉IMT、颈总动脉内径均高于单支病变组,多支病变组斑块积分高于双支病变组,差异具有统计学意义(P0.05),颈动脉IMT、斑块积分、颈总动脉内径随病变支数增加而增加,颈动脉病变程度与冠状动脉病变程度呈正相关。结论超声检测可有效显示颈动脉粥样硬化与冠状动脉粥样硬化程度,颈动脉粥样硬化与冠状动脉粥样硬化密切相关,并随冠状动脉粥样硬化程度加重而加重。     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

目的 应用光学相干断层成像(OCT)技术比较不稳定性心绞痛(UAP)和稳定性心绞痛(SAP)患者冠状动脉粥样硬化斑块特征.方法 对临床诊断的23例UAP和24例SAP患者,在完成冠状动脉造影并确诊冠心病后进行OCT检查.根据OCT结果 回顾性比较分析UAP和SAP患者冠状动脉粥样硬化斑块特征,包括富含脂质斑块(≥2个象限的脂质斑块)、斑块纤维帽厚度、薄纤维帽粥样斑块(TCFA)、斑块破裂、钙化和血栓等.结果 47例患者中有44例成功进行OCT检查,包括22例UAP和22例SAP患者.UAP患者冠状动脉富含脂质斑块为91%(20/22),多于SAP患者的73%(16/22),但差异无统计学意义(P=0.741).UAP患者冠状动脉脂质斑块表面纤维帽厚度明显小于SAP患者[(69.5±34.7)μm比(141.1±68.5)μm,P=0.000],纤维帽侵蚀比例为59%(13/22),明显多于SAP患者的9%(2/22,P=0.000);TCFA[73%(16/22)比14%(3/22),P=0.000]和斑块破裂[50%(11/22)比9%(2/22),P=0.003]多于SAP患者.UAP患者冠状动脉斑块表而可见血栓形成多于SAP患者,但差异无统计学意义[27%(6/22)比9%(2/22),P=0.761].在斑块钙化方面,UAP与SAP患者之间差异无统计学意义.结论 OCT技术可清晰显示冠状动脉粥样斑块特征.与SAP患者比较,UAP患者冠状动脉粥样硬化斑块表现为纤维帽更薄、更多的纤维帽侵蚀、更多的破裂斑块和TCFA.     

肺炎衣原体抗体IgA和CRP与冠状动脉粥样硬化及再狭窄的相关性研究

目的探讨肺炎衣原体感染和炎症对冠状动脉粥样硬化和支架内再狭窄的影响.方法628例接受冠状动脉造影检查的患者根据造影结果分为冠状动脉粥样硬化组(n=433)和非冠状动脉粥样硬化组(n=195),记录两组基线临床资料、检测血清肺炎衣原体抗体IgA及C-反应蛋白(CRP).92例放置冠状动脉内支架的患者分感染组(n=49)和非感染组(n=53),随访0.5年,再次冠状动脉造影检查,测量支架内管腔丢失率.结果冠状动脉粥样硬化组肺炎衣原体抗体IgA的阳性率及滴度均高于非动脉粥样硬化组(48.32%,26.1%,P=0.000;1.31±1.19,0.92±1.12,P=0.000);血清CRP水平明显升高(34.67±3.24,23.22±3.27,P=0.008),且随着病变程度加重而增加.肺炎衣原体感染组和非感染组内膜增厚发生率分别为(64.7%,63.3%,P=0.909),差别无显著性.但有内膜增厚者血清CRP水平明显高于无内膜增厚者(36.13±4.04,16.51±3.92,P=0.042).结论肺炎衣原体感染与冠状动脉粥样硬化相关,但不能预示支架内再狭窄的发生;而炎症标志物与冠状动脉粥样硬化和再狭窄的发生均相关,提示炎症反应不仅在动脉粥样硬化而且在支架内再狭窄的发生中扮演重要角色.     

冠心病病人冠状动脉与颈动脉粥样硬化相关分析

目的 探讨冠心病病人颈动脉与冠状动脉粥样硬化的关系.方法 冠心病病人122例,经冠状动脉造影确诊,用颈动脉超声检测颈动脉内膜.中膜厚度(intima-media thickness,IMT)及粥样硬化程度.结果 病人病变冠状动脉支数分组间,IMT、颈动脉斑块积分和斑块发生率的差异有统计学意义.冠状动脉病变支数与IMT相关(r=0.73),与颈动脉斑块积分相关(r=0.67).冠状动脉造影积分与IMT相关(r=0.69),与颈动脉斑块积分相关(r=0.68).结论 冠心病病人颈动脉粥样硬化与冠状动脉粥样硬化呈正相关,颈动脉病变可间接反映冠状动脉粥样硬化病变程度.     

Prevalence of putative periodontopathogens from periodontal patients and healthy subjects in Sao Paulo, SP, Brazil

A. actinomycetemcomitans, B. forsythus, P. gingivalis, C. rectus, E. corrodens, P. intermedia, F. nucleatum, and T. denticola were identified from subgingival plaque from 50 periodontal patients and 50 healthy subjects. PCR products from each species showed a specific band and could be used to identify periodontal organisms from clinical specimens. Identical negative or positive results between PCR and culture occurred in 66% (A. actinomycetemcomitans) to 93% (F. nucleatum) of the samples. PCR detection odds ratio values for A. actinomycetemcomitans, B. forsythus, C. rectus, E. corrodens, P. intermedia, and T. denticola were significantly associated with disease having a higher OR values for B. forsythus (2.97, 95% CI 1.88 - 4.70). Cultures showed that A. actinomycetemcomitans, B. forsythus and P. intermedia were associated with periodontitis, however, P. gingivalis, C. rectus, E. corrodens and F. nucleatum were not significantly associated with the disease.     

High incidence of actinobacillus actinomycetemcomitans infection in acute coronary syndrome

Recent epidemiological studies suggest that periodontitis is an important risk factor for coronary heart disease (CHD). The aim of this study was to evaluate the association between periodontitis and CHD, particularly acute coronary syndrome (ACS), focusing on microbiological and immunological features. Twenty-eight CHD patients, 15 with ACS and 13 with chronic CHD, were included in this study. Coronary angiography, periodontal examination, and dental radiography were performed in all patients. Subgingival plaque, saliva, and blood samples were analyzed for the periodontopathogens Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia using polymerase chain reaction. Specific serum antibody titers to the 5 periodontal pathogens were determined by enzyme-linked immunosorbent assay. It was found that 33% of the ACS patients (5/15) harbored A. actinomycetemcomitans in oral samples, whereas no A. actinomycetemcomitans (0/13) was found in the chronic CHD patients (P < 0.05). Furthermore, ACS patients showed significantly higher serum IgG titers to A. actinomycetemcomitans (P < 0.05) compared with chronic CHD. More tooth loss and alveolar bone loss were noted in ACS patients than in chronic CHD patients, although the differences were not statistically significant. Periodontal pathogens, particularly A. actinomycetemcomitans, may play a role in the development of ACS.     

Periodontal infections and coronary heart disease: role of periodontal bacteria and importance of total pathogen burden in the Coronary Event and Periodontal Disease (CORODONT) study

BACKGROUND: Chronic inflammation from any source is associated with increased cardiovascular risk. Periodontitis is a possible trigger of chronic inflammation. We investigated the possible association between periodontitis and coronary heart disease (CHD), focusing on microbiological aspects. METHODS: A total of 789 subjects (263 patients with angiographically confirmed, stable CHD and 526 population-based, age- and sex-matched controls without a history of CHD) were included in the Coronary Event and Periodontal Disease (CORODONT) study. Subgingival biofilm samples were analyzed for periodontal pathogens Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola using DNA-DNA hybridization. The need for periodontal treatment in each subject was assessed using the Community Periodontal Index of Treatment Needs (CPITN). The main outcome measures included total periodontal pathogen burden, number of the various periodontal pathogens in the subgingival biofilm, and periodontal treatment needs (according to the CPITN). RESULTS: In multivariable analyses, we found a statistically significant association between the periodontal pathogen burden (log10 of the sum of all pathogens) (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.34-2.74; P<.001) or the number of A actinomycetemcomitans in periodontal pockets (log10) (OR, 2.70; 95% CI, 1.79-4.07; P<.001) and the presence of CHD. In addition, a statistically significant association between an increase in mean CPITN score by 1 and the presence of CHD (OR, 1.67; 95% CI, 1.08-2.58; P = .02) was observed. CONCLUSIONS: Our findings suggest an association between periodontitis and presence of CHD. Periodontal pathogen burden, and particularly infection with A actinomycetemcomitans, may be of special importance.     

金铂合金、含钛镍铬合金与种植钛对龈下优势菌黏附的影响

目的 研究金铂合金、含钛镍铬合金对不同龈下优势菌黏附的影响。方法 将上述两种冠修复材料粘接在种植纯钛材料上，与四种龈下优势菌伴放线共生放线杆菌（Aa）、牙龈卟啉单胞菌（Pg）、中间普氏菌（Pi）、具核梭杆菌（Fn）共同厌氧孵育，采用菌落形成单位（CFU）计数法测定培养试件表面的细菌黏附量，扫描电镜观察试件表面细菌黏附情况。结果 四种龈下优势菌在金铂合金一钛试件表面细菌黏附量明显多于含钛镍铬合金一钛试件。结论 ①四种龈下优势菌单独附着能力有差异，Aa〉Fn〉Pg〉Pi。②金铂合金对细菌的生长黏附无抑制作用。     

不同粗糙度金铂、含钛镍铬合金与种植钛表面龈下优势菌黏附情况观察

目的观察两种粗糙度（Ra）的金铂、含钛镍铬合金对不同龈下优势菌黏附的影响。方法将上述不同Ra的两种冠合金黏附在种植钛上，与四种龈下优势菌[伴放线共生放线杆菌（Aa），牙龈卟啉单胞菌（Pg），中间普氏菌（Pi），具核梭杆菌（Fn）]共同厌氧孵育，采用菌落形成单位（CFU）计数法比较培养试件表面的细菌黏附量，并于扫描电镜下观察。结果四种龈下优势菌在同种合金表面的黏附量随合金Ra增加而明显增多，在相同Ra的金铂合金-钛试件表面细菌黏附量明显多于含钛镍铬合金-钛试件。结论不同Ra的合金及相同Ra的不同合余上同种细菌黏附骨不同。     

Periodontopathic bacteria in English HIV-seropositive persons

Selected periodontopathic bacteria were sought in 20 HIV-infected English patients and eight noninfected control subjects with similar periodontal status, using highly specific DNA probes. Actinobacillus actinomycetemcomitans (A. a), Porphyromonas gingivalis, Campylobacter rectus, Prevotella intermedia, and Fusobacterium nucleatum were more frequently detected and were found at higher levels in HIV-infected individuals than in controls. Significantly increased levels of Treponema denticola but, in contrast, lower levels of Eikenella corrodens were found in nonbleeding sites of HIV-infected patients compared with controls. The results of the present investigation on English patients suggest a periodontopathogenic role for A. a, P. gingivalis and C. rectus, and possibly P. intermedia and are in general accord with most previously reported data from the United States. Longitudinal studies are now required to determine more precisely the association between periodontopathic microflora, immune competence and periodontal health and disease in HIV-infected persons.     

Molecular analysis shows the presence of periodontal bacterial DNA in atherosclerotic plaques from patients with coronary artery disease

Links between periodontitis and atherosclerosis can be predicted based on inflammatory mechanisms initiated by bacteria associated with periodontal lesions, which then influence the initiation or propagation of the atherosclerotic lesion. This study aimed to detect the presence of three periodontal pathogens, in atheromatous plaques of patients with coronary artery disease. Subgingival and atherosclerotic plaque samples were obtained from 80 patients scheduled for CABG or angioplasty. A nested PCR was done for the detection of the pathogens in the plaque samples. Porphyromonas gingivalis, Tanarella forsythia, and Treponema denticola were detected in 10%, 12.5%, and 1.3% of the atherosclerotic plaque samples respectively. It was also observed that patients whose atherosclerotic plaques tested positive for one or more of the pathogens had chronic periodontitis.     

Detection of periodontal microorganisms in coronary atheromatous plaque specimens of myocardial infarction patients: A systematic review and meta-analysis

BackgroundMicrobial translocation from inflamed periodontal pockets into coronary atheroma via systemic circulation is one of the proposed pathways that links periodontitis and myocardial infarction (MI). The purpose of this systematic review is to determine the reported prevalence of periodontal microorganisms in coronary atheroma and/or aspirated clot samples collected from MI patients with periodontal disease.MethodologyThe “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines were followed. Six databases were systematically searched using Medical Subject Headings/Index and Entree terms. After a thorough screening, fourteen publications spanning over ten years (2007–2017) were eligible for this systematic review and meta-analysis.ResultsOut of 14 included studies, 12 reported presence of periodontal bacterial DNA in coronary atherosclerotic plaque specimens. Overall, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were the most frequently detected periodontal bacterial species. Meta-analysis revealed that the prevalence of P. gingivalis was significantly higher than A. actinomycetemcomitans in coronary atheromatous plaque samples. Apart from periodontal microbes, DNA from a variety of other microbes e.g. Pseudomonas fluorescens, Streptococcus species, Chlamydia pneumoniae were also recovered from the collected samples.ConclusionConsistent detection of periodontal bacterial DNA in coronary atheroma suggests their systemic dissemination from periodontal sites. It should further be investigated whether they are merely bystanders or induce any structural changes within coronary arterial walls.     

应用16层螺旋CT评价辛伐他汀对冠状动脉斑块的影响

目的 评价辛伐他汀对冠状动脉粥样斑块的影响.方法 对43例经16层螺旋CT及回顾性心电门控技术检测出的冠脉粥样斑块患者,给予辛伐他汀20 mg/d口服,12个月后复查斑块情况.结果 43例患者有119支冠状动脉存在132个粥样斑块,治疗后各种斑块大小有不同程度的缩小,其中脂质斑块(27个)缩小幅度26.4%(P＜0.05),纤维斑块(34个)缩小幅度14.1%(P＜0.05),混合斑块(13个)缩小幅度12.7%(P＜0.05),而钙化斑块(58个)缩小幅度不明显(3.7%,P＞0.05).结论 辛伐他汀可逆转或稳定冠脉粥样斑块,从而降低急性冠状动脉事件的发生;16层螺旋CT可定量评价粥样斑块的变化,为临床治疗提供客观依据.