牙周非手术治疗对2型糖尿病伴牙周炎患者糖化血红蛋白A1c和血清可溶性细胞间黏附分子-1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（DMCP）患者牙周状况、糖代谢及血清可溶性细胞间黏附分子-1（sICAM-1）的影响。方法 选择诊断为2型糖尿病伴慢性牙周炎的患者，按糖化血红蛋白A1c （ GHbA1c ）控制水平分为血糖控制良好组（GHbA1c＜7.00％，DMCP1组，30例）和血糖控制较差组（GHbA1c≥7.00％，DMCP2组，30例）；选择不伴有系统性疾病的慢性牙周炎患者（CP组，30例）为对照组。所有患者均进行牙周非手术治疗，分析治疗前（基线）及治疗后1、3个月时探诊深度（PD）、临床附着丧失（CAL）、菌斑指数（PLI）、龈沟出血指数（SBI）、探诊出血（BOP）、空腹血糖（FPG）、GHbA1c及血清sICAM-1水平的变化。结果 治疗后1、3个月时，3组PD、SBI、PLI、BOP阳性率、血清sICAM-1水平比基线时均明显降低（P＜0.05），CP组和DMCP1组CAL比基线时亦均明显降低（P＜0.05），但DMCP2组CAL无明显变化（P＞0.05）。治疗后3个月时，DMCP2组GHbA1c水平与基线时比较平均降低1.12%，差异有统计学意义（P＜0.05），但CP组和DMCP1组在整个观察期间GHbA1c水平与基线时比较差异均无统计学意义（P＞0.05）。结论 牙周非手术治疗可降低2型糖尿病伴牙周炎患者的牙周炎症程度及血清sICAM-1的水平，并可改善血糖控制良好者的牙周附着水平；该治疗还可以降低血糖控制较差者的GHbA1c水平。

Effect of non-surgical periodontal therapy on level of serum soluble intercellular adhesion molecule-1 and glycated hemoglobin A1c in patients with type 2 diabetes and chronic periodontitis

Objective To evaluate the effects of non-surgical periodontal treatment on clinical periodontal measurements, glycemic control, and level of serum soluble intercellular adhesion molecule-1（sICAM-1） in type 2 diabetes mellitus with chronic periodontitis patients. Methods Patients with type 2 diabetes and chronic periodontitis were selected and classified into well-controlled groupglycated hemoglobin A1c （ GHbA1c ） ＜7.00%, n=30, DMCP1 group] and poorly-controlled group（GHbA1c≥7.00%, n=30, DMCP2 group）. Thirty systemically healthy patients with chronic periodontitis were recruited as control group（CP group）. All subjects underwent non-surgical periodontal therapy. Plaque index（PLI）, sulcus bleeding index（SBI）, bleeding on probing（BOP）, probing depth（PD）, clinical attachment loss （CAL）, serum sICAM-1 concentration, and the value of fasting plasma glucose（FPG）, GHbA1c were recorded at baseline, 1 and 3 months after periodontal treatment. Results The three study groups showed significant improvements for the levels of PD, SBI, PLI, BOP, and serum sICAM-1 concentration at 1 and 3 months after non-surgical periodontal treatment（P＜0.05）. The level of CP group and DMCP1 group also showed significant improvements for the levels of CAL（P＜0.05）, but no significant change was found in DMCP2 group（P＞0.05）. At 3 months after periodontal treatment, GHbA1c levels in DMCP2 group significantly decreased by 1.12%（P＜0.05）, whereas no significant changes were found in CP and DMCP1 groups（P＞0.05）. Conclusion Non-surgical periodontal treatment can significantly improve periodontal health status in patients with type 2 diabetes and periodontitis, reduce the level of serum sICAM-1, and can reduce the level of GHbA1c in poorly controlled type 2 diabetic patients.