糖尿病患者牙髓组织微血管病变的超微结构观察

目的:通过对糖尿病(diabetes mellitus,DM)患者和正常人牙髓组织状况、微血管超微结构的比较,探讨DM与牙髓病变的关系及DM患者牙髓病变的发病机制.方法:采用分组对照法,DM组(30颗)为Ⅱ型DM患者拔除的外观完好、无牙髓病症状的阻生第三磨牙,对照组(30颗)为正常人拔除的阻生第三磨牙.光镜下观察2组牙髓组织的结构特点,电镜下观察牙髓组织中微血管超微结构及改变,测量微血管基底膜厚度,并通过组织化学电镜技术进行VEGF上负电荷位点的计数.采用SAS6.12软件包对数据进行统计学分析.结果:光镜下可见DM组牙髓毛细血管壁增厚.电镜下见DM组牙髓毛细血管壁增厚,管腔狭窄、变形,毛细血管基底膜显著增厚(P＜0.01),毛细血管内皮细胞肿胀、结构紊乱.特殊染色电镜下见DM组牙髓毛细血管基底膜上负电荷位点显著减少(P＜0.01).结论:DM患者无龋坏、创伤缺损、牙髓病症状的牙的牙髓中毛细血管内皮细胞肿胀、结构紊乱,毛细血管基底膜增厚,基底膜上负电荷位点数目减少,可能是导致DM性牙髓病变的病理基础.

Ultramicrostructural study of pathological changes of capillary vessels in pulp tissues of diabetes mellitus patients

PURPOSE: To investigate the relationship between diabetes mellitus and pulposis and the pathogenesis of diabetes mellitus pulposis,via comparing the pulp tissue conditions and ultramicrostructures of capillary vessels in pulp tissues of diabetes mellitus patients and normal control.METHODS: Pulp tissues were obtained from clinically extracted human third molars with impaction(control group,30 cases) and intact third molars with impaction(non-insulin dependent diabetes patients) whilst without pulposis symptom(diabetic group,30 cases).The pathological changes of two groups’ pulp tissues were evaluated under light microscope and electron microscopy.The thickness of pulp capillary basement membrane and their anionic sites were quantitatively analyzed by electron microscopy and special staining. Statistical analysis was performed using SAS6.12 software package.RESULTS: The tricked blood capillary wall was observed in diabetic pulp under light microscope.The thickened blood capillary wall and constrictive lumen were observed in diabetic pulp under electron microscope,accompanied with vascular endothelial cell swelling and structural destruction and thickened basement membrane(P<0.01).The decrease of anionic sites of capillary basement membrane was observed in diabetic pulp under specially stained electron microscope(P<0.01).CONCLUSIONS: Inflammatory reaction existed in the pulp of intact teeth of DM patients without symptoms.The changes observed in diabetic vessels may occur in the dental pulp.Diabetes mellitus is closely related to pulposis.