北京大学学报(医学版) ›› 2022, Vol. 54 ›› Issue (1): 48-53. doi: 10.19723/j.issn.1671-167X.2022.01.008
XU Xin-ran,HUO Peng-cheng,HE Lu(),MENG Huan-xin,ZHU Yun-xuan,JIN Dong-si-qi
摘要:
目的: 比较伴与不伴糖尿病的牙周炎患者牙周基础治疗的临床疗效差异,并分析两组患者牙周基础治疗与白细胞水平的相关性。方法: 纳入无系统性疾病的慢性牙周炎患者32例(CP组),伴2型糖尿病的慢性牙周炎患者27例(CP+DM组)。所有患者行全口牙周检查和空腹血液检查,记录患者入院时的数据作为基线资料,包括探诊深度(probing depth, PD)、附着丧失(attachment loss, AL)、出血指数(bleeding index, BI)、菌斑指数(plaque index, PLI)、白细胞(white blood cell, WBC)计数和空腹血糖(fasting blood glucose, FBG),CP+DM组额外记录糖化血红蛋白(hemoglobin A1c, HbA1c)。对所有患者进行牙周基础治疗,治疗后3个月和6个月时重复入院时的所有检查。比较两组治疗前后牙周临床指标及血液指标的变化差异,采用广义线性混合模型分析WBC与牙周临床指标及糖代谢指标的相关性。结果: 入院时两组患者的牙周炎症和破坏程度一致,但CP+DM组WBC水平显著高于CP组[(7.14±1.99)×109/L vs. (6.01±1.26)×10 9/L, P=0.01]。牙周基础治疗3个月及6个月后,两组患者的全口平均PD、AL、BI及PLI均显著低于入院时基线水平,且6个月时CP+DM组的PD比3个月时仍有进一步降低[(3.33±0.62) mm vs. (3.61±0.60) mm,P<0.05]。治疗后3个月和6个月相比,两组各项牙周指标之间差异无统计学意义。CP+DM组治疗后3个月和6个月的HbA1c水平均显著低于基线水平[(7.09±0.79)% vs. (7.64±1.16)%,P<0.05;(7.06±0.78)% vs. (7.64±1.16)%,P<0.05], 6个月时的FBG显著低于基线水平[(7.35±1.14) mmol/L vs. (8.40±1.43) mmol/L,P<0.05]。CP组的WBC水平在治疗后3个月时显著低于基线水平[(5.35±1.37)×10 9/L vs. (6.01±1.26)×10 9/L,P<0.05],CP+DM组的WBC水平在治疗后6个月时显著低于基线水平[(6.00±1.37)×109/L vs. (7.14±1.99)×10 9/L,P<0.05]。广义线性混合模型分析显示,WBC水平与PD及FBG呈一定程度正相关。结论: 牙周基础治疗均能有效改善伴与不伴2型糖尿病的慢性牙周炎患者的牙周状况,有利于糖尿病患者的血糖控制,但糖尿病患者的牙周指标及WBC水平对牙周基础治疗的反应慢于不伴糖尿病的患者,WBC在糖尿病与牙周炎的相互关联中有重要意义。
中图分类号:
[1] |
Graves DT, Ding Z, Yang Y. The impact of diabetes on periodontal diseases[J]. Periodontol 2000, 2020, 82(1):214-224.
doi: 10.1111/prd.12318 pmid: 31850631 |
[2] |
Genco RJ, Graziani F, Hasturk H. Effects of periodontal disease on glycemic control, complications, and incidence of diabetes mellitus[J]. Periodontol 2000, 2020, 83(1):59-65.
doi: 10.1111/prd.v83.1 |
[3] |
Costa FO, Cota LM, Lages EP, et al. Progression of periodontitis and tooth loss associated with glycemic control in individuals undergoing periodontal maintenance therapy: A 5-year follow-up study[J]. J Periodontol, 2013, 84(5):595-605.
doi: 10.1902/jop.2012.120255 |
[4] |
Mirza RE, Fang MM, Weinheimer-Haus EM, et al. Sustained inflammasome activity in macrophages impairs wound healing in type 2 diabetic humans and mice[J]. Diabetes, 2013, 63(3):1103-1114.
doi: 10.2337/db13-0927 |
[5] |
da Cruz GA, de Toledo S, Sallum EA, et al. Clinical and laboratory evaluations of non-surgical periodontal treatment in subjects with diabetes mellitus[J]. J Periodontol, 2008, 79(7):1150-1157.
doi: 10.1902/jop.2008.070503 |
[6] |
Correa F, Goncalves D, Figueredo C, et al. The short-term effectiveness of non-surgical treatment in reducing levels of interleukin-1beta and proteases in gingival crevicular fluid from patients with type 2 diabetes mellitus and chronic periodontitis[J]. J Periodontol, 2008, 79(11):2143-2150.
doi: 10.1902/jop.2008.080132 |
[7] |
Goncalves D, Correa F, Khalil NM, et al. The effect of non-surgical periodontal therapy on peroxidase activity in diabetic patients: A case-control pilot study[J]. J Clin Periodontol, 2010, 35(9):799-806.
doi: 10.1111/cpe.2008.35.issue-9 |
[8] |
Vozarova B, Weyer C, Lindsay RS, et al. High white blood cell count is associated with a worsening of insulin sensitivity and predicts the development of type 2 diabetes[J]. Diabetes, 2002, 51(2):455-461.
pmid: 11812755 |
[9] |
Zhang H, Zhen Y, Zhang W, et al. White blood cell subtypes and risk of type 2 diabetes[J]. J Diabetes Complications, 2016, 31(1):31-37.
doi: 10.1016/j.jdiacomp.2016.10.029 |
[10] |
NibaliI L, D’Aiuto F, Griffiths G, et al. Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: A case-control study[J]. J Clin Periodontol, 2010, 34(11):931-937.
doi: 10.1111/cpe.2007.34.issue-11 |
[11] |
Wang X, Meng H, Xu L, et al. Mean platelet volume as an inflammatory marker in patients with severe periodontitis[J]. Platelets, 2015, 26(1):67-71.
doi: 10.3109/09537104.2013.875137 |
[12] |
Sonoki K, Nakashima S, Takata Y, et al. Decreased lipid peroxidation following periodontal therapy in type 2 diabetic patients[J]. J Periodontol, 2006, 77(11):1907-1913.
pmid: 17076618 |
[13] |
Navarro-Sanchez AB, Faria-Almeida R, Bascones-Martinez A. Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis[J]. J Clin Periodontol, 2007, 34(10):835-843.
pmid: 17850602 |
[14] | 徐菁玲, 孟焕新, 李峥, 等. 牙周基础治疗对2型糖尿病伴慢性牙周炎患者血糖代谢指标及血清生化指标的影响[J]. 北京大学学报(医学版), 2013, 45(1):27-32. |
[15] |
Suvan J, Harrington Z, Petrie A, et al. Obesity as predictive factor of periodontal therapy clinical outcomes: A cohort study[J]. J Clin Periodontol, 2020, 47(5):594-601.
doi: 10.1111/jcpe.13261 pmid: 31994205 |
[16] |
Retamal I, Hernandez R, Velarde V, et al. Diabetes alters the involvement of myofibroblasts during periodontal wound healing[J]. Oral Dis, 2020, 26(5):1062-1071.
doi: 10.1111/odi.v26.5 |
[17] |
Trombelli L, Simonelli A, Franceschetti G, et al. What periodontal recall interval is supported by evidence?[J]. Periodontol 2000, 2020, 84(1):124-133.
doi: 10.1111/prd.12340 pmid: 32844410 |
[18] |
Mauri-Obradors E, Merlos A, Estrugo-Devesa A, et al. Benefits of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial[J]. J Clin Periodontol, 2018, 45(3):345-353.
doi: 10.1111/jcpe.12858 pmid: 29265454 |
[19] |
Shiny A, Bibin YS, Shanthirani CS, et al. Association of neutrophil-lymphocyte ratio with glucose intolerance: An indicator of systemic inflammation in patients with type 2 diabetes[J]. Diabetes Technol Ther, 2014, 16(8):524-530.
doi: 10.1089/dia.2013.0264 |
[20] |
Cersosimo E, Defronzo RA. Insulin resistance and endothelial dysfunction: The road map to cardiovascular diseases[J]. Diabetes-Metab Res Rev, 2010, 22(6):423-436.
doi: 10.1002/(ISSN)1520-7560 |
[21] |
Tong PC, Lee KF, So WY, et al. White blood cell count is associated with macro- and microvascular complications in Chinese patients with type 2 diabetes[J]. Diabetes Care, 2004, 27(1):216-222.
doi: 10.2337/diacare.27.1.216 |
[22] |
Gao H, Xu J, He L, et al. Calprotectin levels in gingival crevicular fluid and serum of patients with chronic periodontitis and type 2 diabetes mellitus before and after initial periodontal therapy[J]. J Periodont Res, 2021, 56(1):121-130.
doi: 10.1111/jre.v56.1 |
[23] |
Gao H, Hou J, Meng H, et al. Proinflammatory effects and mecha-nisms of calprotectin on human gingival fibroblasts[J]. J Periodont Res, 2017, 52(6):975-983.
doi: 10.1111/jre.2017.52.issue-6 |
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