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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (1): 45-50. doi: 10.19723/j.issn.1671-167X.2024.01.008

• 论著 • 上一篇    下一篇

Ⅲ期牙周炎患者牙周基础治疗前后炎症性贫血相关指标的变化

殳畅,韩烨,孙雨哲,杨再目,侯建霞*()   

  1. 北京大学口腔医学院·口腔医院牙周科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，北京 100081
  • 收稿日期:2023-10-11 出版日期:2024-02-18 发布日期:2024-02-06
  • 通讯作者: 侯建霞 E-mail:jxhou@163.com
  • 基金资助:
    国家自然科学基金(82071117);北京市自然科学基金(7212136)

Changes of parameters associated with anemia of inflammation in patients with stage Ⅲ periodontitis before and after periodontal initial therapy

Chang SHU,Ye HAN,Yuzhe SUN,Zaimu YANG,Jianxia HOU*()   

  1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2023-10-11 Online:2024-02-18 Published:2024-02-06
  • Contact: Jianxia HOU E-mail:jxhou@163.com
  • Supported by:
    the National Natural Science Foundation of China(82071117);the Beijing Natural Science Foundation(7212136)

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摘要：

目的: 比较Ⅲ期牙周炎患者与牙周健康者炎症性贫血相关指标的异同，探究牙周基础治疗对Ⅲ期牙周炎患者炎症性贫血指标的影响。方法: 纳入2020年2月至2023年2月于北京大学口腔医院牙周科就诊的Ⅲ期牙周炎患者25名，招募牙周健康者25名，记录人口学信息并进行牙周检查(探诊深度、临床附着丧失、出血指数)，采集空腹静脉血。Ⅲ期牙周炎患者经牙周基础治疗后3个月再次行牙周检查并采血。血液分析包括全血细胞分析以及用酶联免疫吸附法(enzyme-linked immunosorbent assay, ELISA)检测铁调素、铁蛋白、促红细胞生成素(erythro-poietin，EPO)。统计分析由SPSS 21.0统计软件完成，使用独立样本t检验、配对t检验及协方差分析进行组间比较。结果: Ⅲ期牙周炎患者的年龄显著大于牙周健康者[(36.72±7.64)岁vs. (31.44±7.52)岁，P=0.017]，血红蛋白显著低于牙周健康者[(134.92±12.71) g/L vs. (146.52±12.51) g/L，P=0.002]，铁调素[(48.03±34.44) μg/L vs. (27.42±15.00) μg/L，P=0.009]、铁蛋白[(225.08±103.36) μg/L vs. (155.19±115.38) μg/L，P=0.029]、EPO [(41.28±12.58) IU/L vs. (28.38±10.52) IU/L，P < 0.001]显著高于牙周健康者。用协方差分析校正年龄后，以上趋势维持不变且差异均有统计学意义。经牙周基础治疗后，Ⅲ期牙周炎患者所有牙周指标均有明显改善，血红蛋白[(146.05±15.48) g/L vs. (133.77±13.15) g/L，P < 0.001]显著升高，铁调素[(32.54±18.67) μg/L vs. (48.18±36.74) μg/L，P=0.033]、铁蛋白[(128.52±90.95) μg/L vs. (221.22±102.15) μg/L，P < 0.001]、EPO显著降低[(27.66±19.67) IU/L vs. (39.63±12.48) IU/L，P=0.004]。结论: Ⅲ期牙周炎患者具有炎症性贫血及铁代谢紊乱的倾向，牙周基础治疗可改善这种状况。

关键词: 牙周炎, 炎症性贫血, 铁代谢, 牙周疾病

Abstract:

Objective: To investigate the differences and similarities of parameters associated with anemia of inflammation between patients with stage Ⅲ periodontitis and periodontally healthy volunteers, and to explore the influence of periodontal initial therapy on those indicators. Methods: Patients with stage Ⅲ periodontitis and periodontally healthy volunteers seeking periodontal treatment or prophylaxis at Department of Periodontology, Peking University School and Hospital of Stomatology from February 2020 to February 2023 were enrolled. Their demographic characteristics, periodontal parameters (including probing depth, clinical attachment loss, bleeding index), and fasting blood were gathered before periodontal initial therapy. Three months after periodontal initial therapy, the periodontal parameters of the patients with stage Ⅲ periodontitis were re-evaluated and their fasting blood was collected again. Blood routine examinations (including white blood cells, red blood cells, hemoglobin, packed cell volume, mean corpuscular volume of erythrocytes, and mean corpuscular hemoglobin concentration) were performed. And ferritin, hepcidin, erythropoietin (EPO) were detected with enzyme-linked immunosorbent assay (ELISA). All data analysis was done with SPSS 21.0, independent sample t test, paired t test, and analysis of covariance were used for comparison between the groups. Results: A total of 25 patients with stage Ⅲ periodontitis and 25 periodontally healthy volunteers were included in this study. The patients with stage Ⅲ periodontitis were significantly older than those in periodontally healthy status [(36.72±7.64) years vs. (31.44±7.52) years, P=0.017]. The patients with stage Ⅲ periodontitis showed lower serum hemoglobin [(134.92±12.71) g/L vs. (146.52±12.51) g/L, P=0.002] and higher serum ferritin [(225.08±103.36) μg/L vs. (155.19±115.38) μg/L, P=0.029], EPO [(41.28±12.58) IU/L vs. (28.38±10.52) IU/L, P < 0.001], and hepcidin [(48.03±34.44) μg/L vs. (27.42±15.00) μg/L, P=0.009] compared with periodontally healthy volunteers. After adjusting the age with the covariance analysis, these parameters (hemoglobin, ferritin, EPO, and hepcidin) showed the same trends as independent-sample t test with statistical significance. Three months after periodontal initial therapy, all the periodontal parameters showed statistically significant improvement. The serum hemoglobin raised [(146.05±15.48) g/L vs. (133.77± 13.15) g/L, P < 0.001], while the serum ferritin [(128.52±90.95) μg/L vs. (221.22±102.15) μg/L, P < 0.001], EPO [(27.66±19.67) IU/L vs. (39.63± 12.48) IU/L, P=0.004], and hepcidin [(32.54±18.67) μg/L vs. (48.18±36.74) μg/L, P=0.033] decreased compared with baseline. Conclusion: Tendency of iron metabolism disorder and anemia of inflammation was observed in patients with stage Ⅲ periodontitis, which can be attenuated by periodontal initial therapy.

Key words: Periodontitis, Anemia of inflammation, Iron metabolism, Periodontal diseases

中图分类号: 

  • R781.4

表1

牙周健康组和牙周炎组年龄、性别分布情况"

Items Control Stage Ⅲ periodontitis P
Age/years, ${\bar x}$±s 31.44±7.52 36.72±7.64 0.017
Gender, n
  Male 13 14 0.777
  Female 12 11
PD/mm, ${\bar x}$±s 1.56±0.68 4.71±0.95 < 0.001
BI, ${\bar x}$±s 1.12±0.52 3.44±0.57 < 0.001
CAL/mm, ${\bar x}$±s 0 4.27±0.98 < 0.001

表2

Ⅲ期牙周炎患者与牙周健康者空腹血参数比较"

Items Control, ${\bar x}$±s Stage Ⅲ periodontitis, ${\bar x}$±s P
WBC/(×109/L) 5.90±1.13 6.48±1.74 0.169
RBC/(×1012/L) 4.85±0.45 4.86±0.56 0.962
HGB/(g/L) 146.52±12.51 134.92±12.71 0.002**
HCT 0.43±0.04 0.42±0.04 0.382
MCV/fL 89.24±3.75 87.62±5.81 0.246
MCH/(pg/cell) 29.86±1.56 29.68±2.67 0.763
MCHC/(g/dL) 334.52±10.35 338.2±13.56 0.286
Transferrin/(mg/dL) 268.81±37.86 254.92±47.25 0.254
Ferritin/(μg/L) 155.19±115.38 225.08±103.36 0.029*
Hepcidin/(μg/L) 27.42±15.00 48.03±34.44 0.009**
EPO/(IU/L) 28.38±10.52 41.28±12.58 < 0.001***

表3

Ⅲ期牙周炎患者与牙周健康者空腹血参数的协方差分析"

Items Control, ${\bar x}$±s Stage Ⅲ periodontitis, ${\bar x}$±s P
WBC/(×109/L) 5.79±0.30 6.59±0.30 0.070
RBC/(×1012/L) 4.84±0.11 4.87±0.11 0.811
HGB/(g/L) 146.51±2.63 134.93±2.63 0.004**
HCT 0.43±0.01 0.43±0.01 0.627
MCV/fL 89.08±1.02 87.79±1.02 0.386
MCH/(pg/cell) 29.86±0.46 29.68±0.46 0.784
MCHC/(g/dL) 335.18±2.48 337.54±2.48 0.518
Transferrin/(mg/dL) 269.48±8.92 254.36±8.92 0.250
Ferritin/(μg/L) 152.01±22.75 228.26±22.75 0.026*
Hepcidin/(μg/L) 27.33±5.54 48.13±5.54 0.013*
EPO/(IU/L) 28.64±2.41 41.02±2.41 0.001**

表4

牙周炎患者牙周基础治疗前后临床指标变化"

Items Baseline, ${\bar x}$±s After therapy, ${\bar x}$±s P
PD/mm 4.66±0.88 2.92±0.45 < 0.001
BI 3.46±0.57 1.66±0.74 < 0.001
CAL/mm 4.23±0.89 3.03±0.75 < 0.001

表5

Ⅲ期牙周炎患者牙周基础治疗前后空腹血参数变化"

Items Baseline, ${\bar x}$±s After therapy, ${\bar x}$±s P
WBC/(×109/L) 6.43±1.83 6.28±1.88 0.401
RBC/(×1012/L) 4.85±0.60 4.79±0.56 0.272
HGB/(g/L) 133.77±13.15 146.05±15.48 < 0.001***
HCT 0.42±0.04 0.42±0.04 0.244
MCV/fL 87.40±6.14 87.27±6.19 0.655
MCH/(pg/cell) 29.64±2.83 29.31±2.60 0.051
MCHC/(g/dL) 338.55±14.33 335.18±12.12 0.102
Transferrin/(mg/dL) 257.45±49.62 258.06±34.06 0.957
Ferritin/(μg/L) 221.22±102.15 128.52±90.95 < 0.001***
Hepcidin/(μg/L) 48.18±36.74 32.54±18.67 0.033*
EPO/(IU/L) 39.63±12.48 27.66±19.67 0.004**
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