伴与不伴糖尿病的牙周炎患者牙周基础治疗的疗效比较及其与白细胞水平的相关分析

doi:10.19723/j.issn.1671-167X.2022.01.008

摘要/Abstract

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。

关键词: 牙周炎, 糖尿病, 2型, 牙科刮治术, 牙周指数

Abstract:

Objective: To compare the clinical efficacy of initial periodontal therapy in periodontitis patients with or without type 2 diabetes mellitus and its correlation with white blood cell counts. Methods: In this study, 32 chronic periodontitis patients without systemic disease (CP group) and 27 chronic periodontitis patients with type 2 diabetes mellitus (CP+DM group) were enrolled. At admission, all the patients went through periodontal examination and fasting blood examination(baseline). Probing depth (PD), attachment loss (AL), bleeding index (BI), plaque index (PLI), white blood cells (WBC) counts and fasting blood glucose (FBG) were recorded respectively, while hemoglobin A1c (HbA1c) was recorded only in CP+DM group. After that, initial periodontal therapy was performed. All the tests were repeated 3 and 6 months after treatment. The changes of periodontal clinical indexes and WBC levels were compared between the two groups before and after treatment, and the correlation between WBC and periodontal clinical indexes and glucose metabolism indexes were analyzed by generalized linear mixed model. Results: At baseline, the periodontal inflammation and destruction were similar in CP and CP+DM group, but the WBC level was significantly higher in CP+DM groups [(6.01±1.26)×10⁹/L vs. (7.14±1.99)×10 ⁹/L, P=0.01]. After 3 and 6 months of initial periodontal therapy, the mean PD, AL, BI, and PLI in CP+DM and CP groups were significantly lower than the baseline, and the PD in CP+DM group was further decreased by 6 months compared with 3 months [(3.33±0.62) mm vs. (3.61±0.60) mm, P<0.05]. However, none of these periodontal indexes showed significant difference between the two groups by 3 or 6 months. In CP+DM group, HbA1c at 3 months and 6 months were significantly lower than the baseline [(7.09±0.79)% vs. (7.64±1.16)%, P<0.05; (7.06±0.78)% vs. (7.64±1.16)%, P<0.05], and FBG was significantly lower than the baseline by 6 months [(7.35±1.14) mmol/L vs. (8.40±1.43) mmol/L, P<0.05]. The WBC level in CP group was significantly lower than the baseline level by 3 months [(5.35±1.37)×10 ⁹/L vs. (6.01±1.26)×10 ⁹/L, P<0.05], while that in CP+DM group was significantly lower than the baseline level by 6 months [(6.00±1.37)×10 ⁹/L vs. (7.14±1.99)×10 ⁹/L, P<0.05]. The analysis of genera-lized linear mixed model showed that WBC level was significantly positively correlated with PD and FBG (P<0.05). Conclusion: Initial periodontal therapy can effectively improve the periodontal clinical status of patients with or without type 2 diabetes mellitus, and have benefits on glycemic control in diabetic patients. However, the response of periodontal indexes and WBC level to initial therapy were relatively delayed in diabetic patients. WBC plays an important role in the correlation between diabetes mellitus and periodontitis.

Key words: Periodontitis, Diabetes mellitus, type 2, Dental scaling, Periodontal index

中图分类号:

R781.4

徐欣然,霍芃呈,和璐,孟焕新,朱筠轩,靳东思奇. 伴与不伴糖尿病的牙周炎患者牙周基础治疗的疗效比较及其与白细胞水平的相关分析[J]. 北京大学学报（医学版）, 2022, 54(1): 48-53.

XU Xin-ran,HUO Peng-cheng,HE Lu,MENG Huan-xin,ZHU Yun-xuan,JIN Dong-si-qi. Comparison of initial periodontal therapy and its correlation with white blood cell level in periodontitis patients with or without diabetes mellitus[J]. Journal of Peking University (Health Sciences), 2022, 54(1): 48-53.

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Items	CP group (n=32)	CP+DM group (n=27)	P
Age/years	47.16±5.35	54.22±7.87	<0.001
Male	13 (40.6)	18 (66.7)	0.046
BMI/(kg/m²)	23.48±2.11	24.25±2.26	0.182
WHR	0.88±0.06	0.88±0.03	0.614
PD/mm	4.68±0.59	4.63±0.95	0.821
AL/mm	4.43±1.20	4.56±0.99	0.669
BI	3.20±0.63	2.90±0.73	0.089
PLI	2.97±0.12	2.85±0.21	0.009
WBC/(×10⁹/L)	6.01±1.26	7.14±1.99	0.010
FBG/(mmol/L)	5.20±0.35	8.40±1.43	<0.001
HbA1c/%	-	7.64±1.16

Items	Baseline	3 months	6 months	Δ3 months	Δ6 months
PD/mm
CP group	4.68±0.59	3.62±0.64^*	3.47±0.57^*	1.07±0.63	1.20±0.68
CP+DM group	4.63±0.95	3.61±0.60^*	3.33±0.62^*§	1.02±0.86	1.30±0.84
AL/mm
CP group	4.43±1.20	3.87±1.07^*	3.58±0.81^*§	0.56±0.66	0.85±0.66
CP+DM group	4.56±0.99	3.79±0.83^*	3.76±0.86^*	0.77±0.85	0.80±0.62
BI
CP group	3.20±0.63	2.09±0.61^*	2.03±0.55^*	1.12±0.82	1.18±0.82
CP+DM group	2.90±0.73	1.97±0.56^*	1.84±0.42^*	0.93±0.85	1.06±0.68
PLI
CP group	3.00±0.22	2.59±0.57^*	1.85±0.75^*§	0.41±0.52	1.15±0.73
CP+DM group	2.85±0.21^#	2.42±0.58^*	2.03±0.65^*§	0.43±0.52	0.81±0.65
WBC/(×10⁹/L)
CP group	6.01±1.26	5.35±1.37^*	5.51±1.51	0.66±1.11	0.50±1.18
CP+DM group	7.14±1.99^#	6.57±1.68	6.00±1.37^*	0.57±2.20	1.14±1.80
FBG/(mmol/L)
CP group	5.20±0.35	5.20±0.32	5.33±0.42	0.00±0.31	-0.13±0.47
CP+DM group	8.40±1.43^#	7.72±1.40^#	7.35±1.14^*#	0.68±1.52^#	1.05±1.59^#
HbA1c/%
CP group	-	-	-	-	-
CP+DM group	7.64±1.16	7.09±0.79^*	7.06±0.78^*	0.55±0.78	0.58±0.83

Parameter	β	SE	t/Z	P	95%CI
Model 1
Intercept	3.19	0.77	4.12	<0.001	1.66 to 4.71
PD	0.57	0.22	2.56	0.011	0.13 to 1.00
FBG	0.28	0.09	3.25	0.001	0.11 to 0.45
Model 2
Intercept	3.37	0.99	3.39	0.001	1.41 to 5.33
PD	0.55	0.22	2.48	0.014	0.11 to 0.99
FBG	0.27	0.09	2.98	0.003	0.09 to 0.44
Model 3
Intercept	4.10	2.34	1.75	0.082	-0.52 to 8.72
PD	0.53	0.22	2.36	0.019	0.09 to 0.96
FBG	0.29	0.09	3.33	0.001	0.12 to 0.46
Model 4
Intercept	4.73	2.47	1.91	0.058	-0.16 to 9.61
PD	0.45	0.23	1.98	0.050	0.001 to 0.90
FBG	0.26	0.09	2.94	0.004	0.09 to 0.44