牙周基础治疗对2型糖尿病伴牙周炎患者脂肪因子及胰岛素抵抗的影响

发布时间：2018-05-14 02:25

本文选题：牙周基础治疗 + 2型糖尿病　；参考：《青岛大学》2017年硕士论文

【摘要】：研究目的:糖尿病是一种由于糖代谢障碍引起的,以多饮、多食、多尿、消瘦为特征的代谢性疾病,严重影响患者的身心健康,2型糖尿病是糖尿病的主要类型,发病占糖尿病患者90%以上;而牙周炎以破坏牙齿支持组织为特征,在我国发病率高达80%以上,以慢性牙周炎最为常见,占所有牙周炎患者的95%。糖尿病与牙周炎存在明确的相关关系,拥有共同的临床危险因素。然而,牙周炎与糖尿病的相互作用机制尚不清楚,成为牙周医学研究的难点。本研究目的为探讨牙周基础治疗对2型糖尿病伴慢性牙周炎患者血清及龈沟液中瘦素,内脂素浓度和胰岛素抵抗的影响,以期更好地了解2型糖尿病伴慢性牙周炎患者全身及局部的炎症状况,为认识糖尿病及牙周炎的相互影响机制,提供新的研究思路。研究方法:实验选取30例2型糖尿病伴慢性牙周炎患者,所有患者均来自青岛大学附属医院口腔科、内分泌门诊及病房,将研究对象按照是否接受牙周基础治疗随机分为治疗组和对照组。治疗组患者进行牙周基础治疗,治疗内容包括口腔卫生宣传教育、全口龈上洁治、龈下刮治,根面平整,对照组仅进行口腔卫生宣传教育。分别记录治疗前后两组牙周指数,包括菌斑指数(PLI)、探诊深度(PD),附着丧失(AL),测定糖化血红蛋白水平(Hb A1c),胰岛素抵抗指数(HOMA-IR)并收集治疗前及治疗后3个月血清及龈沟液样本,采用酶联免疫吸附试验方法测定瘦素、内脂素浓度。比较各组治疗前后牙周指数、Hb A1c、HOMA-IR及脂肪因子含量的变化,分析脂肪因子水平与其他指标的相关性。结果:与牙周基础治疗前相比,治疗后3个月,治疗组局部牙周炎症得到显著改善,表现在PLI、PD、AL水平显著下降(P0.05),对照组改变不具有统计学意义;龈沟液中瘦素水平显著上升,内脂素水平显著下降,血清中瘦素及内脂素浓度显著下降,且差异具有统计学意义(P0.05),而对照组无明显变化(P0.05);治疗组Hb A1c水平及HOMA-IR较基线显著下降(P0.05),而对照组变化无统计学意义(P0.05);血清中内脂素水平与Hb A1c呈正相关(r=0.839,P0.05),龈沟液中瘦素水平和PD呈负相关(r=-0.775,P0.05)。结论:牙周基础治疗可显著改善2型糖尿病伴慢性牙周炎患者牙周炎症、糖化血红蛋白水平及胰岛素抵抗指数;牙周基础治疗可升高2型糖尿病伴慢性牙周炎患者的龈沟液瘦素水平、降低龈沟液内脂素水平,两者水平的变化可能与牙周炎症的改善相关;而2型糖尿病伴慢性牙周炎患者血糖的改善可能与血清中瘦素、内脂素水平降低相关。
[Abstract]:Objective: diabetes is a metabolic disease caused by impaired glucose metabolism, characterized by polydrink, polydiet, polyuria and wasting. Type 2 diabetes is the main type of diabetes mellitus, which seriously affects the physical and mental health of patients. The incidence of periodontitis is more than 80% in China, and chronic periodontitis is the most common disease, accounting for 95% of all periodontitis patients. Diabetes has a clear correlation with periodontitis and has a common clinical risk factor. However, the mechanism of periodontitis and diabetes is not clear, and become a difficult point in periodontal medicine. Objective to investigate the effects of periodontal basic therapy on serum and gingival crevicular fluid concentrations of leptin, endolipidins and insulin resistance in patients with type 2 diabetes mellitus with chronic periodontitis. To better understand the systemic and local inflammation in patients with type 2 diabetes mellitus and chronic periodontitis, and to provide new research ideas for understanding the interaction mechanism of diabetes mellitus and periodontitis. Methods: thirty patients with type 2 diabetes mellitus with chronic periodontitis were selected. All the patients were from the Department of Stomatology, Endocrine Clinic and Ward, affiliated Hospital of Qingdao University. The subjects were randomly divided into treatment group and control group according to whether or not they received periodontal basic therapy. The patients in the treatment group were treated with periodontal basic treatment, including oral health education, whole gingival scaling, subgingival curettage, and flat root surface, while the control group only carried out oral health education. The periodontal index, including plaque index (PLI), depth of diagnosis (PD), attachment loss (ALP), HbA1cI, insulin resistance index (HOMA-IRR) before and after treatment were recorded, and serum and gingival crevicular fluid (GCF) samples were collected before and after treatment. The concentrations of leptin and endolipin were determined by enzyme-linked immunosorbent assay (Elisa). The changes of HOMA-IR and fat factor content in periodontal index (HbA1cU) before and after treatment were compared, and the correlation between the level of fat factor and other indexes was analyzed. Results: compared with those before basic periodontal treatment, the local periodontitis was significantly improved in the treatment group 3 months after treatment, which showed that the level of PLI PDL decreased significantly (P 0.05), the change in the control group was not statistically significant, and the level of leptin in gingival crevicular fluid increased significantly. The levels of endolipidins and leptin in serum decreased significantly, and the concentrations of leptin and endolipidins in serum decreased significantly. The difference was statistically significant (P 0.05), but there was no significant change in the control group (P 0.05), the level of HB A1c and HOMA-IR in the treatment group decreased significantly compared with the baseline (P 0.05), but the change in the control group was not statistically significant (P 0.05), and the serum lipid level was positively correlated with HB A 1c (0.839 P 0.05) and gingival crevicular fluid (GCF). There was a negative correlation between leptin level and PD. Conclusion: periodontal basic therapy can significantly improve periodontitis, glycosylated hemoglobin level and insulin resistance index in patients with type 2 diabetes mellitus and chronic periodontitis. The level of leptin in gingival crevicular fluid was increased and the level of lipopolipin in gingival crevicular fluid was decreased in patients with type 2 diabetes mellitus and chronic periodontitis after periodontal treatment. The changes of both levels may be related to the improvement of periodontitis. The improvement of blood glucose in type 2 diabetic patients with chronic periodontitis may be related to the decrease of serum leptin and endolipidin levels.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R781.42

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