牙周炎患者龈下刮治前后褪黑素表达水平的研究

发布时间：2018-09-01 18:47

【摘要】：目的：检测牙周炎患者相关体液中褪黑素(melatonin, MT)、中瘤坏死因子-α (tumor necrosis factor-α, TNF-α)、白细胞介素-1β (interleukin-1β,IL-1β)表达水平并观察龈下刮治对其表达水平的影响,结合牙周临床指标,探讨褪黑素在牙周炎发病机制中的可能作用。方法：根据rmitage的牙周炎诊断标准纳入牙周炎初诊患者27例。同时纳入无系统疾病且牙周健康者18例作为健康对照组。收集患者病史资料及曲面断层片,进行牙周专科检查确定取样牙位,并进行龈上洁治,1周后行龈下刮治,4周后复诊。分别于龈下刮治前及刮治后4周复诊时,记录临床指标并采集血液、唾液及取样牙牙位龈沟液(gingival crevicular fluid, GCF)。记录健康对照组牙周临床指标并采集血液和唾液。采用酶联免疫吸附试验(enzyme-linked immunosorbent assay, ELISA)检测样本中MT、TNF-α及IL-1β的浓度,应用秩和检验比较其在牙周炎组与健康对照组中的表达差异,并比较牙周炎组龈下刮治前后其表达水平的变化,运用Spearman秩相关检验分析样本中MT、TNF-α、IL-1β与牙周临床指标探诊深度(probing depth, PD)、探诊出血(bleeding on probing, BOP)、附着丧失(clinical attachment level, CAL)的相关关系。结果：1、牙周炎组患者血液中MT水平刮治前低于刮治后(Z=-2.186,P=0.029),且均低于健康对照组(P0.001);牙周炎组患者唾液中MT水平在刮治前、后和健康对照组三组间相比差异均无统计学意义(P0.05)；牙周炎组患者GCF中MT水平刮治前高于刮治后(Z=-2.667,P0.001)。2、刮治前,牙周炎组患者血液、唾液与GCF中MT水平无明显相关性；健康对照组中血液和唾液MT水平无明显相关性。3、牙周炎组患者IL-1β、TNF-α与牙周临床指标的关系：刮治前唾液中IL-1β、TNF-α与牙周临床指标无明显相关性；GCF中IL-1β水平与取样牙PD成正相关(r=0.350,P=0.041),与取样牙BOP阳性率成正相关(r=0.514,P=0.011),TNF-α水平与取样牙PD成正相关(r=0.304,P=0.045),与取样牙BOP阳性率成正相关(r=0.427,P=-0.036)。其余指标无明显相关性。4、牙周炎组患者MT与牙周临床指标的关系：刮治前血液MT水平与全口PD (r=-0.465, P=0.034)、BOP (r=-0.466, P=0.025)均成负相关；唾液MT水平与全口BOP阳性率成负相关(r=0.401,P=0.021)；GCF中MT水平与取样牙PD成正相关(r=0.465,P=0.045)。其余指标无明显相关性。5、牙周炎组患者MT与IL-1β,TNF-α的关系：刮治前唾液中MT与IL-1β,TNF-α无明显相关；GCF中MT水平与IL-1β水平呈正相关(r=0.442,P=0.015),与TNF-α无明显相关。6、Logistic回归分析结果显示血液MT水平与牙周炎OR值为0.756(B=-0.280,P=0.030,95%CI：0.587-0.974),提示高水平血液MT为牙周炎的保护因素。结论：1、牙周炎患者GCF中MT水平与IL-1β水平正相关,且与PD成正相关,提示MT与牙周炎症严重程度正相关。2、牙周炎患者血液中MT呈低表达水平,在GCF中MT可能为局部诱导上调表达。
[Abstract]:Objective: to detect the expression of tumor necrosis factor- 伪 (TNF- 伪) and interleukin-1 尾 (interleukin-1 尾 -IL-1 尾) in melatonin (melatonin, MT), and observe the effect of subgingival curettage on the expression of melatonin (melatonin, MT), in patients with periodontitis. To explore the possible role of melatonin in the pathogenesis of periodontitis. Methods: according to the rmitage criteria of periodontitis, 27 patients with periodontitis were included. At the same time, 18 patients with no systemic disease and periodontal health were included as healthy control group. Collect the patient's medical history and curved surface tomograph, make periodontal examination to determine the position of the sampled teeth, and do the supragingival scaling for 1 week and then the subgingival curettage for 4 weeks. Before and 4 weeks after subgingival curettage, clinical data were recorded and (gingival crevicular fluid, GCF). Was collected from blood, saliva and gingival crevicular fluid. The periodontal clinical indexes were recorded and blood and saliva were collected in healthy control group. Enzyme linked immunosorbent assay (enzyme-linked immunosorbent assay, ELISA) was used to detect the concentration of MT,TNF- 伪 and IL-1 尾 in the samples. The expression of MT,TNF- 伪 and IL-1 尾 in periodontitis group was compared with that in healthy control group by rank sum test, and the expression level of MT,TNF- 伪 and IL-1 尾 in periodontitis group was compared before and after subgingival curettage. Spearman rank correlation test was used to analyze the relationship between MT,TNF- 伪 IL-1 尾 and periodontal clinical index, the depth of (probing depth, PD), probing bleeding, (bleeding on probing, BOP), attachment and loss of (clinical attachment level, CAL). Results the blood MT level in the periodontitis group was lower than that in the control group before and after curettage (P0. 001) and was lower than that in the healthy control group (P0. 001), but there was no significant difference between the three groups before and after the curettage (P0.05). The level of MT in GCF of periodontitis group was higher than that after curettage (ZP0.001). Before curettage, there was no significant correlation between blood, saliva and MT level in GCF in periodontitis group. There was no significant correlation between MT level in blood and saliva in healthy control group. The relationship between IL-1 尾 TNF- 伪 and periodontal clinical index in periodontitis group: there was no significant correlation between IL-1 尾 -TNF- 伪 in saliva and periodontal clinical index before curettage. The level of IL-1 尾 in GCF was positively correlated with the PD of sampled teeth (r = 0.350), and with the positive rate of BOP in sampled teeth (r = 0.514). There was a positive correlation between the level of TNF- 伪 and the PD of sampled teeth (r = 0.304), and a positive correlation with the positive rate of BOP in sampled teeth (r ~ (0.427) P ~ (-0.036). There was no significant correlation between other indexes. The relationship between MT and periodontal clinical indexes in periodontitis group: before curettage, there was a negative correlation between MT level in blood and PD (r-0.466, P0. 025) in the whole mouth, and there was a negative correlation between MT level in saliva and the positive rate of BOP in the whole mouth (r0. 401, P0. 021). There was a positive correlation between MT level in GCF and PD in sampled teeth (r = 0.465, P = 0.045). There was no significant correlation between MT and IL-1 尾 TNF- 伪 in periodontitis patients. There was no significant correlation between MT and IL-1 尾 TNF- 伪 in saliva before curettage. There was a positive correlation between MT level and IL-1 尾 level in GCF (r = 0.442 P 0.015), but no significant correlation with TNF- 伪. Logistic regression analysis showed that the serum MT level and OR value of periodontitis were 0.756 (BM-0.280), suggesting that the high level of blood MT was the protective factor of periodontitis. Conclusion MT level in GCF of periodontitis patients is positively correlated with IL-1 尾 level, and is positively correlated with PD, suggesting that MT is positively correlated with the severity of periodontitis, and MT expression is low in the blood of periodontitis patients. In GCF, MT may be locally induced and up-regulated.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R781.42

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