牙周机械治疗对慢性牙周炎患者龈沟液中牙周致病菌的影响  

Effect of periodontal mechanical treatment on periodontal pathogenic bacteria in gingival crevicular fluid of chronic periodontitis patients

作　　者：丁芳[1] 孟焕新[2] 李启强[3] 赵亦兵[2] 冯向辉[2] 张立[2] 

机构地区：[1]首都医科大学附属北京安贞医院口腔科,北京100029 [2]北京大学口腔医学院.口腔医院牙周科 [3]首都医科大学附属北京口腔医院牙周黏膜科

出　　处：《北京大学学报（医学版）》2010年第2期202-206,共5页Journal of Peking University:Health Sciences

基　　金："十一五"国家科技支撑计划重点项目(2007BAI18B00)~~

摘　　要：目的:纵向观察分析慢性牙周炎(chronic periodontitis,CP)患者治疗前及治疗后不同时间点内龈沟液中6种牙周致病菌检出率的变化,并分析检出率的变化与牙周临床指标间的关系,试为评价牙周炎治疗效果及判断预后提供一个微生物学手段。方法:应用16S rRNA为基础的PCR技术检测13名CP患者基线、牙周机械治疗后2周、2个月、4个月时以及11名健康对照者龈沟液中的6种牙周致病菌:伴放线放线杆菌(Actinobacillus actinomyce-temcomitans,Aa)、牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)、福赛类杆菌(Bacteroides forsythus,Bf,现已更名为Tannerella forsythensis,Tf)、中间普氏菌(Prevotella intermedia,Pi)、具核梭杆菌(Fusobacterium nucleatum,Fn)、变黑普氏菌(Prevotella nigrescens,Pn)。结果:CP组在牙周机械治疗后2个月和4个月的菌斑指数(plague index,PLI)、探诊深度(probing depth,PD)、出血指数(bleeding index,BI)比治疗前显著降低,但治疗后4个月比2个月有少量升高。CP组基线的6种牙周致病菌的检出率均显著高于健康组。CP组在治疗后2周、2个月、4个月3个时间点的Tf(42.1%、73.7%、70.2%)、Pg(47.4%、68.4%、77.2%)、Aa(15.8%、22.8%、7.0%)、Pn(38.6%、57.9%、64.9%)、Pi(15.8%、38.6%、42.1%)检出率均明显低于治疗前(Tf96.5%、Pg93.0%、Aa36.8%、Pn86.0%、Pi84.2%),而Fn的检出率则仅在治疗后2周减少明显(84.2%vs98.2%),在治疗后2个月(93.0%)和4个月(96.5%)略有回升,但与治疗前相比差异无统计学意义;所有被检致病菌在治疗后2个月检出率比2周时回升。结论:Tf、Pg、Aa、Pn、Pi等牙周致病菌的共同感染可能在CP发病中起一定的作用。CP组在牙周机械治疗后牙周致病菌的变化早于临床指标的变化,治疗后2个月内即应开始定期复查复治。Objective：To evaluate the subgingival prevalent rates of 6 periodontal pathogenic bacteria in gingival crevicular fluids of CP patients before and after treatment,to analyze the relationship between the prevalent variance and periodontal clinical parameters,and to provide a microbiologic method of evaluating curative effect and estimating the prognosis.Methods： Gingival crevicular fluids of 13 CP patients were collected at baseline,2 weeks,2 months and 4 months after periodontal mechanical treatment.Also,gingival crevicular fluids were collected from 11 healthy subjects.Six periodontal pathogenic bacteria including Actinobacillus actinomycetemcomitans（Aa）、Porphyromonas gingivalis（Pg）、Tannerella forsythensis（Tf）、Prevotella intermedia（Pi）、Fusobacterium nucleatum（Fn）、Prevotella nigrescens（Pn）were detected by 16S rRNA based PCR.Results： The PLI、PD、BI of the CP patients 2 months and 4 months after periodontal mechanical treatment were evidently less than those before treatment.These 4 months after treatment were a little more than those 2 months after.The six bacteria were more frequently detected in the CP patients at baseline than in healthy controls.The prevalent rates of Tf（42.1%、73.7%、70.2%）、Pg（47.4%、68.4%、77.2%）、Aa（15.8%、22.8%、7.0%）、Pn（38.6%、57.9%、64.9%）、Pi（15.8%、38.6%、42.1%） 2 weeks,2 months and 4 months following treatment were significantly lower than those at baseline（Tf 96.5%、Pg 93.0%、Aa 36.8%、Pn 86.0%、Pi 84.2%）,but the prevalent rates of all the detected bacteria 2 months after treatment were higher than those at 2 weeks after.Conclusion： Tf、Pg、Aa、Pn and Pi may cooperate in the development of CP.The changes of periodontal pathogenic bacteria could be detected before the changes of clinical parameters and the patients should be re-evaluated and re-treated regularly within 2 months after treatment.

关 键 词：牙周炎 龈沟液 细菌 聚合酶链反应 

分 类 号：R781.4[医药卫生—口腔医学]