牙周非手术治疗对维持性血液透析伴牙周炎患者牙周状况及血清超敏C反应蛋白的影响  

Effect of non-surgical periodontal therapy on periodontal status and hs-CRP in maintenance hemodialysis patients with chronic periodontitis

作　　者：刘涛[1] 李根[1] 卢锦莲[1] 胡爱霞[1] 刘情操[1] 袁慧中[1] 

机构地区：[1]黄石市第二医院肾内科血液净化中心,湖北435002

出　　处：《中国血液净化》2016年第7期336-340,共5页Chinese Journal of Blood Purification

基　　金：湖北省自然科学基金面上项目(NO.2014CFC1038)

摘　　要：目的调查维持性血液透析(maintenance hemodialysis,MHD)患者牙周炎情况,观察牙周非手术治疗对MHD伴牙周炎患者牙周状况和微炎症状态的影响。方法选择MHD患者85例,匹配对照组85例。记录一般情况,测取血清超敏c反应蛋白(high sensitivity-c-reactive protein,hs-CRP)及牙周疾病情况。分析比较两组患者的软垢指数(debris index,DI)、牙石指数(calculus index,CI)和牙周病指数(periodontal disease index,PDI)的差异。对中、重度牙周炎患者30例,实施牙周非手术治疗。调查治疗前及治疗1、3个月后的牙周情况和hs-CRP的变化以及各临床指标变化。结果 MHD患者牙周病患病率83.5%,DI2.11(1.22)、CI1.80(0.81)、PDI 3.91(1.92)均高于健康对照组DI1.61(0.71)、CI1.50(0.82)、PDI3.30(2.04)(DI:Z=3.131,P=0.016;CI:Z=2.973,P=0.003;PDI:Z=2.035,P=0.043)。治疗前中、重度牙周病组中患者hs-CRP水平高于牙周健康和轻度牙周病组[(15.98±6.85)mmol/L比(11.13±7.41)mmol/L,t=2.994,P=0.004]。中、重度牙周病组实施牙周非手术治疗1月后DI(Z=3.481,P=0.001)、CI(Z=3.335,P=0.001)、PDI(Z=2.037,P=0.045)均较前显著下降;hs-CRP水平在非手术治疗1、3个月后均明显降低[1月后:(9.03±6.19)mmol/L,t=4.120,P<0.001,3月后:(11.04±5.92)mmol/L,t=2.985,P=0.004]。术后第3个月前白蛋白较术前[(282.62±91.04)g/L比(229.71±86.80)g/L,t=2.300,P=0.018]升高,血红蛋白亦较术前[(86.21±10.63)g/L比(79.22±17.23)g/L,t=1.891,P=0.023]升高。结论牙周非手术治疗在改善MHD伴牙周炎患者的牙周健康状况的同时,也减轻了患者的微炎症状态。Objective To investigate the periodontal status in maintenance hemodialysis （MHD） patients, and to evaluate the clinical efficacy of non-surgical periodontal therapy on periodontal status and high- sensitivity C-reactive protein （hs-CRP） in MHD patients with chronic periodontitis. Methods We recruited 85 MHD patients as the experiment group, and 85 healthy individuals as the control group. Clinical parameters, hs-CRP and periodontal status in experiment group were observed. We compared debris index （DI）, calculus index （CI） and periodontal disease index （PDI） between the two groups. Patients in the experiment group were further divided into moderate or severe chronic periodontitis subgroup （MSCP, n=30） and mild chronic periodontitis subgroup （MCP, n=55）. Patients in the MSCP subgroup were treated with non-surgical periodontal therapy. Periodontal status （DI, CI and PDI）, hs-CRP and clinic parameters were evaluated before and after the treatment. Results In experiment group, the prevalence of periodontal disease was 83.5%, and DI, CI and PDI were higher than those in control group [DI2.11（1.22） vs, DI1.61 （0.71）, Z=3.131, P=0,016; CI1.80（0.81） vs. CI1.50 （0.82）, Z=2.973, P=0.003; PDI 3.91（1.92） vs. PDI 3.30 （2.04）, Z=2.035, P=-0.043]. Serum hs-CRP was higher in MSCP subgroup than in MCP subgroup （15.98±6.85 mmol/L vs. 11.13±7.41 mmol/L, t=2.994, P=0.004）. In MSCP subgroup, DI, CI and PDI decreased at the first month after non-surgical periodontal thera- py （DI： Z=3.481, P=0.001; CI： Z=3.335, P=0.001; PDI： Z=2.037, P=-0.045）; serum hs-CRP also decreased significantly after the therapy as compared with the initial hs-CRP level （after one month： 9.03±6.19mmol/L, t=- 4.120, P〈0.001; after 3 months： 11.04±5.92 mmol/L, t=-2.985, P=0.004）; prealbumin and hemoglobin increased after the treatment for 3 months as compared with the levels before treatment （prealbumin： 282.62± 91.04 g/L vs. 229.71±6.80 g/L, t=-2.300, P=0.018; hemoglobin�

关 键 词：维持性血液透析 牙周病 牙周非手术治疗 高敏C反应蛋白 

分 类 号：R318.16[医药卫生—生物医学工程]