牙周基础治疗后龈沟液中4种生物标志物水平变化及临床意义  

Changes and clinical significance of four biomarkers in gingival crevicular fluid after nonsurgical periodontal therapy

作　　者：张倩[1] 陈斌[2] 闫福华[2] ZHANG Qian;CHEN Bin;YAN Fuhua(Department of Pediatric Dentistry,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of Periodontics,Nanjing Sto-matological Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院,南京市口腔医院儿童口腔科,江苏南京210008 [2]南京大学医学院附属口腔医院,南京市口腔医院牙周病科,江苏南京210008

出　　处：《口腔疾病防治》2021年第12期828-835,共8页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：部省共建临床医学研究中心培育计划(2019060009);江苏省临床医学科技专项(BL2013002)。

摘　　要：目的研究牙周基础治疗前后重度慢性牙周炎患者不同牙位龈沟液(gingival crevicularfluid,GCF)中白细胞介素6(interleukin 6,IL⁃6)、白细胞介素10(interleukin 10,IL⁃10)、肿瘤坏死因子α(tumor necrosisα,TNF⁃α)、碱性磷酸酶(alkaline phosphatase,ALP)水平的变化,探讨以上4种生物标志物GCF水平与牙周状态的关系以及对牙周基础治疗效果、牙周炎活动性评估的临床意义。方法共30例重度慢性牙周炎患者参与了为期1年的纵向试验研究(中国临床试验注册中心:ChiCTR⁃OCH⁃13004679)。在术前和基础治疗后1、3、6、12个月,记录牙周临床指标(菌斑指数、龈沟出血指数、探诊深度、临床附着丧失),并用滤纸条收集每例患者2个深袋牙位(探诊深度≥6 mm)和2个浅袋牙位(探诊深度≤4 mm)的GCF并称重,ELISA法测定GCF中IL⁃6、IL⁃10、TNF⁃α和ALP的水平。选取15名牙周健康者的30个健康牙位为重度慢性牙周炎患者的基线对照。结果基线时,重度慢性牙周炎患者的疾病位点GCF中TNF⁃α、ALP、IL⁃6水平显著高于对照组的牙周健康位点(P<0.001),IL⁃10水平显著低于对照组(P<0.001);重度慢性牙周炎患者深袋位点的GCF中TNF⁃α、ALP、IL⁃6水平显著高于浅袋位点(P<0.001);深袋位点IL⁃10水平显著低于浅袋位点(P<0.001)。相较于基线,基础治疗后1、3、6、12个月,重度慢性牙周炎患者深袋、浅袋位点GCF中的TNF⁃α、ALP水平显著降低,IL⁃10水平显著升高(P<0.005),深袋位点GCF中IL⁃6水平显著降低(P<0.005),浅袋位点的IL⁃6无统计学意义上的改变(P>0.05)。治疗后1、3、6、12个月,4项牙周临床指标较基线均有改善,以上4种生物标志物水平与牙周临床指标之间均存在显著相关性,与IL⁃6、TNF⁃α、ALP呈正相关,与IL⁃10呈负相关(P<0.05)。在基础治疗后的2次随访期间临床附着丧失增加超过2 mm的位点,GCF中4种生物标志物水平与上一次相比,差异有统计�Objective To study the changes in levels of interleukin(IL)-6, IL-10, tumor necrosis factor-alpha(TNF-α), and alkaline phosphatase(ALP) in the gingival crevicular fluid(GCF) of patients with severe chronic periodontitis before and after nonsurgical periodontal therapy and to explore the relationship among the levels of these four biomarkers in GCF, their periodontal status and their clinical significance to evaluate the effect of nonsurgical periodontal therapy and periodontitis activity.MethodsIn total, 30 patients with severe chronic periodontitis were enrolled in a 1-year longitudinal pilot study(Chinese Clinical Trial Registry: ChiCTR-OCH-13004679). At baseline and 1, 3, 6, and 12 months after nonsurgical therapy, the periodontal clinical indicators plaque index(PLI), probing depth(PD), clinical attachment loss(CAL), sulcus bleeding index(SBI) were recorded. Filter paper strips were used to collect two deep-pocket(probing depth ≥ 6 mm) and two shallow-pocket(probing depth ≤ 4 mm) periodontal sites for each patient and weighed. The levels of interleukin IL-6, IL-10, TNF-α, and ALP in GCF were assessed using enzyme-linked immunosorbent assay. Meanwhile, 30 healthy sites of 15 subjects with healthy periodontium were used as the baseline controls for patients with severe chronic periodontitis.ResultsAt the baseline, the TNF-α, ALP and IL-6 levels in GCF of the disease sites of patients with periodontitis were significantly higher than those in healthy periodontal sites of the control group(P < 0.001), and the levels of IL-10 were significantly lower than those in the control group(P < 0.001). In patients with severe chronic periodontitis, the levels of TNF-α, ALP and IL-6 in GCF at deep-pocket sites were significantly higher than those at shallow-pocket sites(P <0.001), and the IL-10 levels were significantly lower than those at shallow-pocket sites(P < 0.001). 1, 3, 6, and 12 months after nonsurgical treatment, the levels of TNF-α and ALP in GCF at the shallow-and deep-pocket sites in patients with chro

关 键 词：生物标志物 白细胞介素⁃10 肿瘤坏死因子⁃α 白细胞介素⁃6 碱性磷酸酶 龈沟液 牙周基础治疗 重度慢性牙周炎 临床试验 

分 类 号：R78[医药卫生—口腔医学]