伴糖尿病牙周炎患者白细胞水平对牙周治疗后糖脂代谢指标的影响  

Influences of leukocytes in patients with type 2 diabetes and periodontitis to the effects of periodontal treatment on glycemic control

作　　者：霍芃呈 徐菁玲[2] 和璐[1] 孟焕新[1] 杨炳涛 朱筠轩 靳东思奇 Huo Pengcheng;Xu Jingling;He Lu;Meng Huanxin;Yang Bingtao;Zhu Yunxuan;Jin Dongsiqi(Department of Periodontology,Peking University School and Hospital of Stomatology&National Center of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China;Department of Stomatology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学口腔医学院·口腔医院牙周科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京100081 [2]北京大学第三医院口腔科,北京100191

出　　处：《中华口腔医学杂志》2022年第7期716-723,共8页Chinese Journal of Stomatology

基　　金：国家自然科学基金(81570980)。

摘　　要：目的分析伴2型糖尿病(type 2 diabetes,T2DM)牙周炎患者基线时白细胞水平对牙周治疗后糖脂代谢指标的影响。方法于2011年3月至2012年8月北京大学第三医院口腔科,2011年3月至2012年8月、2016年12月至2018年12月北京大学口腔医学院·口腔医院牙周科的就诊患者中选取69例不吸烟、伴T2DM的中重度慢性牙周炎患者。治疗前对其全口探诊深度、附着丧失、出血指数、菌斑指数等指标进行检查,同时检测血液指标包括白细胞水平、空腹血糖、糖化血红蛋白(glycosylated hemoglobin,HbA_(1c))、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白(low density lipoprotein,LDL)。随后进行全口洁治、刮治和根面平整(scaling and root planing,SRP),治疗后3个月重复基线检查。以基线时白细胞水平中位数(6.19×10^(9)/L)为界限,将白细胞计数低于中位数的患者作为白细胞低组(33例),其余患者作为白细胞高组(36例)。对治疗后糖脂代谢指标变化进行Logistic回归分析,并对性别进行交互作用检验。结果SRP治疗后3个月,两组患者各项牙周指标与基线相比均显著改善。与基线相比,白细胞高组白细胞计数显著下降(6.89±1.53对比7.64±1.51,P=0.008),HbA_(1c)(7.18±1.09对比7.67±1.35,P=0.001)和LDL(2.67±0.85对比3.28±0.76,P=0.042)也均显著下降。回归分析结果显示,基线白细胞水平与HbA_(1c)(OR=0.12,P=0.038)和LDL(OR=0.15,P=0.001)下降程度呈正相关;进一步分层分析显示,这一相关性在女性[HbA1c(OR=0.30,P=0.021)、LDL(OR=0.34,P=0.001)]和重度牙周炎患者[HbA_(1c)(OR=0.15,P=0.025)、LDL(OR=0.24,P=0.017)]中表现显著。交互作用检验显示,女性与基线白细胞水平共同影响HbA1c(P=0.036)和LDL(P=0.005)下降水平,其交互作用具有相对超额风险。结论白细胞水平较高的伴T2DM牙周炎患者SRP后3个月可显著改善糖脂代谢水平,在女性重度牙周炎人群中更明显。Objective To analyze the influences of leukocytes on improving blood glucose control in patients with type 2 diabetes mellitus(T2DM)and periodontitis after periodontal mechanical therapy.Methods Thirty-five patients visiting Peking University Third Hospital from March 2011 to August 2012,as well as thirty-four patients visiting Peking University School and Hospital of Stomatology from March 2011 to August 2012 and December 2016 to December 2018 were selected in this research.These subjects were non-smokers,and with moderate to severe chronic periodontitis and T2DM.The full set of periodontal examinations including probing depth(PD),attachment loss(AL),bleeding index(BI)and plaque index(PLI)were conducted.Besides,counts of white blood cells(WBC),parameters of glucose and lipids metabolites such as fasting blood glucose(FBG),glycosylated hemoglobin(HbA_(1c)),total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL)and low density lipoprotein(LDL)in serum were examined before treatment.Then,oral hygiene instruction,scaling and root planing(SRP)were carried out.Three months after SRP,the baseline examinations were repeated in all patients.According to the baseline leukocyte counts,the patients were divided into subgroups:low WBC group(WBC<6.19×109/L)and high WBC group(WBC≥6.19×10^(9)/L).Paired t-test for comparison of changes after treatment,analysis of co-variance for comparing the intervention effects between subgroups,and multifactor Logistic regression analysis were performed.Results Three months after SRP,all periodontal indexes were significantly improved in both groups.Leukocyte counts decreased significantly in high WBC group(6.89±1.53 vs.7.64±1.51,P=0.008).In high WBC group,HbA_(1c)(7.18±1.09 vs.7.67±1.35,P=0.001)and LDL(2.67±0.85 vs.3.28±0.76,P=0.042)decreased significantly,while there were no such differences in low WBC group.Influence of leukocyte level on HbA_(1c)(OR=0.12,P=0.038)and LDL(OR=0.15,P=0.001)improvement was statistically significant.Hierarchical analysis showed such impro

关 键 词：牙周炎 糖尿病 2型 白细胞 低密度脂蛋白 糖化血红蛋白 

分 类 号：R781.42[医药卫生—口腔医学] R587.2[医药卫生—临床医学]