双波长激光结合多肽凝胶治疗牙周牙髓联合病变的疗效及对MIP-1α、RANKL表达的影响  

Joint Curative Effect of Dual-Wavelength Laser and Peptide Gel in Treating Combined Periodontal-Endodontic Lesions & Its Influence on Expression of MIP-1α and RANKL

作　　者：刘惠 陈艳艳 王洪伟 LIU Hui;CHEN Yanyan;WANG Hongwei(Department of Stomatology,Qinhuangdao Third Hospital,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第三医院口腔科,秦皇岛市066000

出　　处：《中国激光医学杂志》2022年第4期200-206,共7页Chinese Journal of Laser Medicine & Surgery

基　　金：秦皇岛市科学技术研究与发展计划(202101A145)。

摘　　要：目的探究双波长激光结合多肽凝胶治疗牙周牙髓联合病变患者的疗效,以及对巨噬细胞炎症蛋白-1α(macrophage inflammatory protein-1α,MIP-1α)和核因子κB受体活化因子配体(receptor activator of NF-κB ligand,RANKL)表达的影响。方法选取2019年7月至2022年1月,牙周牙髓合并病变患者160例,随机分为观察组和对照组,每组患者各80例。两组患者均先进行常规牙周基础治疗后,对照组采用牙周袋内注满抗菌多肽凝胶治疗;观察组在对照组基础上给予Nd∶YAG激光(脉冲峰值功率1.5 W,频率2 Hz,脉冲能量300 mJ,光斑直径1 mm,波长532 nm)消毒牙根和Er∶YAG激光(脉冲峰值功率2.0 W,频率15 Hz,脉冲能量60 mJ,光斑直径1 mm,波长2.94μm)照射牙周袋抗炎治疗。治疗前和末次治疗后6周,采用视觉模拟评分法(visual analogue scale,VAS)判定患者的疼痛程度。末次治疗后6周,观察两组患者牙周菌斑指数(plaque index,PLI)、临床附着水平(clinical attachment level,CAL)、牙周探测深度(probing depth,PD)和出血指数(bleeding index,BI)临床指标变化,并检测MIP-1α和RANKL水平的改变。治疗后6个月,记录两组牙周炎、叩痛、牙齿松动发生率等不良反应情况。结果两组患者治疗后6周的VAS评分明显低于治疗前(P<0.001),观察组的VAS评分低于对照组(P<0.001)。治疗后6周,两组患者的PLI、CAL、PD和BI水平较治疗前降低(P<0.001),且观察组的PLI、CAL、PD和BI水平显著低于对照组(P<0.05);治疗后6周,两组患者的MIP-1α和RANKL水平均低于治疗前(P<0.001),且观察组较对照组降低更明显(P<0.05);治疗后6周,观察组临床总有效率(91.3%)高于对照组(76.3%),两组差异具有统计学意义(P<0.05)。治疗后6个月,观察组患者牙周炎、叩痛、牙齿松动发生率均低于对照组(P<0.05)。结论双波长激光结合多肽凝胶治疗牙周牙髓联合病变疗效显著,能够下调龈沟液的MIP-1α和RANKL表达,具有较高的临床应用价值。Objective To investigate the joint efficacy of dual-wavelength laser and polypeptide gel in treating patients with combined periodontal-endodontic lesions and its influence on the expression of macrophage inflammatory protein-1α(MIP-1α)and receptor activator of NF-κB ligand(RANKL).Methods Totally 160 patients with combined periodontal-endodontic lesions that were treated from Jul.2019 to Jan.2022 were selected and randomly divided into the observation group and control group,80 patients in each group.After the conventional basic periodontal therapy,the patients in the control group were given periodontal pocket filling with antibacterial polypeptide gel,and those in the observation group were treated with Nd:YAG laser(pulse peak power 1.5 W,frequency 2 Hz,pulse energy 300 mJ,spot diameter 1 mm,wavelength 532 nm)to disinfect the roots and Er:YAG laser(pulse peak power 2.0 W,frequency 15 Hz,pulse energy 60 mJ,spot diameter 1 mm,wavelength 2.94μm)to irradiate the periodontal pocket in addition.Visual analogue scale(VAS)was used to determine the degree of pain before the treatment and 6 weeks after the treatment respectively.The changes of plaque index(PLI),clinical attachment level(CAL),probing depth(PD)and bleeding index(BI)were observed 6 weeks after the treatment,and the changes of MIP-1αand RANKL levels were also detected.The incidence of periodontitis,percussion pain,tooth mobility and other adverse reactions were recorded for both groups over the 6 months after the treatment.Results For both groups,the VAS score dropped significantly 6 weeks after the treatment(P<0.001),and the VAS score of the observation group was lower than that of the control group(P<0.001).PLI,CAL,PD and BI levels in both groups dropped 6 weeks after the treatment(P<0.001),and the PLI,CAL,PD and BI levels in the observation group were significantly lower than those in the control group(P<0.001).The MIP-1αand RANKL levels dropped in both groups 6 weeks after the treatment(P<0.001),and the decrease was more significant in the observat

关 键 词：牙周牙髓联合病变 双激光波长 多肽凝胶 

分 类 号：R616.4[医药卫生—外科学] R781.4[医药卫生—临床医学]