牙周基础治疗对2型糖尿病伴中度牙周炎患者糖代谢的影响

Effect of initial periodontal therapy on glycometabolism of type 2 diabetic patients with moderate periodontitis

目的研究牙周基础治疗对2型糖尿病伴牙周炎患者牙周状况和糖代谢的影响。方法选取2008年5月-2009年10月在解放军总医院口腔医学中心和内分泌科就诊的牙周炎患者及伴有2型糖尿病的牙周炎患者各12例,进行牙周基础治疗(包括口腔卫生指导、龈上洁治、龈下刮治和根面平整)。治疗前及治疗后3个月和6个月时,检查龈沟出血指数(SBI)、临床附着丧失(CAL)、探针深度(PD)等牙周临床指标,并检测血液中糖化血红蛋白(HbA1c)和龈沟液中细胞因子白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)的含量,比较治疗前后的变化及两组间的差异。结果两组患者经治疗后各项牙周临床指标均明显改善(P<0.01),龈沟液中IL-1β和TNF-α水平降低(P<0.05),两组间无显著性差异(P>0.05)。糖尿病牙周炎患者治疗后3个月时外周血HbA1c显著降低(P<0.01),6个月时略有回升,但仍低于治疗前(P<0.05)。结论牙周基础治疗能够改善2型糖尿病伴牙周炎患者的牙周状况,并降低其外周血中HbA1c水平。

Objective To compare the local efficacy of initial periodontal therapy between type 2 diabetic and non-diabetic patients with moderate periodontitis, and the effect of initial periodontal therapy on glyeometabolism. Methods Twenty-four moderate periodontitis patients were selected including 12 with diabetes and 12 without diabetes admitted to the Department of Stomatology Center and Department of Endocrinology of General Hospital of PLA. After the pre-treatment phase, all the subjects underwent initial periodontal therapy including oral hygiene introduction, supragingival and suhgingival scaling and root planing. Before and 3, 6 months after the treatment, sulcus bleeding index （SBI）, clinical attachment loss （CAL）, probing depth （PD） and biochemical analysis of peripheral blood and gingival crevicular fluid, glycosylated haemoglobin （HbAlc）, interleukin-1β （IL-1β）, tumor necrosis factor-α （TNF-α） of the subjects were examined. The variation before and after treatment, and the differences between the two groups, were then analyzed. Results Diabetic and non-diabetic subjects with moderate periodontitis responded well after therapy, showing a very similar progression during the follow-up period. Both groups showed clinically significant improvements （P〈0. 01）. Significant reductions were also found in the levels of IL-1β and TNF-α （P〈0. 05）. Diabetic subjects showed an improvement in their metabolic control. The HbAlc decreased significantly in diabetic patients with moderate periodontitis 3 months after treatment （P〈0. 01）. Although the HbAlc increased slightly at the 6th month after treatment, it was still lower than that before treatment （P〈0. 05）. Conclusion The clinical improvement is expected in type 2 diabetic patients with moderate periodontitis treated by initial periodontal therapy, accompanied by a significant reduction in HbAlc values in peripheral blood.