社区牙周干预对2型糖尿病患者牙周健康及血糖代谢水平的影响

Effect of community periodontal care intervention on periodontal health and glycemic control in type 2 diabetic patients with chronic periodontitis

目的:评价社区定期龈上洁治对2型糖尿病伴慢性牙周炎患者的干预效果。方法:采取随机、平行对照、盲法设计,将某社区66名2型糖尿病伴慢性牙周炎患者分为实验组Ⅰ(牙周基础治疗组,22例)、实验组Ⅱ(社区龈上洁治组,19例)及空白对照组(25例),并于基线治疗或检查完成后6周、3个月、6个月分别进行复查和复治,比较各组牙周临床指标、血糖代谢水平的变化。结果:Ⅰ、Ⅱ组各项牙周临床指数均较基线显著降低(P<0.05),其中探诊深度分别减少0.71和0.70 mm,显著高于对照组改变0.20 mm(P<0.05)。3组附着水平增加依次为0.86、0.57和0.03 mm,各组间差异均具有统计学意义(P值依次为0.03、0.00、0.00)。Ⅱ组糖化血红蛋白水平较基线显著降低(θ=1.01%,P=0.03),且与牙龈炎症改善显著相关(r=0.51,P=0.03)。结论:定期龈上洁治能显著改善牙周健康及血糖水平,可用于社区糖尿病患者基本保健服务。

Objective： To evaluate the effectiveness of community periodontal care intervention in type 2 diabetic patients with chronic periodontitis who participated in community non-communicable diseases management service.Methods： The randomized controlled and blinded community trial with a duration of six months was designed to compare effects of ＂periodontal initial therapy＂ on group Ⅰ（22 cases）,of ＂professional mechanical tooth cleaning（PMTC）,i.e.coronal scaling＂ on group Ⅱ（19 cases）and of ＂non-clinical therapy＂ on the control group（25 cases）.The clinical periodontal indexes,such as probing depth（PD）,attachment loss（AL）,modified bleeding index（mBI）,plaque index（PLI） were obtained with a Williams type periodontal probe;Laboratory examinations including glycosylated haemoglobin A1（HbA1C）,glucose assay,were conducted.Results： The reductions of PD in groups Ⅰ and Ⅱ were 0.71 and 0.70 mm,respectively,which was more significant than in control group（0.20 mm）;the reductions of AL in groups Ⅰ,Ⅱ,and control group were 0.86,0.57,and 0.03 mm,respectively,which showed significance in all the three groups.The subjects of groups Ⅰ and Ⅱ had 0.56% and 1.01% reductions of HbA1C respectively,and the significance was observed in group Ⅱ.In addition,the improvement of HbA1C values in group Ⅱ was highly correlated with the decrease in gingivitis（r=0.51,P=0.03）.Conclusion： The community periodontal care approaches implemented in the community health service centers have significantly improved periodontal health as well as reduced glycemic level,which could be regarded as basic health care strategies for the patients with diabetes.