慢性牙周炎合并冠心病患者牙周基础治疗对细胞因子水平的影响

Influence of periodontal initial therapy on cytokines in patients with chronic periodontitis and coexistent coronary heart disease

目的研究牙周基础治疗对重度慢性牙周炎合并冠心病患者牙周临床指标、外周血细胞因子和C反应蛋白水平的影响。方法筛选重度慢性牙周炎合并稳定型冠心病患者32例,采用非手术牙周基础治疗方法,治疗前及治疗后4周测量牙周探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)和探诊出血指数(bleed-ing index,BI),并采集外周静脉血,采用放射免疫法和免疫比浊分析法分别检测白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-2(interleukin-2,IL-2)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis fac-tor-α,TNF-α)和C反应蛋白(C-reactive protein,CRP)含量。结果牙周基础治疗4周后,PD由(5.35±0.97)mm减至(2.72±0.65)mm,AL由(5.83±1.12)mm减至(3.24±0.79)mm,BI由3.45±0.83降至0.80±0.77,差异均有统计学意义(P<0.05)。外周血IL-1β、IL-2和IL-6水平均有所下降,TNF-α及CRP水平均数略有升高,其中IL-1β由(0.184±0.045)ng/mL降至(0.145±0.039)ng/mL,TNF-α由(1.082±0.206)ng/mL升高至(1.182±0.154)ng/mL,治疗前后IL-1β及TNF-α水平的差异有统计学意义(P<0.05)。结论重度慢性牙周炎合并冠心病的患者,牙周基础治疗可显著改善牙周临床指标,降低外周血IL-1β水平,升高TNF-α水平。

Objective To evaluate the influence of periodontal initial therapy on serum cytokines and C-reactive pro- tein （CRP） in patients with severe chronic periodontitis and coexistent eoronal.＇y heart disease. Methods Thirty-two pa-tients suffered from severe chronic periodontitis and stable coronary heart disease were inwdved in the study. Peripheral vein blood samples were taken before and four weeks after periodontal initial therapy. Cytokines and CRP levels of serumwere measured by radioimmunoassay and immunoturbidimetry respectively. Results Four weeks after periodontal initial therapy, the mean PD （ probing depth） of patients decreased from （ 5.35 ± 0.97） ,nm to （ 2.72 ± 0.65 ） mm, the meanAI. （attachment loss） from （5.83 ± 1. 12） mm to （3.24 ±0.79） mm and the mean BI （bleeding index） from （3.45 ± 0.83 ） to （0.80 ± 0.77 ）. Anti the differences above were all statistically significant （ P 〈 0. 05 ）. The mean levels of ser-um IL-1β, IL-2 and IL-6 declined, while TNF-α and CRP increased. The decrease of serum IL-1β [ from （0. 184 ± 0.045） ng/mL to （0. 145 ± 0. 039） ng/mL] and the increase of serum TNF-α [ from （1. 082 ± 0. 206） ng/mL to（ 1. 182 ±0. 154） ng/mL] were statistically different（ P 〈 0. 05）. Conclusion Periodontal initial therapy is effective clinically for severe chronic periodontitis patients with coexistent stable coronary heart disease. It could also reduce thelevel of serum IL.-1β and increase the level of serum TNF-α.