辅以抗生素的牙周机械治疗对伴动脉粥样硬化牙周炎大鼠的颈动脉及血清超敏C-反应蛋白的影响

Effects of periodontal mechanical therapy with local and systemic drugs on carotid artery and serum high-sensitivity C-reactive protein in rats with chronic periodontitis associated with atherosclerosis

目的研究伴动脉粥样硬化(As)的慢性牙周炎(CP)大鼠模型中血清超敏C反应蛋白(hsCRP)的表达及颈动脉血管的病理变化,探讨牙周基础治疗辅以抗生素对As的影响。方法 35只SD大鼠随机分为两大组:A组(正常对照)和B组(CP+As),建立CP+AS模型后再将B组分为4组,自然进程组(B1)、牙周机械治疗组(B2)、机械治疗+局部药物组(B3)、机械治疗+局部药物+抗生素组(B4),每组7只,接受相应的牙周干预治疗。通过酶联免疫吸附(ELISA)法检测血清中hsCRP的质量浓度,光镜下观察颈动脉血管组织的病理变化。结果随着时间推移,B1组hsCRP质量浓度逐渐升高,在第2次干预后5周(第5次取样时间点)明显高于其他组(P<0.001);B2、B3、B4组hsCRP先逐渐升高,在第2次干预后1周(第3次取样时间点)达到高峰,之后逐渐下降,低于其基线水平,但仍高于A组(P<0.05)。第2次干预后3周(第4次取样时间点)起,B3、B4组hsCRP显著低于B2组(P<0.001)。病理结果:B1组可见炎症细胞浸润及大量泡沫细胞,弹性纤维明显紊乱破坏;B2组血管壁厚薄不均,可见泡沫细胞,弹性纤维紊乱;B3组血管壁轻度增厚,弹性纤维排列较整齐;B4组血管壁厚度较均匀,弹性纤维排列整齐。结论对于伴有As+CP的大鼠,牙周基础治疗短期内可能会增加As的发展风险,而从长期作用来看可能会改善As病变;在牙周机械治疗的基础上增加局部抗炎、全身抗生素治疗可优化其疗效。

Objective The aim of this study is to investigate the effects of serum high-sensitivity C-reactive protein （hsCRP） and the pathological changes in the carotid artery after periodontal mechanical therapy with local and systemic drugs in SD rats with chronic periodontitis （CP） associated with atherosclerosis （As）. Methods Thirty-five SD rats were randomly divided into two groups： control group （group A） and CP＋As group （group B）. Group B was further divided into the natural process group （B1）, the periodontal mechanical treatment group （B2）, the periodontal mechanical treatment plus local drugs group （B3）, and the periodontal mechanical treatment plus local and systemic drugs group （B4）. Each group comprised seven rats. Serum hsCRP levels were evaluated at baseline 1 week after the first periodontal therapy and 1, 3, and 5 weeks after the second periodontal therapy by enzyme linked irnmunosorbent assay （ELISA）. The pathological lesion in the carotid artery plaque was stained with hematine and eosin. Results The levels of serum hsCRP in group B 1 increased gradually as time passed and became significantly higher than that of the other groups five weeks after periodontal therapy （P〈0.001）. The levels of serum hsCRP in groups B2, B3, and B4 increased gradually and reached the peak 1 week after the second periodontal therapy. After that, the levels of serum hsCRP decreased gradually but were still higher than that of group A （P〈0.05）. The levels of serum hsCRP in groups B3 and B4 were significantly lower than that in group B2 3 and 5 weeks after the second periodontal therapy （P〈0.001）.Histologic sections revealed increased foam cell infiltration and disordered and destructed elastic fibers in groups B 1 and B2. The thickness of the blood vessels in groups B3 and B4 was more uniform than that in groups B1 and B2. The elastic fibers in groups B3 and B4 were lined up in order. Couelusion Direct periodontal mechanical treatment results in acute, short-term, systemic inflammation and might increase the risk of atherosclerosis in SD rats. However, the levels of serum hsCRP decreased gradually 3 to 5 weeks after therapy. With periodontal mechanical treatment, the benefits of local and systemic drugs are associated with improvement in atherosclerotic lesion progression.