牙周干预对2型糖尿病伴牙周病患者糖化血红蛋白水平影响的初步分析

Preliminary analysis on the influence of periodontal intervention on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus associated with periodontal disease

目的:观察2型糖尿病(T2DM)伴慢性牙周病患者干预治疗后牙周指数、糖化血红蛋白(HbA1c)的变化及其主要影响因素。方法:将T2DM 58例伴慢性牙周病患者随机分为A组(观察组)28例和B组(对照组)30例,A组给予牙周基础治疗,B组常规处理,定期复查并记录牙龈指数(GI)、菌斑指数(PLI)、龈沟出血指数(SBZ),附着丧失(AL)和HbA1c、空腹血糖(FBG),比较两组基线值及36个月后各指标的变化。结果:(1)A组与B组基线值比较HbA1c、FBG、GI、PLI、SBI、AL无显著性的差异(P>0.05);(2)A组干预后3～6个月与B组比较,AL、GI、PLI、SBI明显改善(AL的P<0.05,余P值<0.01),HbA1c和FBG无统计学的意义(P>0.05);(3)A组干预后与基线值比较,FBG、PLI、GI、SBI等指标明显改善(FBG和PLI的P<0.05,余P均<0.01),HbA1c和AL无显著性差异(P>0.05),B组3～6个月后各指标与基线值比较均无显著性变化(P>0.05);(4)多因素回归分析:①以HbA1c为应变量,年龄、病程、BMI、GI、PLI、SBI、AL为自变量进行多元逐步回归,结果显示:HbA1c与BMI、GI、显著正相关(P均<0.05);②先后分别以GI或PLI或SBI或AL等牙周指数为应变量,年龄、病程、BMI、HbA1c和FBG为自变量,多元逐步回归结果显示,各牙周指数均分别与HbA1c显著正相关(除AL P为自变量时P<0.05,余P均<0.01)。结论:牙周干预治疗可改善T2DM伴慢性牙周病的牙周健康及糖代谢状况,各牙周指数均与HbA1c呈正相关关系,牙周指数均与HbA1c互为主要影响因素。

Objective To observe the change of periodontal index and glycated hemoglobin （HbAlc） in patients of type 2 diabetes mellitus （T2DM） with chronic periodontal after intervention therapy, and its main influencing factors. Methods Fifty-eight cases of T2DM patients with chronic（ periodontitis ） disease were randomly divided into group A （observations group,28 cases ） and group B （control group,30 cases）.Group A received periodontal basic treatment and group B only was checked regularly.The gingival index （GI）, plaque index （PLI）, gingival sulcus bleeding index （SBZ）, attachment loss （AL） and HbAlc, fasting blood glucose （FBG） were reviewed.Compared the changes of various indexes beteen the two groups in baseline and 3-6 months after. Results （1）In group A and group B baseline comparison on age, course of the disease, body mass index （BMI）,HbAlc,FBG,GI, PLI SBI,AL had no significant difference （P〉 0.05）. （2） Compared beteen the two groups in 3N6 months after,in group A AL,GI, PLI, SBI obviously improved,the P of AL〈0.05, other P〈0.01）, HbAlc and FBG had no statistical significance （P〉0.05）.（3）After the intervention in group A FBG, PLI, GI and SBI improved significantly （FBG and PLI P〈0.05,other P〈0.01）,HbAlc and AL were no significant difference （P〉0.05）;In group B 3N6 months after not intervene the index were no significant difference compared with baseline values （all P〉0.05）.（4）Multiple factors regression analysis：（~When HbAlc as dependent variable,age,course of the disease, BMI, GI, PLI SBI, AL as the independent variable stepwise regression,the analysis showed： HbAlc was significant positively correlated with G I, BMI （P〈 0.05）; （~When successively GI/PLI/SBI or AL as the dependent variable, age, duration, BMI, HbAlc and FBG as independent variables, multiple stepwise regression results showed that the periodontal index as？ Were respectively significant positively correlated with HbAlc （when AL as independent variables P〈0.05;others P〈0.01）. Conclusion Periodontal intervention treatment can improves periodontal health and sugar metabolism in T2DM patients with chronic periodontal disease. Periodontal indexes are positively correlated with HbAlc, periodontal indexes and HbAlc are main influencing factors for each other.