HIV阳性的牙周炎患者CD4＋ T淋巴细胞计数和龈沟液前列腺素E2与牙周临床指标的相关性分析

Association of CD4＋ T lymphocyte count and gingival crevicular fluid prostaglandin E2 with periodontal parameters in HIV-positive periodontitis patients

目的 评估HIV＋牙周炎患者的CD4＋ T淋巴细胞计数（简称CD4计数）和龈沟液中前列腺素E2（prostaglandin E2,PGE2）与牙周临床指标的相关性,以期为临床提供参考.方法 选择符合纳入标准的20例HIV＋牙周炎患者,计数其血液CD4＋T淋巴细胞.按CD4计数分组：A组（CD4计数＜ 200个/mm3,共计5例30颗牙）、B组（CD4计数为200～500个/mm3,共计13例78颗牙）、C组（CD4计数＞500个/mm3,共计2例12颗牙）,对受试者共计120颗指数牙进行牙周检查：菌斑指数（plaque index,PLI）、出血指数（bleeding index,BI）、附着水平（attachment level,AL）、牙周探诊深度（probing depth,PD）,用放射免疫法检测龈沟液中PGE2.组间牙周临床指标和PGE2的比较采用Mann-Whitney秩和检验,CD4计数和牙周临床指标的相关性采用偏相关分析,PGE2与牙周临床指标的关系采用Spearman相关分析.结果 B组的BI值、PGE2质量浓度、PGE2总量分别为3.00（2.00）、90.75（30.60） μg/L及447.58（243.08） pg,均显著高于A组[分别为2.00（1.25）、79.75 （30.50） μg/L、339.52（200.97） pg]和C组[分别为2.00（1.00）、73.38（14.83） μg/L、299.18（108.33） pg]（P＜0.0167）,而A组和C组的各项牙周临床指标差异及三组两两之间的PD和AL差异均无统计学意义（P＞0.0167）.A组和B组的CD4计数与BI有相关性,偏相关系数分别为0.657（P ＜0.05）、-0.369（P＜0.05）;C组的CD4计数与BI无相关性（P＞0.05）.PGE2质量浓度与探诊深度、附着丧失呈负相关（P＜0.05）,PGE2总量与各项牙周临床指标呈正相关（P＜0.05）.结论 HIV＋牙周炎患者的牙周炎症程度与CD4计数有关,其龈沟液中PGE2水平与牙周临床指标有关.

Objective To investigate the correlation of CD4＋ T lymphocyte count and prostaglandin E2 （PGE2 ） in gingival crevicular fluid（GCF） with periodontal status in HIV-positive patients with periodontitis. Methods Twenty subjects were selected according to inclusion criteria. The plasmatic CD4＋ T lymphocytes were counted. All the individuals were divided into three groups, group A （ CD4 T lymphocyte count 〈 200 cell/mm3 ）, group B （200 cell/mm3 ≤ CD4 T lymphocyte count ≤ 500 cell/mm3 ） and group C （ CD4 T lymphocyte count 〉 500 cell/mm3 ）. Periodontal indexes, including plaque index （ PLI ）, bleeding index（BI） ,attachment level（AL） and probing depth（PD） were recorded. GCF samples were taken from 120 index teeth by means of sterile paper strips. GCF PGE2 levels were determined by radioimmunoassays. Mann- Whitney was used to compare the periodontal indexes and PGE2 levels among the three groups. Partial correlations and Spearman correlations were applied to analyze the correlation of CD4＋ T lymphocytes count and PGE2 in gingival crevicular fluid with periodontal status. Results BI value, PGE2 concentration and total PGE2 were 3.00 （ 2.00 ） , 90. 75 （ 30. 60 ） ug/L, 447.58 （ 243.08 ） pg in group B, which were higher than those in group A[2. 00（1.25） ,79. 75（30. 50） ug/L and 339.52（200. 97） pg respeetively] and group C [2.00（1.00）,73.38（14.83） ug/L and 299. 18（108.33） pg respectively] （P 〈0.0167）.But the differences of PD and AL among the three groups were not significantly different （ P 〉 0. 0167 ） . The correlations were observed between CD4 T lymphocyte count and BI for the subpopulations with CD4 T lymphocyte count 〈 200 cells/mm3 （ r = 0. 657, P 〈 0.05 ） and between 200-500 cells/mm3 （ r = - 0. 369, P 〈 0. 05 ）. PGE2 concentration was negatively correlated with BI, PD and AL（ P 〈 0. 05 ）, and total PGE2 was positively correlated with PD and AL （P 〈 0. 05 ）. Conclusions There was an association between the periodontal status and CD4 T lymphocyte count in HIV ＋ patients. GCF PGE2 level was related to periodontal parameters including BI, PD and AL.