牙周基础治疗对慢性牙周炎伴继发性咬合创伤牙位龈沟液中IL-1β、RANKL-OPG系统的影响

Effect of periodontal initial therapy on IL-1β and RANKL-OPG in gingival crevicular fluid of patients with chronic periodontitis and secondary occlusal trauma

目的评价不同程序牙周基础治疗对慢性牙周炎伴继发性咬合创伤牙位龈沟液(GCF)中白细胞介素-1β(IL-1β)、核因子-κb受体活化因子配体(RANKL)-骨保护蛋白(OPG)系统的影响。方法收集2012年7月至2013年10月在海军总医院口腔科就诊的中、重度慢性牙周炎合并继发性咬合创伤患者21例纳入研究,分层区组随机分为A、B两组。研究结束时18例患者纳入分析:其中A组9例,咬合创伤牙位共计18颗,包括9颗前牙及9颗前磨牙;B组9例,咬合创伤牙位共计18颗,包括7颗前牙及11颗前磨牙。基线时,A组先实施全口龈下刮治术+根面平整(SRP)治疗,B组实施咬合创伤牙位咬合调整治疗;第28天,A组接受咬合创伤牙位咬合调整治疗,B组接受全口SRP治疗。其中,咬合调整治疗在T-ScanⅢ型咬合分析系统指导下完成。采用ELISA法检测两组基线、第28天和第56天咬合创伤牙位GCF中IL-1β、RANKL、OPG水平。两组组内SRP治疗前后、咬合调整前后咬合创伤牙位GCF中IL-1β、RANKL、OPG水平变化比较采用配对t检验;两组咬合创伤牙位GCF中IL-1β水平在第28、56天时比较采用协方差分析。结果 SRP治疗后两组咬合创伤牙位GCF中IL-1β水平降低,RANKL/OPG比值升高,与SRP治疗前相比差异有统计学意义(P<0.05);咬合调整治疗后两组咬合创伤牙位GCF中IL-1β水平、RANKL/OPG比值降低,与咬合调整治疗前相比差异有统计学意义(P<0.05)。结论咬合调整治疗可降低慢性牙周炎伴继发性咬合创伤牙位GCF中IL-1β水平及RANKL/OPG比值,提示咬合调整治疗可能有助于抑制牙周骨组织破坏。

Objective To evaluate the effect of different periodontal initial therapy on levels of IL-1β and RANKL-OPG in gingival crevicular fluid in patients with chronic periodontitis and secondary occlusal trauma. Methods Eighteen patients with moderate-severe chronic periodontitis and secondary occlusal trauma were included and ran- domly divided into group A （9） and group B （9）. On day O, group A was treated by full-mouth subgingival sealing and root planning while group B was treated by oeclusal adjustment therapy in occlusal trauma site. On day 28, group A was treated by occlusal adjustment in ocelusal trauma site while group B was treated by full-mouth SRP.The gingival crevicu- lar fluid was collected on day 0,28 and 56 in occlusal trauma site. The level of IL-1β and RANKL-OPG in GCF from 18 patients were determined by ELISA.Data was statistically analyzed by SPSS 18.0 software for Student＇ s T test and analy- sis of covariance. Results Levels of IL- 1β in GCF were significantly decreased after SRP therapy （P 〈 0.05） ; however, levels of RANKL and OPG were increased （P〈O.05）. After occlusal adjustment therapy, levels of IL-1β and RANKL-OPG in GCF were significantly decreased （P 〈 0.05）, Conclusion Levels of IL-1β and RANKL-OPG in GCF are decreased after occlusal adiustment therapy, which indicates that occlusal adjustment therapy may help to inhibit periodontal bone destruction.