类风湿关节炎患者龈下菌斑精氨酸脱亚胺酶活性研究

Investigation of arginine deiminase activity of subgingival plaque in patients with rheumatoid arthritis

目的研究类风湿关节炎(rheumatoid arthritis,RA)患者牙周状况及龈下菌斑产生的精氨酸脱亚胺酶(arginine deiminase,ADI)活性,明确RA与慢性牙周炎的相关性是否与ADI有关。方法采用病例对照研究,患者入组时间为2014年1月至2016年12月。RA组:选择在中国医科大学附属第四医院风湿免疫科确诊为RA的患者34例,其中男2例,女32例;年龄40~60岁。对照组:选择同期在本院体检中心进行体检者29例,符合基线入选标准,无关节炎症状和脊柱疾病史;其中男1例,女28例;年龄40~60岁。采集入选者的龈下菌斑制成混悬液,采用二乙酰一肟-氨基硫脲比色法测定ADI活性。采集静脉血留取血清,用ELISA法测定抗环瓜氨酸肽(CCP)抗体。检查入选者全部牙齿的菌斑指数(PI)、探诊深度(PD)、附着丧失(AL)和缺失牙数。对两组患者牙周状况以及龈下菌斑ADI活性和血清抗CCP抗体阳性率进行比较分析。结果 RA组PI值3.03±1.97、PD值(2.52±0.89)mm,对照组PI值3.52±0.92、PD值(2.63±0.45)mm,两组差异均无统计学意义(均P>0.05)。RA组AL(1.41±1.21)mm、人均缺失牙齿(4.29±5.85)颗,对照组AL(0.40±0.33)mm、人均缺失牙齿(0.56±0.80)颗,两组差异均有统计学意义(均P<0.05)。RA组ADI活性[(1.59±1.05)IU]明显高于对照组[(0.68±1.08)IU],差异有统计学意义(t=3.38,P<0.01)。抗CCP抗体阳性率(≥20 RU/m L):RA组为55.9%,对照组为0,两组差异有统计学意义(χ~2=21.91,P<0.01)。结论 RA患者牙周状况差且龈下菌斑ADI活性高,提示ADI活性增高可能是RA与慢性牙周炎相关联的关键环节。

Objective To investigate the role of arginine deiminase（ADI）in the correlation between rheumatoid arthritis （RA） and chronic periodontitis through examining the activities of ADI from subgingival plaque of patients with RA. Methods In this study, case-control study was adopted. From Jan. 2014 to Dec. 2016, thirty-four RA patients were recruited from Department of Rheumatology at the Fourth Affiliated Hospital of China Medical University. Twenty-nine healthy volunteers （without arthritis）were recruited as controls, who meat the inclusion criteria and had no arthritis symptoms or spinal disease history. ADI activities were tested by diacetylmonoxime-thiosemicarbazide colorimetry. Antibodies to cyclic citrullinated peptides （anti-CCP）in serum were tested by ELISA. Plaque index （PI）, probing depth （PD）, at- tachment loss （AL）and the number of missing teeth were examined for each participant. The independent-samples t test was used to compare the periodontal index and ADI. For anti-CCP, X^2 analysis was used to compare the positive proportions. Results PI was 3.03 ± 1.97 in RA group and 3.52 ± 0.92 in control group（P 〉 0.05）. PD was（2.52 ± 0.89）ram in RA group and（2.63 ± 0.45） mm in control group （P 〉 0.05）. AL was（1.41 ±1.21）mm in RA group and （0.40 ± 0.33） mm in control group （P 〈 0.01）. The number of losing teeth was 4.29 ± 5.85 and 0.56 ± 0.80 in RA group and in control group, respectively （P 〈 0.05）. The activity of ADI was （1.59 ± 1.05）IU in RA group, significantly higher than （0.68 ± 1.08）IU in control group （t = 3.38, P 〈 0.01 ）. The positive proportion of anti- CCP antibody （t〉 20 RU/mL）was 55.9% in RA group and 0 in control group（x^2 = 21.91,P 〈 0.01）. Conclusion The periodontal health is poorer and the activity of ADI in subgingival plaque is higher in patients with RA. It indicates that higher activity of ADI in subgingival plaque plays a key role in the correlation between RA and chronic periodontitis.