慢性根尖周炎患者IL-34与miR-146a-5p的测定、病原学分布及相关因素分析

Distribution of the pathogens causing chronic apical periodontitis, determination of IL-34 and iR-146a-5p expression, and analysis of related factors

目的探讨慢性根尖周炎患者IL-34与miR-146a-5p的水平及病原学分布,并分析感染相关因素。方法选择首都医科大学附属北京潞河医院2016年4月-2017年6月口腔科门诊接诊的60例慢性根尖周炎患者作为观察组,选择同期正畸拔除的健康者40例为对照组,应用q-PCR法测定两组牙根尖周组织IL-34mRNA与miR-146a-5p的表达水平;检测观察组患者感染根管的病原菌分布及耐药情况。采用卡方检验及多元Logistic回归分析法分析感染的相关因素。结果q-PCR法检测观察组60例患者慢性根尖周病损组织IL-34 mRNA和miR-146a-5p相对表达量分别为3.47±0.36和11.06±1.17,对照组40例分别为1.15±0.13和1.17±0.16,差异均有统计学意义(t=39.041,53.044,P<0.05)。观察组共检出79株病原菌,其中革兰阳性菌47株,以葡萄球菌属、粪肠球菌和微单胞菌居多;革兰阴性菌32株,主要以中间普雷沃菌、牙龈卟啉单胞菌和产黑普雷沃菌为主。检出的革兰阳性菌对美罗培南、亚胺培南及头孢曲松较敏感,耐药率为0~9.09%;对氨卞西林、多黏菌素等其他抗菌药物的耐药性较高,为87.50~93.75%。革兰阴性菌对氯霉素、氨苄西林、氨苄西林/舒巴坦、头孢菌素类和庆大霉素等耐药性较高,为63.63%~90.91%;对替考拉宁、美罗培南和万古霉素较敏感,耐药率为0~9.09%。观察组患者和对照组患者在年龄、刷牙时间、是否合理使用抗菌药物、饮食喜好及龋牙等方面存在差异(均P<0.05)。患者高龄、刷牙时间<3min、不合理应用抗菌药物、喜食甜食硬食及有龋牙均是感染的独立危险因素(均P<0.05)。结论IL-34、miR-146a-5p表达水平与慢性根尖周炎发生发展密切相关,且CAP患者主要以革兰阳性菌感染为主。高龄、刷牙时间<3min、不合理应用抗菌药物、喜食甜食硬食及有龋牙是CAP发生危险因素,应引起高度重视。

Objectives To investigate the distribution of pathogens causing chronic apical periodontitis,to determine IL-34 and miR-146a-5p expression,and to analyze related factors.Methods Clinical data on 60 patients with chronic apical periodontitis seen by Stomatology in Beijing Luhe Hospital,Capital Medical University from April 2016 to June 2017 were collected,and those patients served as the study group.Forty healthy people who underwent orthodontic removal served as the control group.The levels of IL-34 and miR-146a-5p expression in the periapical tissues of the two groups were determined using q-PCR.The distribution of pathogens infecting the roots of teeth and their drug resistance of the infected root canal were determined.The chi-square test and multivariate logistic regression were used to analyze the factors related to development of an infection.Results The levels of IL-34 and miR-146a-5p in chronic periapical lesions in the study group were significantly higher than those in the control group(t=39.041,53.044,P<0.05).A total of 79 pathogens were detected in 60 patients with chronic apical periodontitis,including 47 strains of Gram-positive bacteria.Those bacteria were mainly Staphylococcus,Enterococcus faecalis,and Parvimonas micra.The isolated strains included 32 strains of Gram-negative bacteria,which were mainly Prevotella intermedia,Porphyromonas gingivalis,and P.melaninogenica.Gram-positive bacteria were more sensitive to meropenem,imipenem,and ceftriaxone but were more resistant to other antibiotics such as polymyxin.Gram-negative bacteria were more sensitive to chloramphenicol,ampicillin,ampicillin/sulbactam,cephalosporins,and gentamicin but were more resistant to teicoplanin,meropenem,and vancomycin.Patients in the study group and control group differed in age,toothbrushing time,whether or not antibiotics were used rationally,dietary preferences,and tooth decay(P<0.05).Being older,brushing for<3 min,irrational use of antibiotics,eating sweets and hard foods,and cavities are independent risk factors for development of an infection.Conclusion The expression of IL-34,miR-146a-5p is closely related to the development and progression of chronic periapical periodontitis.Patients with chronic apical periodontitis were mainly infected with Gram-positive bacteria.Being elderly,brushing for<3 min,irrational use of antibacterials,eating sweets and hard foods,and cavities are risk factors for development of chronic apical periodontitis,so greater attention must be paid to those factors.