牙周干预对2型糖尿病病人牙周炎控制及血糖水平的影响

Effects of periodontal intervention on periodontal inflammation and blood glucose levels in patients with type 2 diabetes mellitus

目的探讨牙周干预对2型糖尿病病人牙周炎控制及血糖代谢的影响。方法选取2015年11月至2017年6月西安医学院第二附属医院收治的120例2型糖尿病伴牙周炎病人,按随机数字表法分为A组、B组、对照组,每组40例。对照组仅在24 h内进行口腔卫生宣教。A组在进行卫生宣教基础上,进行牙周非手术治疗。B组在上述治疗基础上,3个月时进行牙周维护干预治疗。记录并比较各组基线、3个月、12个月时的牙周探诊深度(PD)、探诊出血指数(BOP)、附着丧失(AL)、菌斑指数(PLI)、空腹血糖、糖化血红蛋白水平。结果A组、B组治疗3个月、12个月后PD、AL、PLI、BOP值均明显低于基线值(P<0.01),而对照组治疗期间PD、AL、PLI、BOP值差异无统计学意义(P>0.05)。A组治疗后3个月、12个月时的PD、AL、PLI、BOP改善值分别为(0.40±0.03)比(0.45±0.05)mm、(0.30±0.02)比(0.25±0.03)mm、(0.49±0.05)比(0.39±0.04)、(23.51±2.11)%比(13.22±1.36)%;B组治疗后3个月、12个月时的PD、AL、PLI、BOP改善值分别为(0.44±0.05)比(0.47±0.06)mm、(0.66±0.07)比(0.61±0.06)mm、(0.48±0.05)比(0.36±0.04)mm、(22.81±2.11)%比(12.06±1.13)%;均明显高于对照组(P<0.01)。B组治疗后各时间点的PD、AL的改善值明显高于A组(P<0.01)。对照组空腹血糖、糖化血红蛋白随时间变化无差异(P>0.05)。A组、B组治疗3个月、12个月的空腹血糖及糖化血红蛋白改善程度均明显高于对照组及基线(P<0.01)。B组治疗期间的空腹血糖的改善程度优于A组(P<0.01),但糖化血红蛋白的改善程度两组间差异无统计学意义(P>0.05)。A组、B组PD改善>0.5 mm病人的空腹血糖分别为(0.65±0.04)mmol/L、(0.69±0.10)mmol/L,明显高于PD改善≤0.5 mm的病人(P<0.01)。A组、B组PD改善>0.5 mm病人的糖化血红蛋白水平分别为(0.74±0.11)%、(0.84±0.12)%明显高于PD改善≤0.5 mm的病人(P<0.01)。结论口腔卫生宣教结合牙周非手术治疗对于改善牙周炎状态有明显的优势,治疗3个月时再进行牙周维护干预的效果更佳。牙周干预能够明显控制2型糖尿病伴牙周炎病人的牙周炎症,并改善糖代谢状况。

Objective To explore the effects of periodontal intervention on periodontal inflammation and blood glucose levels in patients with type 2 diabetes mellitus.MethodsA total of 120 patients with type 2 diabetes and periodontitiswho were admitted to the Second Affiliated Hospital of Xi’an Medical University from November 2015 to June 2017 were selected and assigned into group A,Group B and control group according to the random number table method,with 40 patients in each group.The control group received oral health education within 24 hours.Group A performed periodontal nonsurgical treatment on the basis of health education.Group B underwent periodontal maintenance intervention for 3 months based on the above treatment.The periodontal probing depth(PD),explore clinical bleeding index(BOP),attachment loss(AL),plaque index(PLI),fasting blood glucose,glycosylated hemoglobin levels at baseline,3 months,12 months were recorded and compared.Results PD,AL,PLI and BOP values of group A and group B were significantly lower than the baseline values after 3 months and 12 months of treatment(P<0.01),while PD,AL,PLI and BOP values of the control group were not significantly different during the treatment(P>0.05).The improvement values of PD,AL,PLI and BOP after 3 months in group A was(0.40±0.03)mm,(0.30±0.02)mm,(0.49±0.05),and(23.51±2.11)%,respectively,the improvement values of PD,AL,PLI and BOP after 12 months in group A was(0.45±0.05)mm,(0.25±0.03)mm,(0.39±0.04),and(13.22±1.36)%,respectively;the improvement values of PD,AL,PLI and BOP after 3 months in group Bwas(0.44±0.05)mm,(0.66±0.07)mm,(0.48±0.05),and(22.81±2.11)%,respectively;the improvement values of PD,AL,PLI and BOP after 12 months in group B was(0.47±0.06)mm,(0.61±0.06)mm,(0.36±0.04),and(12.06±1.13)%,and the improvement values of PD,AL,PLI and BOPin group B were significantly higher than those in the control group(P<0.01).The improvement values of PD and AL in group B at each time point after treatment were significantly higher than those in group A(P<0.01).The fasting blood glucose and glycosylated hemoglobin of group A and group B all showed a decreasing trend with the progress of treatment time(P<0.01).The fasting blood glucose and glycosylated hemoglobin in the control group showed no difference with the progress of treatment time(P>0.05).The improvement of fasting blood glucose and glycosylated hemoglobin in group A and group B at 3 months and 12 months after treatment was significantly higher than those in the control group and baseline(P<0.01).The improvement degree of fasting blood glucose in group B was superior to that in group A during the treatment(P<0.01),but there was no statistically significant difference in the improvement degree of glycosylated hemoglobin(P>0.05).Fasting blood glucose of patients with PD improvement>0.5 mm in group A and group B was(0.65±0.04)mmol/L and(0.69±0.10)mmol/L,respectively,which was significantly higher than that of patients with PD improvement≤0.5 mm(P<0.01).The glycosylated hemoglobin levels of patients with PD improvement>0.5 mm in group A and group B were(0.74±0.11)%and(0.84±0.12)%,respectively,which were significantly higher than those that of patients with PD improvement≤0.5 mm(P<0.01).ConclusionOral health education combined with periodontal non-surgical treatment has obvious advantages in improving periodontal inflammation,and the effect of periodontal maintenance intervention after 3 months of treatment is better.Periodontal intervention can significantly control periodontal inflammation,control periodontal inflammation in patients with type 2 diabetes and periodontitis,and improve glucose metabolism.