慢性牙周炎合并肝硬化患者口腔微生物群失调对疾病严重程度的影响

Influence of oral microbiota imbalance on disease severity in patients with chronic periodontitis and liver cirrhosis

目的:探讨慢性牙周炎合并肝硬化患者口腔微生物群失调对疾病严重程度的影响。方法:选取慢性牙周炎患者120例为研究对象,依据是否合并肝硬化分为牙周炎合并肝硬化组(A组,n=65)和牙周炎组(B组,n=55),另选同期体检的50名健康志愿者为对照组(C组,n=50)。比较各组牙龈卟啉单细胞菌、福赛类杆菌、放线杆菌以及双歧杆菌菌落数。检测各组肠道屏障指标血清二胺氧化酶(DAO)、内毒素(ET)、D-乳酸(D-lac)和降钙素原(PCT)水平。检测各组血清炎症因子白细胞介素6(IL-6)、IL-8及肿瘤坏死因子α(TNF-α)。检测各组肝功能指标血清天冬氨酸转移酶(AST)、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)水平。结果:A组的牙龈卟啉单细胞菌、福赛类杆菌、放线杆菌菌落数多于B组和C组(P<0.05),双歧杆菌菌落数低于B组和C组(P<0.05);B组的牙龈卟啉单细胞菌、福赛类杆菌、放线杆菌菌落数多于C组(P<0.05),双歧杆菌菌落数低于C组(P<0.05)。A组DAO、PCT、ET、D-lac、IL-8、IL-6和TNF-α水平均高于B组和C组(P<0.05),B组DAO、PCT、ET、及D-lac、IL-8、IL-6和TNF-α水平均高于C组(P<0.05)。A组ALP、ALT和AST水平均高于B组和C组(P<0.05),而B组ALP、ALT和AST水平均高于C组(P<0.05)。Pearson相关性分析表明,牙龈卟啉单细胞菌、福赛类杆菌、放线杆菌与DAO、PCT、ET、D-lac、IL-8、IL-6、TNF-α、ALP、ALT和AST水平呈正相关(P<0.05),双歧杆菌与DAO、PCT、ET、D-lac、IL-8、IL-6、TNF-α、ALP、ALT和AST水平呈负相关(P<0.05)。结论:慢性牙周炎合并肝硬化患者口腔微生物失调更为严重,且与炎症反应、肠道屏障及肝功能密切相关,保持口腔菌群稳定可能是慢性牙周炎合并肝硬化患者的新的治疗策略。

Objective:To investigate the influence of oral microbiota imbalance on disease severity in patients with chronic periodontitis and liver cirrhosis.Methods:A total of 120 patients with chronic periodontitis were selected as study subjects.They were divided into the periodontitis combined with cirrhosis group(Group A,n=65)and the periodontitis group(Group B,n=55)according to whether they had cirrhosis of liver.Another 50 healthy volunteers who underwent physical examination during the same period were selected as the control group(Group C).The bacterial colonies of Porphyrin gingivalisa,Becteroides forsythus,Actinobacillus and Bifidobacteria in each group were compared.The levels of diamine oxidase(DAO),endotoxin(ET),D-lactic acid(D-lac)and procalcitonin(PCT)in serum were also measured.Moreover,the inflammatory factors interleukin6(IL-6),IL-8 andαtumor necrosis factor(TNF-α)were detected in each group.The levels of liver function indexes including aspartate transferase(AST),alkaline phosphatase(ALP)and alanine aminotransferase(ALT)in serum were detected in each group.Results:The colonies of Porphyrin gingivalis,Becteroides forsythus and Actinobacillus in Group A were significantly more than those in Group B and Group C(P<0.05),while the colonies of Bifidobacteria in Grouo A was lower than that in Group B and Group C(P<0.05).The colonies of Porphyrin gingivalis,Becteroides forsythus,and Actinobacillus in Group B were notably more than those in Group C(P<0.05),but the colonies of Bifidobacteria was lower than that in group C(P<0.05).The levels of DAO,PCT,ET,D-lac,IL-8,IL-6 and TNF-αin Group A were obviously higher than those in Group B and Group C(P<0.05).The levels of DAO,PCT,ET,D-lac,L-8,IL-6 and TNF-αin Group B were significantly higher than those in Group C(P<0.05).The levels of ALP,ALT and AST in Group A were significantly higher than those in Group B and Group C(P<0.05).The levels of ALP,ALT and AST in Group B were observably higher than those in Group C(P<0.05).Pearson correlation analysis showed that the colonies of Porphyrin gingivalis,Becteroides forsythus,and Actinobacillus were positively correlated with the levels of DAO,PCT,ET,D-lac,IL-8,IL-6,TNF-α,ALP,ALT and AST(P<0.05),while the colonies of Bifidobacteria was negatively related to the levels of DAO,PCT,ET,D-lac,IL-8,IL-6,TNF-α,ALP,ALT and AST(P<0.05).Conclusion:The oral microbial imbalance in patients with chronic periodontitis complicated with cirrhosis is more serious,and it is closely related to the reaction of inflammatory,intestinal barrier and liver function.Keeping the oral microbial stability may be a novel treatment strategy for patients with chronic periodontitis complicated with cirrhosis.