重症患者牙周情况与呼吸机相关性肺炎发生的关系研究

Study on the relationship between periodontal disease and ventilator-associated pneumonia of patients in ICU.

目的探讨重症监护室患者牙周情况与呼吸机相关性肺炎(VAP)发生的关系。方法回顾性选取2018年6月至2020年7月在东莞市滨海湾中心医院重症病房诊断为慢性牙周炎患者73例为研究组,非牙周炎患者70例为对照组。记录入组患者基本资料及是否合并VAP。利用酶联免疫吸附试验(ELISA)检测研究组和对照组患者血清及龈沟液中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、基质金属蛋白酶-8(MMP-8)水平,检查患者牙周状态指标,如菌斑指数(PLI)、牙周袋探诊深度(PD)、牙龈沟出血指数(SBI)、临床附着水平(CAL)。利用Logistic多元回归分析影响重症监护室患者发生VAP的危险因素。结果研究组合并VAP患者比例(39.73%)明显高于对照组(18.58%),差异有统计学意义(P<0.05)。研究组患者血清TNF-α、IL-1β、MMP-8水平均明显高于对照组患者,差异均有统计学意义(P<0.05);对照组合并VAP患者血清TNF-α、IL-1β、MMP-8水平明显高于未合并VAP患者,差异均有统计学意义(P<0.05)。研究组患者龈沟液TNF-α、IL-1β、MMP-8水平均明显高于对照组患者,差异均有统计学意义(P<0.05),且研究组合并VAP患者龈沟液TNF-α、MMP-8水平明显高于未合并VAP患者,差异均有统计学意义(P<0.05)。研究组患者牙周指标PLI、PD、SBI、CAL均显著高于对照组,差异均有统计学意义(P<0.05),且研究组合并VAP患者PLI、SBI、CAL均明显高于未合并VAP患者(P<0.05)。Logistic多元回归分析结果显示,牙周状况变差、TNF-α、IL-1β、MMP-8升高是影响重症监护室患者发生VAP的危险因素。结论重症监护室患者牙周状况变差与VAP的发生密切相关,重症收治的牙周炎患者比非牙周炎患者更容易出现VAP。

Objective To explore the relationship between the periodontal condition and the occurrence of ventilator-associated pneumonia(VAP)of patients in intensive care unit.Methods From June 2018 to July 2020,73 patients with chronic periodontitis diagnosed in intensive care unit of Dongguan Binhaiwan Central Hospital were selected as the study group and 70 patients with non periodontitis as the control group.The basic data of the patients and VAP were recorded.The levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),matrix metalloproteinase-8(MMP-8)in serum and gingival crevicular fluid of study group and control group were detected by enzyme-linked immunosorbent assay(ELISA),checked the state of patients with periodontal indexes,such as plaque index(PLI),periodontal pocket probing depth(PD),gingival sulcus bleeding index(SBI),clinical attachment level(CAL).Logistic multiple regression analysis was used to analyze the risk factors of VAP in ICU patients.Results The proportion of VAP in the study group(39.73%)was significantly higher than that in the control group(18.58%),the difference was statistically significant(P<0.05).The levels of serum TNF-α,IL-1βand MMP-8 in the study group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).The serum levels of TNF-α,IL-1βand MMP-8 in the control group combined with VAP were significantly higher than those in the patients without VAP,and the differences were statistically significant(P<0.05).The levels of TNF-α,IL-1βand MMP-8 in gingival crevicular fluid of the study group were significantly higher than those of the control group,and the differences were statistically significant(P<0.05),and the levels of TNF-αand MMP-8 in gingival crevicular fluid of the study group combined with VAP were significantly higher than those of the patients without VAP,and the differences were statistically significant(P<0.05).The periodontal indexes PLI,PD,SBI and CAL in the study group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).PLI,SBI and CAL in the study group combined with VAP were significantly higher than those in the patients without VAP,and the differences were statistically significant(P<0.05).The results of Logistic multiple regression analysis showed that the risk factors of VAP in ICU patients were poor periodontal condition,increased TNF-α,IL-1βand MMP-8.Conclusion The deterioration of periodontal condition in ICU patients is closely related to the occurrence of VAP.ICU patients with periodontitis are more likely to have VAP than those with non periodontitis.