牙周源性牙周牙髓联合病变常见病原菌的分布及其意义

Distribution and its sighificance of the common pathogenic bacteria in teeth combined periodontal⁃endodontic lesions of periodontal origin

目的研究牙周源性牙周牙髓联合病变常见病原菌分布及其相关性,为临床治疗提供依据。方法选择2018年1月至2020年6月于新疆维吾尔自治区人民医院口腔科就诊的牙周源性牙周牙髓联合病变患者43例43颗牙作为实验组,重度牙周炎患者41例41颗牙作为对照组。分别采集根管内组织和龈下菌斑,构建含有8种待测细菌基因片段的重组质粒,建立定量标准,应用实时荧光定量PCR技术检测福赛斯坦纳菌(Tannerella forsythia,Tf)、牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)、具核梭杆菌(Fusobacterium nu⁃cleatum,Fn)、中间普氏菌(Prevotella intermedia,Pi)、齿垢密螺旋体(Treponema denticola,Td)、消化性链球菌(Digestive streptococcus,Ds)、粪肠球菌(Enterococcus faecalis,Ef)、牙髓卟啉单胞菌(Porphyromanus endodontics,Pe)数量。结果实验组根管内组织与其龈下菌斑中Ds、Pe数量差异无统计学意义(Ρ>0.05),其余6种病原菌数量差异均有统计学意义(P<0.05);实验组与对照组龈下菌斑中Ds数量差异无统计学意义(P=0.241),其余7种病原菌数量差异均有统计学意义(P<0.05);实验组根管内组织与其龈下菌斑中Ef、Pe、Pg、Td、Tf细菌数量密切相关,Ef(r=0.347,Ρ<0.05)、Pe(r=0.363,Ρ<0.05)、Pg(r=0.437,Ρ<0.01)、Td(r=0.471,Ρ<0.01)、Tf(r=0.679,Ρ<0.01)。结论牙周源性牙周牙髓联合病变常见病原菌在根管内组织中数量低于龈下菌斑但根管内病原菌数量与龈下菌斑密切相关,临床治疗期间在控制牙周组织感染的同时,还应重视牙髓组织感染的控制。

Objective To study the distribution of pathogenic infection and relevance in combined periodontal⁃end⁃odontic lesions of periodontal origin,and provide the basis for clinical treatment.Methods Totally 43 cases of com⁃bined periodontal⁃endodontic lesions of periodontal origin from Jan.2018 to Jun.2020 treated in the hospital were se⁃lected,including a total of 43 teeth as the experimental group.Another 41 teeth from 41 cases with severe periodontitis during the same period were set as the control group.subgingival plaque samples and root canal samples of ill teeth were made for test.Quantitative Real⁃time PCR was used to detect the quantity of Tannerella forsythia(Tf),Porphyromo⁃nas gingivalis(Pg),Fusobacterium nucleatum(Fn),Prevotella intermedia(Pi),Treponema denticola(Td),Digestive strep⁃tococcus(Ds),Enterococcus faecalis(Ef),Porphyromanus endodontics(Pe).Results There was no significant difference in the quantity of Digestive streptococcus and Porphyromanus endodontics in the root canal tissue and subgingival plaque of the experimental group(Ρ>0.05),other six pathogenic bacteria in the subgingival plaque samples was significantly higher than that from the root canal tissue(P<0.05);No significant difference in the quantity of Digestive streptococcus was found in the subgingival plaque between the two groups(P=0.241).Other seven pathogenic bacteria in the subgin⁃gival plaque samples of the experimental group was significantly higher than that from the control group(P<0.05);The number of Ef,Pe,Pg,Td and Tf in the root canal tissue was closely related to the subgingival plaque in the experimen⁃tal group,Ef(r=0.347,Ρ<0.05),Pe(r=0.363,Ρ<0.05),Pg(r=0.437,Ρ<0.01),Td(r=0.471,Ρ<0.01),Tf(r=0.679,Ρ<0.01).Conclusion The quantity of common pathogenic bacteria in the root canal tissue of Combined peri⁃odontaI⁃endodontic lesions of periodontal origin was lower than that from the subgingival plaque sample,and the quanti⁃ty of common pathogenic bacteria in the root canal tissue was closely related to the subgingival plaque.During clinical treatment,attention should be paid to the control of pulp tissue infection while controlling periodontal tissue infection.