绝经期骨质疏松女性牙周状况、炎性水平及骨代谢生化指标的研究

Clinical study on periodontal status,inflammatory level and biochemical indexes of bone metabolism in menopausal women with osteoporosis

目的对比分析处于绝经期的骨质疏松女性与健康女性牙周相关指标、龈沟液和血液炎性水平以及骨代谢生化指标。方法选取2019年2月至2020年6月于中国人民解放军战略支援部队特色医学中心就诊的120例绝经期体检妇女为研究对象,按照患者是否伴有骨质疏松症分为伴有骨质疏松症组(OP组,n=49)及未伴有骨质疏松症组(HL组,n=71)。分别对OP组、HL组患者进行口腔牙周相关指标[牙周袋深度(PD)、牙周附着丧失(CAL)、牙齿松动度(M)、龈沟出血指数(SBI)、牙齿填充指数(DMFT)、口腔卫生指数(OHI-S)]检测,比较两组患者龈沟液、外周血炎性因子[白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]及骨生化代谢指标[血钙(Ca)、血磷(P)水平、血清骨碱性磷酸酶(B-ALP)、骨钙素(BGP)、血清I型胶原C末端肽(CTX-1)、血清抗酒石酸酸性磷酸酶-5b(TRACP-5b)、骨密度(BMD)]的差异性。结果与HL组相比,OP组患者PD、CAL、M、SBI、DMFT及OHI-S均显著升高,差异具有统计学意义(t值分别为11.990、9.438、6.694、18.342、8.404、7.726,P<0.05);与HL组相比,OP组患者龈沟液中IL-1β、IL-6、TNF-α表达更高(t值分别为32.400、11.770、14.750,P<0.05),OP组患者外周血中IL-1β、IL-6、TNF-α也表达较高,差异具有统计学意义(t值分别为16.660、16.921、9.182,P<0.05);HL组与OP组患者血清中Ca和P水平相似,差异无统计学意义(P>0.05);与HL组相比,OP组患者血清中TRACP-5b及CTX-1表达升高,B-ALP、BGP及BMD水平降低(t值分别为33.160、25.210、9.890、14.340、3.373,P<0.05);OHI-S与BMD无显著相关性(P>0.05),其他牙周相关指标及龈沟液中炎性指标均与BMD呈现负相关性(r值介于-0.301~-0.187之间,P<0.05)。结论绝经期骨质疏松患者牙周相关指标评分较高,龈沟液及外周血中促炎因子表达水平较高,且炎症因子的表达水平与骨密度呈现负相关性。

Objective To compare and analyze periodontal related indexes, gingival crevicular fluid(GCF),and serum inflammatory factors levels and bone metabolism biochemical indexes between the menopausal women with osteoporosis(OP) and healthy menopausal women.Methods 120 menopausal women who received phisical examination in The Special Medical Center of P.L.A Strategic Support Forces from February 2019 to June 2020 were selected as research subjects.According to whether the menopausal woman was accompanied with OP,they were divided into two groups: 49 women in OP group and 71 women in healthy group(HL group).The oral periodontal related indexes such as pocket depth(PD),clinical attachment loss(CAL),tooth movement(M),sulcus bleeding index(SBI),decayed-missing-filled tooth(DMFT) and oral hygiene index(OHI-S) of the menopausal women in the OP group and the HL group were examined and tested.The inflammatory factors levels in GCF and peripheral blood[interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],and bone biochemical metabolic indexes such as blood calcium(Ca) level, blood phosphorus(P)level, serum levels of bone alkaline phosphatase(B-ALP),osteocalcin(BGP),type I collagen C-terminal peptide(CTX-I),serum anti-tartrate acid phosphatase-5 b(TRACP-5 b) and bone mineral density(BMD) of the menopausal women were compared between the two groups.Results Compared with the HL group, PD, CAL,M,SBI,DMFT,and OHI-S of the menopausal women in the OP group were significantly increased, and the differences were statistically significant(t=11.990,9.438,6.694,18.342,8.404 and 7.726 respectively, all P<0.05).Compared with the HL group, expression levels of IL-1β,IL-6 and TNF-α in the GCF of the menopausal women in the OP group were higher(t=32.400,11.770 and 14.750 respectively, all P<0.05),and they also expressed highly in the peripheral blood of the menopausal women in the OP group, and the differences were statistically significant(t=16.660,16.921 and 9.182 respectively, all P<0.05).The serum levels of Ca and P of the menopausal women in the two groups were similar, and the differences were not statistically significant(both P>0.05).Compared with the HL group, the menopausal women in the OP group had increased serum TRACP-5 b and CTX-1 expression levels, while they had decreased B-ALP,BGP and BMD levels(t=33.160,25.210,9.890,14.340 and 3.373 respectively, all P<0.05).Except there was no significant correlation between OHI-S and BMD(P>0.05),other periodontal related indexes and inflammatory indexes in the GCF were negatively correlated with BMD,and r values were between-0.301 and-0.187,all P<0.05.Conclusion Menopausal OP women have higher scores in periodontal-related indexes, and the expression levels of inflammatory factors in GCF and peripheral blood are higher, which are negatively correlated with BMD.