牙周非手术治疗对慢性牙周炎患者循环CD34^(+)/CD309^(+)/CD45^(-)内皮祖细胞和氧化三甲胺的影响

Intensive periodontal therapy improves circulating CD34^(+)/CD309^(+)/CD45^(-) endothelial progenitor cells and Trimethylamine N-oxide levels in patients with chornic periodontitis

目的:探讨牙周非手术治疗对慢性牙周炎患者的内皮功能以及血浆氧化三甲胺的影响。方法:2019年11月~2021年2月按照牙周炎新分类在中山大学附属第一医院招募Ⅲ~Ⅳ期牙周炎患者68例,随机分为牙周非手术治疗组(34例)和对照组(34例),前者进行洁治术和刮治术,后者仅进行洁治术。分别在治疗前和治疗后3个月评估牙周状况、循环内皮祖细胞(EPCs)、肱踝脉搏波传导速度(baPWV)、血浆氧化三甲胺(TMAO)以及相关炎性标志物的水平。结果:治疗3个月后,非手术治疗组患者循环CD34^(+)/CD309^(+)/CD45^(-)EPCs水平较治疗前升高,且高于对照组(P<0.01),同时牙周指标、baPWV、超敏C反应蛋白和TMAO水平均较治疗前降低,且低于对照组(P<0.05)。相关分析表明,非手术治疗组治疗前后EPCs的升高伴随着TMAO的下降(r=0.787,P<0.001)。结论:牙周非手术治疗可明显改善Ⅲ~Ⅳ期牙周炎患者的血管内皮功能,降低血浆TMAO以及相关炎症因子水平。

Objective:To investigate the effects of periodontal non-surgical treatment on endothelial function and TMAO in patients with chornic periodontitis.Methods:According to Classification for periodontal diseases in 2018,68 patients with stage Ⅲ~Ⅳ periodontitis were enrolled in the department of the First Affiliated Hospital of Sun Yat-sen University and were randomly assigned to non-surgical treatment group(34 cases)or control group(34 cases)from November 2019 to February 2021.Patients in the control group were only given a standard cycle of supragingival ultrasonic scaling and polishing, while patients in the non-surgical treatment group were assigned to the adjunctive full-mouth intensive removal of dental plaque biofilms with the use of scaling and root planing.Periodontal status, circulating endothelial progenitor cells(EPCs),baPWV,plasma trimethylamine N-oxide(TMAO)levels and inflammatory markers were assessed before and 3 months after treatment.Results:After 3 months of intervention, circulating CD34^(+)/CD309^(+)/CD45^(-)EPCs levels were higher than before treatment, and were relatively higher than that in control group(P<0.01).Meanwhile, periodontal index, baPWV,hs-CRP and TMAO levels were lower than those before treatment and control group(P<0.05).A positive correlation was found between the decreased plasma TMAO and increased circulating CD34^(+)/CD309^(+)/CD45^(-)EPCs in the treatment group(r=0.787,P<0.001).Conclusion:The periodontal non-surgical treatment can significantly improve vascular endothelial function, likewise, lower plasma TMAO and inflammatory factors in patients with moderate to severe periodontitis.