龈沟液中IL⁃1β、hs⁃CRP、LPS水平与牙周牙髓联合病变病情程度及治疗效果的关系

Relationship between the levels of IL⁃1β,hs⁃CRP,LPS in gingival crevicular fluid and the severity of combined periodontal and pulpal lesions and the therapeutic effect

目的探讨龈沟液中白细胞介素⁃1β(IL⁃1β)、超敏C反应蛋白(hs⁃CRP)、内毒素(LPS)水平与牙周牙髓联合病变病情程度、治疗效果的关系。方法选取首都医科大学附属北京康复医院2020年1月至2021年8月收治的牙周牙髓联合病变患者96例作为研究对象,根据临床附着水平(CAL)分为轻度25例、中度41例、重度30例,比较不同病情程度患者龈沟液IL⁃1β、hs⁃CRP、LPS水平,采用单因素、多因素分析牙周牙髓联合病变患者疗效的影响因素,受试者工作特征(ROC)曲线探讨龈沟液IL⁃1β、hs⁃CRP、LPS对疗效的预测价值。结果龈沟液IL⁃1β、hs⁃CRP、LPS水平随病情程度增加呈升高趋势,重度患者>中度患者>轻度患者,比较差异有统计学意义(P<0.05);单因素分析:不同疗效患者病程、病情程度、治疗2、4周后显效者龈沟液IL⁃1β、hs⁃CRP、LPS水平比较,差异有统计学意义(P<0.05);多因素分析:病程>3年、病情程度为重度、治疗2周后、治疗4周后龈沟液IL⁃1β、hs⁃CRP、LPS水平是牙周牙髓联合病变患者疗效的独立危险因素(P<0.05);ROC曲线分析治疗2周后、治疗4周后龈沟液IL⁃1β、hs⁃CRP、LPS均具有一定预测价值,治疗4周后龈沟液IL⁃1β、hs⁃CRP、LPS联合预测AUC(0.933)>治疗2周后(0.882),敏感度为84.81%,特异度为94.12%。结论龈沟液IL⁃1β、hs⁃CRP、LPS水平随牙周牙髓联合病变病情加重而升高,是影响牙周牙髓联合病变患者疗效的独立危险因素,三者联合检测在疗效评估中具有较高预测价值。

Objective To investigate the relationship between the levels of interleukin⁃1β(IL⁃1β),high⁃sensitivity C⁃reactive protein(hs⁃CRP)and endotoxin(LPS)in gingival crevicular fluid and the severity of combined periodontal and pulpal lesions and the therapeutic effect.Methods A total of 96 patients with periodontal and endodontic lesions who were admitted to Beijing Rehabilitation Hospital affiliated to Capital Medical University from January 2020 to August 2021 were selected as the research subjects.According to the clinical attachment level(CAL),they were divided into mild 25 cases and moderate 41 cases.30 cases of severe,gingival crevicular fluid IL⁃1β,hs⁃CRP and LPS levels of patients with different disease degrees were compared,and univariate and multivariate analysis were used to analyze the influencing factors of curative effect in patients with periodontal and endodontic lesions,and receiver operating characteristics(ROC)curve was used to investigate gingival crevicular fluid IL⁃1Predictive value ofβ,hs⁃CRP and LPS for efficacy.Results The levels of IL⁃1β,hs⁃CRP and LPS in gingival crevicular fluid tended to increase with the severity of the disease.Severe patients>moderate patients>mild patients,and the difference was statistically significant(P<0.05).There were statistically significant differences in the course of disease,the degree of disease,and the levels of IL⁃1β,hs⁃CRP,and LPS in the gingival crevicular fluid of the markedly effective patients after 2 weeks of treatment and 4 weeks after treatment(P<0.05).Multivariate analysis:disease duration>3 years,severe disease severity,gingival crevicular fluid IL⁃1β,hs⁃CRP and LPS levels after 2 weeks of treatment and 4 weeks after treatment were independent risk factors for the curative effect of patients with periodontal⁃endodontic combined lesions(P<0.05).ROC curve analysis showed that IL⁃1β,hs⁃CRP,and LPS in gingival crevicular fluid had certain predictive value after 2 weeks and 4 weeks after treatment.The combination of IL⁃1β,hs⁃CRP and LPS in gingival crevicular fluid predicted AUC after 4 weeks of treatment(0.933)>after 2 weeks of treatment(0.882),the sensitivity was 84.81%,and the specificity was 94.12%.Conclusion The levels of IL⁃1β,hs⁃CRP and LPS in gingival crevicular fluid increase with the exacerbation of periodontal and pulp lesions.They are the independent risk factors for the efficacy of patients with combined periodontal and pulpal disease.