牙周炎患者炎症因子表达与妊娠期糖尿病发病关系的病例对照研究

Inflammatory factors in periodontitis patients and their effects toward the occurrence of gestational diabetes mellitus:a case-control study

目的初步探讨牙周炎及炎症因子对妊娠期糖尿病(gestational diabetes mellitus,GDM)发病的影响。方法将2021年3至11月间在西北妇女儿童医院产科进行产前检查的100例GDM孕妇和100名健康孕妇分别纳入病例组与对照组。通过问卷调查采集两组样本信息并对两组受试者牙周状况进行检查。同时,收集两组受试者龈沟液及静脉血,分析C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-1β、IL-6、IL-8、IL-10和IL-33的表达情况。将组间差异表达的因素纳入多元回归模型,初步明确影响GDM发生的危险因素。结果对两组样本基本信息进行比较,病例组年龄[(33.4±5.1)岁]与对照组年龄[(30.5±4.5)岁]差异有统计学意义(t=4.33,P<0.001)。病例组体重指数[(28.11±3.85)kg/m^(2)]显著高于对照组[(23.31±3.15)kg/m^(2)](t=9.65,P<0.001)。GDM孕妇牙周状况较差,牙周炎患病率[47.0%(47/100)]显著高于健康孕妇的牙周炎患病率[29.0%(29/100)](χ^(2)=6.88,P=0.009)。多元回归分析结果显示,牙周炎是影响GDM发生的重要危险因素(OR=1.882,P<0.001)。此外,龈沟液(IL-8)及血清(TNF-α、IL-8和IL-10)中的炎症因子对GDM发生同样具有显著影响(P<0.05)。其中,血清中TNF-α和IL-8影响GDM发生的OR值分别为2.077和2.060(P均<0.001)。结论牙周炎与GDM发病存在关联;牙周局部炎症微环境引起的血清炎症因子表达升高可能在两种疾病关联中发挥中介作用。

Objective To explore the effects of periodontitis and inflammatory factors toward the occurrence of gestational diabetes mellitus(GDM).Methods Pregnant women who came to the Department of Obstetrics,Northwest Women′s and Children′s Hospital for prenatal examinations during March to November of 2021 were invited to participate in this study.Participants with GDM who met the inclusion criteria(n=100)were assigned into the case group;while healthy participants(n=100)were assigned into the control group.Information of participants from the two groups were collected by questionnaires and periodontal statuses were clinically recorded in the meantime.Gingival crevicular fluid(GCF)and venous blood were also collected from participants of two groups to analyze the expression levels of inflammatory factors like C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6,IL-8,IL-10 and IL-33.Factors different between the two groups were included in the multivariate regression analysis model to determine the risk factors of GDM.Results The age of participants was(33.4±5.1)years in case group and(30.5±4.5)years in control group respectively,which had statistical differences(t=4.33,P<0.001).Besides,the body mass index of participants from case group was also significantly higher than control group[(28.11±3.85)kg/m^(2)vs.(23.31±3.15)kg/m^(2),t=9.65,P<0.001].Participants with GDM had more adverse periodontal clinical parameters.Prevalence of periodontitis in GDM group was 47.0%(47/100)compared with 29.0%(29/100)in control group(χ^(2)=6.88,P=0.009).Multivariate regression analysis results indicated that periodontitis was a critical risk factor for the occurrence of GDM(OR=1.882,P<0.001).Besides,GCF IL-8,serum TNF-α,IL-8 and IL-10 were also risk factors of GDM due to their higher expressions.Among them,TNF-αin serum(OR=2.077)and IL-8 in serum(OR=2.060)had more significant impacts(P<0.001).Conclusions This study demonstrated that periodontitis was associated with the occurrence of GDM.Up-regulation of serum pro-inflammatory mediators leaded by local periodontal inflammatory microenvironment might play a critical role in this pathological process.