慢性根尖周炎感染根管微小小单胞菌定植与临床症状和牙髓优势致病菌的关系

Association between colonization of Parvimonas micra in root canals of patients with chronic apical periodontitis and clinical symptoms and dominant dental pulp pathogens

目的 探究微小小单胞菌在慢性根尖周炎(CAP)感染根管中定植情况及其与临床症状和牙髓优势致病菌的关系,为CAP的治疗提供参考。方法 选取2020年7月-2021年7月湖北省第三人民医院阳逻院区收治的149例CAP患者为研究对象,64例首次治疗患者为首次治疗组;85例根管再治疗患者为非首次治疗组。收集纳入研究对象的临床资料,记录患者的临床症状,聚合酶链式反应(PCR)检测微小小单胞菌、牙髓卟啉单胞菌、牙龈卟啉单胞菌、粪肠球菌定植情况。结果 首次治疗组叩痛、根管脓液、根管恶臭及病变直径>5 mm发生率均高于非首次治疗组(P<0.05);首次治疗组微小小单胞菌检出率、牙髓卟啉单胞菌、牙龈卟啉单胞菌检出率明显高于非首次治疗组(P<0.05),粪肠球菌检出率明显低于非首次治疗组(P<0.05);Logistic回归分析结果显示,首次治疗组、非首次治疗组患者微小小单胞菌定植与根管恶臭、病变直径>5 mm、牙髓卟啉单胞菌阳性均有一定的相关性(P<0.05),但与自发痛、咬合痛、叩痛、根尖肿痛、根管脓液、牙龈卟啉单胞菌阳性及粪肠球菌阳性无相关性。结论 微小小单胞菌定植在CAP患者感染根管中较为常见,且与根管恶臭、根尖病变>5 mm及牙髓卟啉单胞菌的定植可能存在一定相关性。

OBJECTIVE To explore the status of colonization of Parvimonas micra in root canals of patients with chronic apical periodontitis(CAP) and observe its association with clinical symptoms and dominant dental pulp pathogens so as to provide guidance for treatment of CAP. METHODS A total of 149 patients with CAP who were treated in Yangluo area of the Third People′s Hospital of Hubei Province from Jul 2020 to Jul 2021 were recruited as the study subjects, 64 patients who received the initial therapy were assigned as the initial treatment group, and 85 patients who received root canal retreatment were assigned as the non-initial treatment group. The clinical data were collected from the research subjects, the clinical symptoms of the patients were recorded, and the colonization of Parvimonas micra, Porphyromonas endodontalis, Porphyromonas gingivalis and Enterococcus faecalis was detected by polymerase chain reaction(PCR). RESULTS The incidence rates of percussion pain, root canal pus, root canal stench and lesion diameter more than 5 mm were higher in the initial treatment group than in the non-initial treatment group(P<0.05). The isolation rates of P. micra, P. endodontalis and P. gingivalis were significantly higher in the initial treatment group than in the non-initial treatment group(P<0.05), while the isolation rate of E. faecalis of the initial treatment group was significantly lower than that of the non-initial treatment group(P<0.05). The result of logistic regression analysis showed that there was certain association between the colonization of P. micra between the root canal stench, lesion diameter more than 5mm and positive P. endodontalis(P<0.05), but it was not associated with the spontaneous pain, occlusal pain, percussion pain, apical swelling, root canal pus, positive P. gingivalis or positive E. faecalis. CONCLUSION The colonization of P. micra in root canals is very common among the patients with CAP, which, to certain degree, is associated with the root canal stench, lesion diameter more than 5mm and colonization of P. endodontalis.