双波长激光治疗牙周炎的疗效分析及患牙龈沟液中细胞因子水平的影响

Effect of dual wavelength laser in the treatment of chronic periodontitis and the influence of cytokines in gingival crevicular fluid

目的探讨掺钕钇铝石榴石(Nd:YAG)激光联合掺铒钇铝石榴石(Er:YAG)激光辅助龈下刮治根面平整术(SRP)治疗牙周炎的临床疗效及预后影响因素。方法采用前瞻性研究的方法,选择2018年8月至2020年8月河北省胸科医院就诊的牙周炎患者66例,按随机数字表法分为试验组和对照组各33例,对照组采用SRP治疗,试验组在SRP的基础上,接受Er:YAG激光刮治联合根面平整,并使用Nd:YAG激光照射牙周袋。分别在治疗前、治疗后4和12周检查两组患者牙周临床指标和龈沟液细胞因子水平变化。依据患者治疗后12周牙周袋探诊深度(PD)情况将患牙分为PD<3 mm组和PD≥3 mm组,对比分析两组患牙临床资料,并采用Logistic回归分析影响牙周炎患者激光治疗预后的危险因素。结果治疗后4、12周,两组患者PD、临床附着丧失(CAL)、龈沟出血指数(SBI)及牙菌斑指数(PLI)均较治疗前显著降低(P<0.05),且试验组PD、CAL、SBI及PLI均明显低于对照组[治疗后4周:(3.36±0.21)mm比(3.91±0.39)mm、(4.14±0.67)mm比(4.75±0.73)mm、(1.83±0.20)分比(2.58±0.17)分、(1.29±0.24)分比(1.61±0.52)分;治疗后12周:(3.04±0.28)mm比(3.66±0.54)mm、(3.91±0.47)mm比(4.68±0.66)mm、(0.88±0.06)分比(1.35±0.14)分、(1.05±0.31)分比(1.57±0.56)分],差异均有统计学意义(P<0.05)。激光治疗后12周,试验组患者龈沟液中白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-8(MMP-8)、白细胞介素-8(IL-8)均较对照组显著降低[(2.95±0.19)μg/L比(4.32±0.84)μg/L、(2.63±0.82)μg/L比(3.58±0.51)μg/L、(12.42±1.19)μg/L比(13.26±0.68)μg/L、(4.15±1.12)ng/L比(5.36±0.42)ng/L、(2.65±0.08)ng/L比(4.12±0.19)ng/L],差异均有统计学意义(P<0.05),转化生长因子-β(TGF-β)水平较对照组显著增加[(51.35±8.95)ng/L比(44.90±5.84)ng/L],且组间比较差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,牙周临床指标PD、SBI、PLI、龈沟液IL-6、IL-8、TNF-α、MMP-8、IL-1β水平及冠根比均为牙周炎双波长激光治疗预后的危险因素(P<0.05)。结论Nd:YAG激光联合Er:YAG激光辅助SRP治疗牙周炎能够获得较好的疗效,牙周临床指标PD、SBI、PLI,龈沟液IL-6、IL-8、TNF-α、MMP-8、IL-1β水平及冠根比均为牙周炎双波长激光治疗预后的独立危险因素。

Objective To investigate the clinical efficacy and prognostic factors of Neodymium doped:Yttrium Aluminum Garnet(Nd:YAG)laser combined with Erbium:Yttrium Aluminum Garnet(Er:YAG)laser assisted subgingival scaling root planing(SRP)in the treatment of periodontitis.Methods A prospective research method was adopted.A total of 66 patients with periodontitis treated in Hebei Chest Hospital from August 2018 to August 2020 were selected and divided into experimental group and control group according to the random number table method,with 33 cases in each group.The control group was treated with SRP,and the experimental group received Er:YAG laser curettage combined with root surface leveling on the basis of SRP,and irradiated the periodontal pocket with Nd:YAG laser.The changes of periodontal clinical indicators and cytokine levels in gingival crevicular fluid were examined before treatment,4 weeks and 12 weeks after treatment.The patients were divided into PD<3 mm group and PD≥3 mm group according to the probing depth(PD)of periodontal pocket after 12 weeks of treatment,the clinical data of the two groups were compared and analyzed,and the Logistic regression analysis was performed to analyze the risk factors affecting the prognosis of patients with periodontitis after laser treatment.Results After 4 and 12 weeks of treatment,the PD,clinical attachment loss(CAL),sulcus bleeding index(SBI)and plaque index(PLI)of the two groups were significantly lower than those before treatment(P<0.05),and the PD,CAL,SBI and PLI in experimental group were significantly lower than those in control group,after 4 weeks of treatment:(3.36±0.21)mm vs.(3.91±0.39)mm,(4.14±0.67)mm vs.(4.75±0.73)mm,(1.83±0.20)scores vs.(2.58±0.17)scores,(1.29±0.24)scores vs.(1.61±0.52)scores;after 12 weeks of treatment:(3.04±0.28)mm vs.(3.66±0.54)mm,(3.91±0.47)mm vs.(4.68±0.66)mm,(0.88±0.06)scores vs.(1.35±0.14)scores,(1.05±0.31)scores vs.(1.57±0.56)scores,the differences were statistically significant(P<0.05).After 12 weeks of treatment,the levels of interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),matrix metalloproteinase-8(MMP-8)and interleukin-1β(IL-1β)in gingival crevicular fluid in experimental group were significantly decreased compared with those in control group:(2.95±0.19)μg/L vs.(4.32±0.84)μg/L,(2.63±0.82)μg/L vs.(3.58±0.51)μg/L,(12.42±1.19)μg/L vs.(13.26±0.68)μg/L,(4.15±1.12)ng/L vs.(5.36±0.42)ng/L,(2.65±0.08)ng/L vs.(4.12±0.19)ng/L,the differences were statistically significant(P<0.05),while the level of transforming growth factor-β(TGF-β)was significantly increased compared with that in control group:(51.35±8.95)ng/L vs.(44.90±5.84)ng/L,and the differences between the groups were statistically significant(P<0.05).Logistic regression analysis showed that the clinical indexes PD,SBI,PLI,IL-6,IL-8,TNF-α,MMP-8,IL-1βand crown root ratio of gingival crevicular fluid were all the risk factors for prognosis of periodontitis treated with dual wavelength laser(P<0.05).Conclusions Nd:YAG laser combined with Er:YAG laser assisted SRP can obtain good curative effect in the treatment of periodontitis.Periodontal clinical indexes PD,SBI,PLI,gingival crevicular fluid IL-6,IL-8 and TNF-α,MMP-8,IL-1βlevel and crown root ratio were independent risk factors for the prognosis of periodontitis treated with dual wavelength laser.