Nd:YAG激光改善伴2型糖尿病牙周炎患者牙周微生态失衡的临床应用研究

Clinical application of Nd:YAG laser to improve the periodontal microecological imbalance in periodontitis patients with type 2 diabetes mellitus

目的探讨钇铝石榴石晶体(neodymium⁃doped yttrium aluminium garnet,Nd:YAG)激光联合龈下刮治和根面平整(scaling and root planing,SRP)对伴2型糖尿病(type 2 diabetes mellitus,T2DM)牙周炎患者的临床疗效和龈下菌群动态变化的影响。方法选取2021年8月至2022年1月在南京医科大学附属口腔医院牙周病科就诊的伴T2DM牙周炎患者16例,随机分为Nd:YAG组和SRP组。Nd:YAG组患者接受SRP和Nd:YAG激光治疗;SRP组仅接受SRP治疗。使用探诊深度(probing depth,PD)、临床附着丧失(clinical attachment loss,CAL)、探诊出血(bleeding on probing,BOP)阳性率、空腹静脉血糖(fasting plasma glucose,FPG)、糖化血红蛋白(glycated hemoglobin,HbA1c)和身体质量指数(body mass index,BMI)等检测指标对患者治疗前后牙周炎症状况及血糖控制情况进行评估,在两组患者治疗结束后即刻记录患者术后疼痛程度。分别在基线及治疗后3个月采集龈下菌斑样本(PD≥5 mm位点),采用16S rRNA全长基因测序进行分析。结果与基线相比,治疗后3个月Nd:YAG组和SRP组PD较基线时均明显降低(P<0.05),且Nd:YAG组明显低于SRP组(P<0.05);CAL治疗前后差异无统计学意义(P>0.05);两组患者BOP均较基线有明显改善(P<0.05),但组间差异不明显(P>0.05);FPG、HbA1c水平以及BMI与基线相比无明显差异(P>0.05)。Nd:YAG组患者治疗结束后即刻VAS评分显著低于SRP组(P<0.05)。菌群分析显示,治疗3个月后Nd:YAG组纤毛菌科及纤毛菌属较基线时丰度显著性升高(P<0.05),SRP组拟杆菌门和拟杆菌纲为显著优势菌。结论Nd:YAG激光联合SRP可改善伴T2DM的牙周炎患者临床牙周参数,减轻疼痛,但在糖代谢水平上没有明显优势;在短期内观察到激光治疗后龈下菌斑主要菌群的组成发生了变化,口腔健康相关菌群显著上升。

Objective To investigate the effects of neodymium⁃doped yttrium aluminium garnet(Nd:YAG)laser combined with scaling and root planing(SRP)on the clinical outcomes and the dynamics of subgingival flora in periodontitis patients with type 2 dia⁃betes mellitus(T2DM).Methods Sixteen periodontitis patients with T2DM admitted to the Department of Periodontology of the Affili⁃ated Stomatology Hospital of Nanjing Medical University from August 2021 to January 2022 were randomly divided into Nd:YAG group and SRP group.Patients in the Nd:YAG group received SRP and Nd:YAG laser treatment;the SRP group received SRP treatment on⁃ly.Probing depth(PD),clinical attachment loss(CAL)and bleeding on probing(BOP)positive rates,fasting plasma glucose(FPG),glycated hemoglobin(HbA1c)and body mass index(BMI)were used to assess the periodontal status and glycemic control of patients before and after treatment.Subgingival plaque samples(PD≥5 mm)were collected at baseline and 3 months after treatment and an⁃alyzed by 16S rRNA full⁃length sequencing.Results Compared with baseline,PD was significantly lower in both the Nd:YAG and SRP groups at 3 months after treatment(P<0.05),and the Nd:YAG group was significantly lower than the SRP group(P<0.05);there was no statistically significant difference before and after treatment in CAL(P>0.05);BOP was significantly improved in both groups(P<0.05),but the difference between groups was not significant(P>0.05).VAS score in the Nd:YAG group was significantly lower than that in the SRP group(P<0.05).FPG,HbA1c levels and BMI were not significantly different after 3 months of treatment compared with baseline(P>0.05).Bacterial flora analysis showed that the abundance of g Leptotrichia and f Leptotrichiaceae was significantly higher in the Nd:YAG group after 3 months of treatment compared with that at baseline(P<0.05),and that the p Bacteroidetes and c Bacteroidiawere significantly higher in the SRP group after 3 months of treatment.Conclusion Nd:YAG laser combined with SRP im⁃proves clinical periodontal parameters and reduces pain in periodontitis patients with T2DM,but there is no significant advantage in terms of glucose metabolism levels.Changes in the composition of the main subgingival microflora are observed in the short term after treatment and an increase in health⁃associated taxa following laser treatment.