超声刮治联合透明质酸钠凝胶对慢性牙周炎及龈沟液中炎性因子hs-CRP、MCP-1、MMP-13的影响

Effect of ultrasonic curettage combined with sodium hyaluronate gel on chronic periodontitis and its effect on inflammatory factors hs-CRP,MCP-1 and MMP-13 in gingival crevicular fluid

目的:探讨超声刮治联合透明质酸钠凝胶对慢性牙周炎(CP)及龈沟液中炎性因子超敏C反应蛋白(hs-CRP)、单核细胞趋化蛋白1(MCP-1)和基质金属蛋白酶13(MMP-13)的影响。方法:选择2021年10月—2022年10月收治的102例CP患者,以随机数字表法分为试验组(51例)和对照组(51例)。对照组给予超声龈下刮治,试验组在对照组的基础上给予透明质酸钠凝胶辅助治疗。比较2组患者牙周康复指标、临床疗效及龈沟液中hs-CRP、MCP-1和MMP-13水平,牙周致病菌、骨代谢指标及治疗期间不良事件发生情况。采用SPSS 22.0软件包对数据进行统计学分析。结果:2组患者治疗后龈沟出血指数(SBI)、牙龈指数(GI)、菌斑指数(PLI)、牙周袋深度(PD)和附着水平(AL)显著低于治疗前(P<0.05),试验组治疗后更低(P<0.05)。试验组有效率显著高于对照组(P<0.05)。2组患者治疗后hsCRP、MCP-1和MMP-13显著低于治疗前(P<0.05),试验组治疗后更低(P<0.05)。2组患者治疗后牙龈卟啉单胞菌、福赛坦菌、齿垢密螺旋体检出率显著低于治疗前(P<0.05),试验组治疗后更低(P<0.05)。2组患者治疗后Ⅰ型胶原C端肽(CTX)显著低于治疗前,骨钙素(BGP)显著高于治疗前(P<0.05),试验组治疗后的CTX显著低于对照组、BGP显著高于对照组(P<0.05)。2组患者总不良反应发生率相比无统计学差异(P>0.05)。结论:超声刮治联合透明质酸钠凝胶治疗CP可促进患者牙周组织康复,增强近期疗效,抑制龈沟液中炎性因子合成,杀灭牙周致病菌,调节骨代谢。

PURPOSE:To investigate the effect of ultrasonic curettage combined with sodium hyaluronate gel in the treatment of chronic periodontitis(CP)and the effect on inflammatory factor hypersensitive C-reactive protein(hs-CRP),monocyte chemotactic protein 1(MCP-1)and matrix metalloproteinase 13(MMP-13)in gingival crevicular fluid.METHODS:A total of 102 patients with CP from October 2021 to October 2022 were selected,divided into experimental group(n=51)and control group(n=51)by random number table method.The control group received ultrasonic subgingival curetage,and the experimental group received sodium hyaluronate gel adjuvant therapy on the basis of the control group.The periodontal rehabilitation indexes,clinical efficacy and the changes of gingival crevicular fluid hs-CRP,MCP-1 and MMP-13 were compared between the two groups.The periodontal pathogens,bone metabolism indexes and the occurrence of adverse events during treatment were compared between the two groups.The data were statistically analyzed using SPSS 22.0 software package.RESULTS:After treatment,the sulcus bleeding index(SBI),gingival index(GI),plaque index(PLI),periodontal pocket depth(PD)and attachment level(AL)of the two groups were significantly lower than before treatment(P<0.05),and even significantly lower(P<0.05)in the experimental group.Total effective rate of the experimental group was significantly higher than that of the control group(P<0.05).hs-CRP,MCP-1 and MMP-13 in both groups after treatment were significantly lower than before treatment(P<0.05),and hs-CRP,MCP-1 and MMP-13 in the experimental group after treatment were significantly lower than those in the control group(P<0.05).The detection rates of Porphyromonas gingivalis,Forsetanella and Treponema dentalis were significantly lower in both groups after treatment than before treatment(P<0.05),and the detection rates of the above indexes in the experimental group after treatment were significantly lower than those in the control group(P<0.05).After treatment,the C-terminal peptide(CTX)of typeⅠcollagen was significantly lower than that before treatment,and bone gla protein(BGP)was significantly higher than that before treatment(P<0.05).The CTX and BGP of the experimental group were significantly lower than that of the control group and significantly higher than that of the control group(P<0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P>0.05).CONCLUSIONS:Ultrasonic curettage combined with sodium hyaluronate gel in the treatment of CP can promote periodontal tissue rehabilitation,enhance short-term efficacy,inhibit synthesis of inflammatory factors in gingival crevicular fluid,kill periodontal pathogens,regulate bone metabolism,and is safe and reliable.