光动力疗法结合龈下喷砂对2型糖尿病牙周炎的临床疗效研究

Clinical efficacy of photodynamic therapy combined with subgingival sandblasting on type 2 diabetes periodontitis

目的:探究光动力疗法(photodynamic therapy,PDT)结合龈下喷砂对2型糖尿病(type 2 diabetes mellitus,T2DM)合并牙周炎患者的临床治疗效果。方法:选取2021年7月~2023年1月本院收治的82例2型糖尿病伴牙周炎患者,随机均分为对照组(n=41)和研究组(n=41),对照组给予牙周基础治疗,研究组则加用光动力疗法结合龈下喷砂,对比治疗前和治疗后3个月患者牙周临床指标、龈沟液细胞因子水平和龈下菌斑菌群结构的变化。结果:治疗后,研究组出血指数(bleeding index,BI)、探诊深度(probing depth,PD)和临床附着丧失(clinical attachment loss,CAL)低于对照组(P<0.05);C反应蛋白(C reactive protein,CRP)、抵抗素低于对照组(P<0.05),超氧化物歧化酶(superoxide dismutase,SOD)高于对照组(P<0.05)。菌群分析显示治疗3个月后研究组变形菌门、拟杆菌门相对丰度低于对照组(P<0.05),厚壁菌门相对丰度高于对照组(P<0.05)。结论:2型糖尿病伴牙周炎患者在牙周基础治疗的同时采用光动力疗法结合龈下喷砂治疗可有效地改善牙周情况和龈下菌斑菌群结构,调节龈沟液CRP、抵抗素和SOD水平,从而有助于提高临床疗效。

Objective:To observe the clinical effect of photodynamic therapy combined with subgingival sandblasting on type 2 diabetes mellitus patients with periodontitis.Methods:Totally 82 cases of type 2 diabetes mellitus patients with periodontitis admitted from July 2021 to January 2023 were randomly divided into two groups by random number table,41 cases in each group,patients of the control group received the basic periodontal treatment,patients of the study group were received photodynamic therapy combined with subgingival sandblasting treatment based on the control group.The periodontal condition,the levels of cytokines in gingival crevicular fluid,the structural changes of subgingival plaque flora were observed at baseline and 3 months after treatment.Results:After treatment,the bleeding index(BI),probing depth(PD)and clinical attachment loss(CAL)in the study group were significantly lower than those in the control group(P<0.05).C-reactive protein(CRP)and resistin were significantly lower than the control group(P<0.05),while superoxide dismutase(SOD)was significantly higher than the control group(P<0.05).Microbial analysis showed that after 3 months of treatment,the relative abundance of Proteobacteria and Bacteroidetes in the study group was significantly lower(P<0.05),while the relative abundance of Firmicutes was significantly higher than that in the control group(P<0.05).Conclusion:Photodynamic therapy combined with subgingival sandblasting along with the basic periodontal treatment can effectively improve the periodontal condition and subgingival plaque flora structure,regulate the CRP,resistin and SOD levels of gingival crevicular fluid in patients with type 2 diabetes mellitus and periodontitis which is helpful to improve the clinical efficacy.