Th1/Th2、TNF-α水平与2型糖尿病慢性牙周炎严重程度的相关性分析

Correlation of Th1/Th2 and TNFαlevels with severity of chronic periodontitis in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)合并慢性牙周炎(CP)患者辅助性T细胞1型/辅助性T细胞2型(Th1/Th2)及肿瘤坏死因子α(TNF-α)水平与牙周炎严重程度的相关性。方法回顾性分析,选取2023年1月至12月在榆林市中医医院诊治的90例T2DM+CP患者及60例单纯CP患者,另选取同期60例健康体检者作为对照组。T2DM+CP组男48例、女42例,年龄(52.35±5.78)岁,CP病程(3.44±0.91)年;CP组男33例、女27例,年龄(52.63±5.69)岁,CP病程(3.56±1.07)年;对照组男31例、女29例,年龄(52.58±5.64)岁。将90例T2DM+CP患者根据牙周评估标准分为轻度(33例)、中度(30例)、重度(27例)。收集患者一般资料,并比较患者牙周指标[探诊深度(PD)、附着丧失(AL)、牙龈指数(GI)、菌斑指数(PLI)]、炎症因子[干扰素γ(INF-γ)、白细胞介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)]水平和Th1/Th2细胞比例。采用Spearman相关性分析Th1/Th2、TNF-α水平与T2DM+CP患者严重程度之间的相关性。采用受试者操作特征曲线(ROC)评估Th1/Th2、TNF-α水平对T2DM+CP的诊断价值。统计学方法采用t检验、F检验、χ^(2)检验。结果3组性别、年龄、体质量指数、CP病程比较,差异均无统计学意义(均P>0.05);T2DM+CP组、CP组INF-γ水平低于对照组[(29.25±8.46)μg/L、(51.45±16.25)μg/L比(90.13±29.85)μg/L],PD、AL、GI、PLI、IL-4、TNF-α、Th1/Th2比值均高于对照组[(6.38±1.23)mm、(4.82±0.64)mm比(1.93±0.52)mm、(5.79±0.82)mm、(3.02±1.06)mm比(0.42±0.11)mm、(1.63±0.25)分、(1.13±0.18)分比(0.52±0.14)分、(1.25±0.14)分、(1.04±0.12)分比(0.73±0.05)分、(25.84±3.72)μg/L、(20.04±5.18)μg/L比(14.38±2.16)μg/L、(67.88±22.22)μg/L、(56.47±15.03)μg/L比(25.17±8.42)μg/L、(2.28±0.68)、(1.33±0.41)比(0.41±0.13)],差异均有统计学意义(F=185.595、423.411、860.564、533.540、367.510、160.486、112.925、253.712,均P<0.05)。T2DM+CP患者Th1/Th2、TNF-α水平比较,轻度<中度<重度[Th1/Th2:(1.47±0.21)比(2.61±0.34)比(2.89±0.26);TNF-α:(46.82±5.93)μg/L比(63.73±7.32)μg/L比(98.24±6.89)μg/L],差异均有统计学意义(F=233.226、436.772,均P<0.05)。Spearman相关性分析显示,Th1/Th2、TNF-α水平与牙周炎严重程度均呈正相关(r=0.852、0.914,均P<0.05)。Th1/Th2、TNF-α水平单独诊断的AUC为0.866、0.631,灵敏度为63.3%(57/90)、57.8%(52/90),特异度为98.3%(59/60)、63.3%(38/60),而联合诊断的AUC为0.881,灵敏度为73.3%(66/90),特异度为88.3%(53/60)。结论T2DM+CP患者中,Th1/Th2细胞比例及TNF-α水平与牙周炎严重程度呈正相关,且两者联合评估对疾病的诊断具有良好的效能。

Objective To explore the correlation of Th1/Th2 and tumor necrosis factor alpha(TNF-α)levels with the severity of chronic periodontitis(CP)in patients with type 2 diabetes mellitus(T2DM).Methods This retrospective analysis included 90 patients with T2DM and CP(a T2DM+CP group),60 patients with CP(a CP group),and 60 healthy examinees(a control group)from Yulin Traditional Chinese Medicine Hospital between January and December 2023.There were 48 males and 42 females in the T2DM+CP group;they were(52.35±5.78)years old;their disease course was(3.44±0.91)years.There were 33 males and 27 females in the CP group;they were(52.63±5.69)years old;their disease course was(3.56±1.07)years.There were 31 males and 29 females in the control group;they were(52.58±5.64)years old.The patients with T2DM and CP were categorized into a mild group(33 cases),a moderate group(30 cases),and a severe group(27 cases)based on the periodontal assessment standards.Their general data were collected.The periodontal indicators[probing depth(PD),attachment loss(AL),gingival index(GI),and plaque index(PLI)],inflammatory markers[interferon gamma(INF-γ),interleukin 4(IL-4),and tumor necrosis factor alpha(TNF-α)],and Th1/Th2 cell ratios were compared.The Spearman's correlation analysis was employed to assess the correlation of Th1/Th2 and TNF-αwith the severity of periodontitis in the T2DM+CP group.The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic values of Th1/Th2 and TNF-αfor CP+T2DM.t,F,andχ^(2) tests were applied.Results There were no statistical differences in gender,age,body mass index,and CP course between the three groups(all P>0.05).The levels of INF-γin the CP+T2DM group and the CP group were lower than that in the control group[(29.25±8.46)μg/L and(51.45±16.25)μg/L vs.(90.13±29.85)μg/L];the PD,AL,GI,PLI,levels of IL-4 and TNF-α,and Th1/Th2 ratios in the CP+T2DM group and the CP group were higher than those in the control group[(6.38±1.23)mm and(4.82±0.64)mm vs.(1.93±0.52)mm,(5.79±0.82)mm and(3.02±1.06)mm vs.(0.42±0.11)mm,(1.63±0.25)and(1.13±0.18)vs.(0.52±0.14),(1.25±0.14)and(1.04±0.12)vs.(0.73±0.05),(25.84±3.72)μg/L and(20.04±5.18)μg/L vs.(14.38±2.16)μg/L,(67.88±22.22)μg/L and(56.47±15.03)μg/L vs.(25.17±8.42)μg/L,and(2.28±0.68)and(1.33±0.41)vs.(0.41±0.13)];there were statistical differences(F=185.595,423.411,860.564,533.540,367.510,160.486,112.925,and 253.712;all P<0.05).The Th1/Th2 ratio and TNF-αlevel in the mild group,the moderate group,and the severe group were(1.47±0.21),(2.61±0.34),and(2.89±0.26)and(46.82±5.93)μg/L,(63.73±7.32)μg/L,and(98.24±6.89)μg/L,with statistical differences(F=233.226 and 436.772;both P<0.05).The Spearman's correlation analysis showed that Th1/Th2 and TNF-αwere positively correlated wtih the severity of periodontitis(r=0.852 and 0.914;both P<0.05).The areas under the curves(AUC)of Th1/Th2 and TNF-αwere 0.866 and 0.631;the sensitivities were 63.3%(57/90)and 57.8%(52/90);the specificities were 98.3%(59/60)and 63.3%(38/60).The AUC of the combination was 0.881;the sensitivity was 73.3%(66/90);the specificity was 88.3%(53/60).Conclusions In patients with T2DM+CP,Th1/Th2 ratio and TNF-αare significantly positively correlated with the severity of periodontitis.Their combination provides good diagnostic efficacy for the disease.