牙周源性牙周牙髓联合病变病原菌分布及临床特征分析

Distribution and clinical characteristics of pathogens in combined periodontal and pulp lesions caused by periodontitis

目的 探析牙周源性牙周牙髓病变患者病原菌分布特点及不同病情程度患者龈沟液IL-1β、hs-CRP、LPS水平,为临床研究提供参考依据。方法 选取65例牙周源性牙周牙髓联合病变患者为本次研究对象(病变组),同期进行正畸的65例患者为对照组,采集患者牙周袋及牙根管标本,采用荧光定量PCR技术检测微生物种类,分析患者病原菌分布情况。按照病情程度将患者分组后,采集患者龈沟液,对比不同分组患者龈沟液IL-1β、hs-CRP、LPS水平。结果 65例病变组病原菌检出率为58.26%(67/115),对照组为15.65%(18/115),两组检出率差异有统计学意义(P<0.05)。病变组患牙牙周袋病原菌检出率100%,牙根管牙髓病原菌检出率50.75%,差异有统计学意义(P<0.05)。对照组牙周袋病原菌检出率100%,牙根管牙髓病原菌检出率11.11%,差异有统计学意义(P<0.05)。病变组患牙弯曲菌属、放线菌属、梭杆菌属、肠杆菌科、嗜血杆菌属、奈瑟菌属、棒状杆菌属的分布率分别为71.64%、52.24%、80.60%、34.33%、25.37%、1.49%、29.85%;对照组患牙弯曲菌属、放线菌属、奈瑟菌属的分布率分别为27.78%、22.22%、72.22%,两组患者各菌属分布率差异有统计学意义(P<0.05)。牙周源性牙周牙髓病变与感染弯曲杆菌属、放线菌属、梭杆菌属、肠杆菌科、嗜血杆菌属、棒状杆菌属呈正相关,与奈瑟菌属呈负相关(P<0.05)。轻度患者组龈沟液IL-1β、hs-CRP、LPS分别为(6.40±1.45)ng/mL、(9.45±2.12)ng/mL、(5.28±1.77)×10^(7)EU/L,中度患者组分别为(8.25±1.90)ng/mL、(12.49±2.90)ng/mL、(7.60±2.22)×10^(7)EU/L,重度患者组分别为(10.27±2.42)ng/mL、(15.20±3.78)ng/mL、(11.24±2.29)×10^(7)EU/L。随着患者病情的加重,患者龈沟液IL-1β、hs-CRP、LPS水平呈上升趋势。结论 牙周源性牙周牙髓联合病变患者病原菌检出率显著升高,发病情况与口腔病原菌感染密切相关。患者龈沟液IL-1β、hs-CRP、LPS水平与病情具有相关性,随着病情发展加重而升高。

Objective The distribution characteristics of pathogens in patients with periodontal and pulp disease and the levels of IL-1p,hs CRP,and LPS in gingival crevicular fluid of patients with different degrees of disease were explored,for providing reference for clinical research.Methods 65 patients with combined periodontal and pulp lesions treated in our dental department were selected as the study subjects(lesion group),while 65 patients who underwent orthodontic treatment in our hospital during the same period were selected as the control group.The periodontal pocket and root canal specimens were collected from patients.The microbial species were detected by fluorescence quantitative PCR technology.The distribution of pathogenic bacteria in patients were analyzed.After grouping patients according to the severity of their condition,the their gingival crevicular fluid were collected to compare the levels of IL-1p,hs CRP,and LPS in the gingival crevicular fluid of patients in different groups.Results The detection rate of pathogenic bacteria in the lesion group of 65 cases was 58.26%(67/115),and that in the control group was 15.65%(18/115).The difference in the detection rate between the two groups was statistically significant(P<0.05).The detection rate of pathogenic bacteria in the periodontal pocket of the affected teeth in the lesion group was 1oo%,and the detection rate of pathogenic bacteria in the dental pulp of the root canal was 50.75%.The difference was statistically significant(P<0.05).The detection rate of pathogenic bacteria in the periodontal pocket of the control group was 1oo%,and the detection rate of pathogenic bacteria in the dental pulp of the root canal was 11.11%.The difference was statistically significant(P<O.05).The distribution rates of Campylobacter,Actinobacteria,Clostridium,Enterobacteriaceae,Haemophilus,Neisseria,and Corynebacterium in the lesion group were 71.64%,52.24%,80.60%,34.33%,25.37%,1.49%,and 29.85%,respectively.The distribution rate of Campylobacter,Actinobacteria,and Neisseria in the control group was 27.78%,22.22%,and 72.22%,respectively.The differences in the distribution rates of each genus between the two groups were statistically significant(P<0.05).Periodontal periodontal and pulp lesions were positively correlated with infections of thegeneraCampylobacter,Actinobacteria,Clostridium,Enterobacteriaceae,Haemophilus,and Corynebacterium,while negatively correlated with Neisseria(P<0.05).The levels of IL-1β,hs-CRP and LPS in the gingival crevicular fluid of the mild patient group were(6.40±1.45)ng/mL,(9.45±2.12)ng/mL,and(5.28±1.77)×10^(7)EU/L.Those of the moderate patient group were(8.25±1.90)ng/mL,was(12.49±2.90)ng/mL,and(7.60±2.22)×10^(7)EU/L.And those of the lesion patient group were(10.27±2.42)ng/mL,hs CRP was(15.20±3.78)ng/mL,and LPS was(11.24±2.29)×10^(7)EU/L.As the patient's condition worsens,the levels of IL-1β,hs CRP,and LPS in the gingival crevicular fluid show an upward trend.Conclusion The detection rate of pathogens in patients with combined periodontal and pulp lesions was significantly increased,and the incidence was closely related to oral pathogen infection.The levels of IL-1p,hs CRP,and LPS in the gingival crevicular fluid of patients were correlated with their condition and increase as the condition worsens.