吸烟对慢性牙周炎患者的炎症因子和骨代谢及氧化应激的影响

Effect of smoking on inflammatory factors,bone metabolism and oxidative stress in patients with chronic periodontitis

目的探讨吸烟习惯对慢性牙周炎(CP)患者牙龈沟液中的炎症因子、骨代谢标志物及氧化应激反应的影响。方法87例CP患者据吸烟史分为吸烟组(n=43)和不吸烟组(n=44),收集2组患者治疗前的一般情况(性别、年龄、病程)及牙周情况(菌斑指数、探诊深度、附着丧失、牙龈出血指数),牙周基础治疗8周,取治疗前后2组患者治疗牙的龈沟液,采用酶联免疫吸附试验(ELISA)检测龈沟液中的氧化应激反应指标[丙二醛(MDA)、过氧化氢(H_(2)O_(2))、超氧化物歧化酶(SOD)及谷胱甘肽过氧化物酶(GSH-Px)]、炎症反应指标[肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素-18(IL-18)、半胱氨酸天冬氨酸蛋白酶1(Caspase-1)及可溶性细胞间黏附分子1(sICAM-1)]及骨代谢指标[如骨保护素(OPG)、碱性磷酸酶(ALP)、骨钙素(OCN)、Ⅰ型胶原(COL-Ⅰ)及破骨细胞分化因子(RANKL)]的水平。结果吸烟组男性较不吸烟组男性人数多(P<0.05);2组CP患者治疗后龈沟液MDA、H_(2)O_(2)、TNF-α、hs-CRP、IL-18、Caspase-1、sICAM-1及RANKL低于治疗前(P<0.05),SOD、GSH-Px、OPG、ALP、OCN及COL-Ⅰ水平高于治疗前(P<0.05);不吸烟组CP患者治疗后龈沟液MDA、H_(2)O_(2)、TNF-α、hs-CRP、IL-18、Caspase-1、sICAM-1及RANKL水平低于吸烟组(P<0.05),SOD、GSH-Px、OPG、ALP、OCN及COL-Ⅰ水平高于吸烟组(P<0.05)。结论吸烟可能会提高CP患者龈沟液的炎症反应和氧化应激水平、降低骨代谢水平,可能对牙周治疗的效果产生不良影响。

Objective To investigate the effect of smoking habits on inflammatory factors,bone metabolic markers and oxidative stress in gingival crevicular fluid of patients with chronic periodontitis(CP).Methods Eighty-seven CP patients were divided into smoking group(n=43)and non-smoking group(n=44)based on their smoking history.Two groups were collected for general information(gender,age,disease duration)and periodontal status(plaque index,probing depth,attachment loss,gingival bleeding index)before treatment.After 8 weeks of periodontal basic treatment,gingival crevicular fluid was collected from two groups of the patients before and after treatment.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of oxidative stress response indicators[malondialdehyde(MDA),hydrogen peroxide(H_(2)O_(2)),superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)],inflammatory response indicators[tumor necrosis factor alpha(TNF-α),high-sensitivity C-reactive protein(hs-CRP),interleukin-18(IL-18),Caspase-1,and soluble intercellular adhesion molecule-1(sICAM-1)]and bone metabolism indicators[such as osteoprotegerin(OPG),alkaline phosphatase(ALP),osteocalcin(OCN),typeⅠcollagen(COL-Ⅰ),and osteoclast differentiation factor(RANKL)].Results The number of males in smoking group was more than that in non-smoking group(P<0.05).The levels of MDA,H_(2)O_(2),TNF-α,hs-CRP,IL-18,Caspase-1,sICAM-1,and RANKL in gingival crevicular fluid of two groups of CP patients were lower after treatment than those before treatment(P<0.05),while the levels of SOD,GSH-Px,OPG,ALP,OCN and COL-Ⅰwere higher than those before treatment(P<0.05).After treatment,the levels of MDA,H_(2)O_(2),TNF-α,hs CRP,IL-18,Caspase-1,sICAM-1,and RANKL in gingival crevicular fluid were lower in non-smoking group than those in smoking group(P<0.05),while the levels of SOD,GSH-Px,OPG,ALP,OCN,and COL-Ⅰwere higher than those in smoking group(P<0.05).Conclusion Smoking may increase the levels of inflammatory response and oxidative stress in gingival crevicular fluid among CP patients,decrease bone metabolic level,thus adversely affecting the efficacy of periodontal treatment.