牙周基础治疗对牙周炎伴2型糖尿病患者Treg/Th17细胞平衡及相关细胞因子表达水平的影响

The effect of periodontal basic therapy on Treg/Th17 cell balance and related cytokine expression levels in periodontitis patients with type 2 diabetes mellitus

目的探讨牙周基础治疗对牙周炎伴2型糖尿病患者Treg/Th17细胞比例及相关细胞因子表达水平的影响。方法选取2021年1月至2022年6月本院口腔门诊收治的牙周炎伴T2DM患者80例作为研究对象,随机分为A组和B组,每组40例。A组接受牙周基础治疗,B组仅进行口腔卫生宣教。两组患者均接受常规血糖调控治疗。检测比较两组在治疗前、后3个月的牙周临床指数,糖、脂代谢指标,外周血Th17/Treg细胞及血清相关细胞因子表达。结果治疗后3个月,B组患者的牙周状况指标与治疗前相似,而A组患者的牙周状况指标(PI,BI,PD)出现显著下降趋势(P<0.05)。B组患者血清TG、HDL-C、LDL-C、FBG、HbAlc、FINS、HOMA-IR表达水平与治疗前相似,而A组患者血清FBG、TG、HbAlc、FINS、HOMA-IR表达水平明显低于治疗前和B组水平,HDL-C表达水平则明显高于治疗前和B组水平,差异有统计学意义(P<0.05)。治疗后3个月,A组患者外周血Th17细胞的比例明显下降,Treg细胞比例明显增高,但B组变化不明显,与A组比较,差异具有统计学意义(P<0.05)。治疗后3个月,两组患者血清中TNF-α、IL-17、IL-6表达均呈现下降趋势,A组下降幅度更显著(P<0.05)。结论对T2DM伴牙周炎患者进行牙周基础治疗干预,不仅能明显改善患者糖脂代谢和降低胰岛素抵抗程度,同时能调节Th17/Treg失衡,降低血清中相关炎性因子。

Objective To investigate the impact of periodontal basic treatment on the ratio of Treg/Th17 cells and the expression levels of related cytokines in patients with periodontitis and type 2 diabetes mellitus(T2DM).Methods From January 2021 to June 2022,80 patients with periodontitis and T2DM treated at the oral outpatient department of Wenzhou Traditional Chinese Medicine Hospital were selected as the study subjects and randomly divided into two groups,Group A and Group B,with 40 cases in each group.Group A received periodontal basic treatment,while Group B only received oral hygiene education.Both groups of patients received routine blood sugar control treatment.The periodontal clinical indices,glycometabolism indicators,peripheral blood Th17/Treg cells,and serum-related cytokine expressions of the two groups were detected and compared before and after treatment for 3 months.Results Three months after treatment,the periodontal condition indicators[plaque index(PI),gingival crevicular bleeding index(BI),depth of exploration(PD)]of the patients in Group B were similar to those before treatment,while those in Group A showed a significant downward trend(P<0.05).The serum levels of TG,HDL-C,LDL-C,fasting blood glucose(FBG),HbA1c,fasting insulin(FINS),and homeostasis model assessment of insulin resistance(HOMA-IR)in Group B patients were similar to those before treatment,while the serum levels of FBG,TG,HbA1c,FINS,and HOMA-IR in Group A patients were significantly lower than those before treatment and in Group B,and the expression level of HDL-C was significantly higher than that before treatment and in Group B,with statistically significant differences(P<0.05).Three months after treatment,the proportion of peripheral blood Th17 cells in Group A patients was significantly decreased,and the proportion of Treg cells was significantly increased,but the changes in Group B were not obvious,and the differences compared with Group A were statistically significant(P<0.05).Three months after treatment,the expressions of TNF-α,IL-17,and IL-6 in the serum of both groups showed a downward trend,with a significant decrease in Group A(P<0.05).Conclusion Periodontal basic treatment intervention for patients with T2DM and periodontitis can not only significantly improve patients'glycolipid metabolism and reduce the degree of insulin resistance but also regulate the imbalance of Th17/Treg and reduce the levels of related inflammatory factors in serum.