2型糖尿病患者患根面龋情况及龈沟液pH值和钙磷离子浓度对其影响研究

Study on the prevalence of root caries and the effects of pH value and calcium and phosphorus ion concentration of gingival crevicular fluid on it in type 2 diabetes mellitus patients

目的研究2型糖尿病(type 2 diabetes mellitus,T2DM)患者患根面龋情况及龈沟液(gingival crevicular fluid,GCF)pH值和钙磷离子浓度对其影响,为T2DM患者患根面龋的风险评估和预防提供新思路。方法于2023年4月至2024年1月招募1625例健康受试者和706例T2DM受试者在中国医科大学附属口腔医院牙体牙髓病科行口腔根面龋筛查,并对根面龋发生率、根面龋龋均、根面龋性质与患病程度进行分析。在招募的受试者中,151例受试者自愿参与问卷调查及进一步口腔检查,其中健康受试者62例,T2DM受试者89例,对其行患根面龋的影响因素分析。在完成问卷调查和口腔检查的受试者中随机选取符合纳入标准的受试者60例行GCF收集与pH值、钙离子浓度、磷酸盐浓度测定,其中健康受试者24例(对照组),T2DM受试者36例(T2DM组);并根据是否患根面龋分为患龋组和未患龋组。结果(1)共招募的2331例受试者根面龋发生率为4.46%(104/2331),其中健康受试者根面龋发生率为2.40%(39/1625),明显低于T2DM受试者[9.21%(65/706)],差异有统计学意义(χ^(2)=53.497,P<0.001)。在患有根面龋的受试者中,健康受试者与T2DM受试者的根面龋龋均、根面龋性质比较,差异均无统计学意义(均P>0.05);但T2DM受试者根面龋的患病程度更易表现为Ⅰ级,且血糖控制良好者相较于血糖控制不佳者更易表现为Ⅰ级(均P<0.05)。(2)对151例受试者行患根面龋影响因素分析显示,刷牙频率≥3次/d(OR=0.376,95%CI:0.211~0.669,P<0.001)和每年于口腔科就诊次数>1~4次(OR=0.282,95%CI:0.131~0.607,P<0.001)是患根面龋的保护因素;进一步分析发现,T2DM受试者患根面龋与患T2DM年限、是否出现并发症及血糖控制情况无关,差异均无统计学意义(均P>0.05)。(3)T2DM组GCF pH值、钙离子浓度均低于对照组,患龋组GCF pH值低于未患龋组、磷酸盐浓度高于未患龋组,差异均有统计学意义(均P<0.05)。对4个亚组进行分析发现,相较于对照组未患龋亚组,T2DM组患龋亚组的pH值、钙离子浓度降低,磷酸盐浓度升高;且T2DM组患龋亚组仅p H值低于T2DM组未患龋亚组,差异均有统计学意义(均P<0.05)。结论增加刷牙频率和每年于口腔科就诊的次数可能会降低T2DM患者患根面龋风险,T2DM患者GCF pH值的降低可能与其根面龋发生率较高有关。

Objective To study the prevalence of root caries in type 2 diabetes mellitus(T2DM)and the effects of gingival crevicular fluid(GCF)pH and calcium and phosphorus ion concentration on it,thus to provide new ideas for the prevention and risk assessment of root caries.Methods From April 2023 to January 2024,1625 healthy subjects and 706 T2DM subjects were recruited for screening for root caries in the Endodontic Disease department of the Stomatological Hospital of China Medical University,and the incidence of root caries,the mean caries,the nature of root caries,the prevalence of root caries and the severity were analyzed.Among the recruited subjects,151 subjects volunteered to participate in the questionnaire survey and further oral examination,including 62 healthy subjects and 89 T2DM subjects,and we analyse the influencing factors of the root caries.Among the subjects who completed questionnaire survey and oral examination,60 subjects who met the inclusion criteria were randomly selected,and their GCF was collected and pH,calcium ion concentration and phosphate concentration determined,including 24 healthy subjects(control group)and 36 T2DM subjects(T2DM group),and they were divided into caries group and no caries group.Results(1)A total of 2331 subjects had a root caries rate of 4.46%(104/2331);among them,the incidence of root caries in healthy subjects was 2.40%(39/1625),which was significantly lower than that in T2DM subjects[9.21%(65/706)],and the difference was statistically significant(χ^(2)=53.497,P<0.001).In subjects with root caries,the mean caries and nature had no statistical difference between healthy subjects and T2DM subjects(all P>0.05);T2DM subjects were more likely to have gradeⅠroot caries,and those with well-controlled glucose were more likely to be gradeⅠroot caries than those with poor-controlled glucose(all P<0.05).(2)Analysis of factors affecting root caries in 151 subjects showed that frequency of tooth brushing(≥3 times/d)(OR=0.376,95%CI:0.211-0.669,P<0.001)and number of annual visits to the stomatology departmen(t>1-4 times)(OR=0.282,95%CI:0.131-0.607,P<0.001)were protective factors for root caries;further analysis found that root caries in T2DM subjects was not related to the length of having T2DM,complications or glycemic control,and the difference was not statistically significan(tall P>0.05).(3)The GCF pH value and calcium ion concentration of T2DM group were lower than those of control group,the GCF p H value of caries group was lower than that of no caries group,and the phosphate concentration was higher than that of no caries group,the differences being statistically significant(all P<0.05).Analysis of the four subgroups showed that compared to the subgroup without caries in the control group,the pH and calcium ion concentration decreased and the phosphate concentration increased in the subgroup with caries in T2DM group;moreover,the pH value of the subgroup with caries of T2DM group was only lower than that of the subgroup without caries of T2DM group;all the differences were statistically significant(all P<0.05).Conclusion Increasing the frequency of tooth brushing and the number of annual dental visits may reduce the risk of root caries in T2DM patients,and the lower GCF pH in T2DM patients may be related to the higher incidence of root caries.