卟啉单胞菌与原发性感染根管相关性及毒力作用机制探讨

Correlation between Porphyromonas endodontalis and root canals of primary infection and its virulence mechanisms

目的探讨牙髓卟啉单胞菌与原发性感染根管相关性研究及毒力作用机制。方法选取2016年8月-2018年5月医院诊治的原发性感染根管患者124例,其中伴牙髓炎62例、伴根尖周炎62例。选取同期健康体检者60例,为对照组。记录所有研究对象根管冠中段、根管尖部牙髓卟啉单胞菌检出情况,分析原发性感染根管患者血清炎症因子内毒素(LPS)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平变化情况及牙髓卟啉单胞菌感染与LPS、IL-6、TNF-α指标的相关性。结果原发性感染根管患者牙髓卟啉单胞菌检出率65.32%(81/124),高于对照组的检出率3.33%(2/60),比较差异有统计学意义(χ~2=3.841,P=0.030)。其中原发性感染根管中伴牙髓炎患者牙髓卟啉单胞菌检出率高于伴根尖周炎患者(χ~2=4.150,P=0.031);牙髓炎患者根管冠中段牙髓卟啉单胞菌检出率高于根尖周炎患者,根管尖段牙髓卟啉单胞菌检出率低于根尖周炎患者;差异均有统计学意义(均P<0.05);原发性感染根管患者血清LPS、IL-6、TNF-α水平均高于对照组(P<0.05),且牙髓卟啉单胞菌感染与LPS、IL-6、TNF-α水平呈正相关。结论牙髓卟啉单胞菌是原发性感染根管的优势病原菌,其感染与原发性感染根管发生密切相关,可通过其毒力作用而损伤根管相关组织。

OBJECTIVE To explore the correlation between Porphyromonas endodontalis and root canals of primary infection and its virulence mechanisms.METHODS A total of 124 patients who were diagnosed with primary infection of root canals and treated in the hospital from Aug 2016 to May 2018 were enrolled in the study,62 of whom were complicated with pulpitis,and 62 were complicated with periapical periodontitis.Meanwhile,60 healthy people who received physical examination were chosen as the control group.The isolation rates of P.endodontalis in middle segment of root canal and tip of root canal of all the study objects were recorded.The changes of levels of serum inflammatory factors endotoxin(LPS),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)of the patients with primary infection of root canals were analyzed,and the correlation between the Pe.ndodontalis infection and the LPS,IL-6 and TNF-αwas observed.RESULTS The isolation rate of P.endodontalis of the patients with primary infection of root canals was 65.32%(81/124),higher than 3.33%(2/60)of the patients in the control group,and there was significant difference(χ~2=3.841,P=0.030).The isolation rate of Pe.ndodontalis of the primary infection of root canal patients complicated with pulpitis was significantly higher than that of the patients complicated with periapical periodontitis(χ~2=4.150,P=0.031).The isolation rate of Pe.ndodontalis in the middle segment of root canal was higher in the patients with pulpitis than in the patients with periapical periodontitis,the isolation rate of Pe.ndodontalis in the tip of root canal was lower in the patients with pulpitis than in the patients with periapical periodontitis,and there were significant differences(all P<0.05).The levels of serum LPS,IL-6 and TNF-αof the patients with primary infection of root canals were significantly higher than those of the patients in the control group(P<0.05),and the Pe.ndodontalis infection was positively correlated with the levels of LPS,IL-6 and TNF-α.CONCLUSION Pe.ndodontalis is the predominant species of pathogen isolated from the patients with primary infection of root canals,and the Pe.ndodontalis infection is closely associated with the primary infection of root canals and leads to the damage of root canal-related tissues through its toxic effect.