黃敏
【摘要】 目的:研究牙周治療對(duì)牙周炎伴冠心病患者血清C反應(yīng)蛋白(CRP)、白細(xì)胞介素-6(IL-6)、腫瘤壞死因子-ɑ(TNF-ɑ)及血脂水平的影響。方法:隨機(jī)選取2013年-2015年在筆者所在醫(yī)院進(jìn)行治療的牙周炎伴冠心病患者60例,按照隨機(jī)原則分為兩組,30例患者行常規(guī)內(nèi)科維持治療為對(duì)照組,此外30例患者在常規(guī)內(nèi)科維持治療的基礎(chǔ)上進(jìn)行牙周基礎(chǔ)治療為研究組,對(duì)比兩組患者治療后血清C反應(yīng)蛋白、炎癥因子及血脂水平的差異。結(jié)果:兩組患者治療前血清CRP、IL-6及TNF-ɑ等血清炎癥因子和TC、TG、HDL-C、LDL-C及FG等血脂水平觀察指標(biāo)比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05);治療后,研究組患者血清CRP、IL-6及TNF-ɑ等血清炎癥因子均較治療前顯著降低,并且低于對(duì)照組患者,組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05);治療后,對(duì)照組患者血清C反應(yīng)蛋白、炎癥因子及血脂水平與治療前相比差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。結(jié)論:對(duì)于牙周炎伴冠心病治療可以顯著降低其血清中CRP、IL-6及TNF-ɑ的含量,有助于后期冠心病的治療,值得進(jìn)行臨床推廣。
【關(guān)鍵詞】 牙周炎; 牙周治療; 冠心??; 炎癥因子; 血脂水平
doi:10.14033/j.cnki.cfmr.2017.1.010 文獻(xiàn)標(biāo)識(shí)碼 B 文章編號(hào) 1674-6805(2017)01-0020-02
【Abstract】 Objective:To study the effect of initial periodontal treatment on serum CRP,IL-6,TNF-ɑ and other inflammatory cytokines,lipids of patients with coronary artery disease and periodontitis.Method:60 cases of patients with coronary artery disease and periodontitis were selected in the authors hospital from 2013 to 2015.30 cases of the patients were treated by conventional medical maintenance therapy as control group.30 cases patients were treated by periodontal treatment performed on the basis of routine medical maintenance therapy as research group.The CRP、inflammatory cytokines and lipids of serum were compared in research group patients and control group patients after treatment.Result:Serum CRP,IL-6,TNF-ɑ and TC,TG,HDL-C,LDL-C,F(xiàn)G of two groups before treatment were no significant differences(P>0.05).Serum CRP,IL-6 and TNF-ɑ of research group were significantly lower than before treatment,and lower than the control group of patients,the differences were statistically significant (P<0.05).After treatment,serum C-reactive protein,inflammatory cytokines and lipid levels of control group compared with before treatment was not significant difference (P>0.05).Conclusion:For the treatment of periodontitis with coronary heart disease can significantly reduce the serum CRP,IL-6 and TNF-ɑ content,contribute to the treatment of coronary heart disease late,worthy of promotion.
【Key words】 Periodontitis; Periodontal treatment; Coronary heart disease; Inflammatory factors; Blood lipid levels
First-authors address:Fujian Provincial Hospital,F(xiàn)uzhou 350001,China
冠心病是一種高發(fā)的、常見的心血管疾病,而牙周炎同樣是一種常見的牙科疾病。臨床研究表明,冠心病與牙周炎之間存在一定的聯(lián)系[1]。本文即研究牙周治療對(duì)牙周炎伴冠心病患者血清C反應(yīng)蛋白(CRP)、白細(xì)胞介素-6(IL-6)、腫瘤壞死因子-ɑ(TNF-ɑ)及血脂水平的影響。
1 資料與方法
1.1 一般資料
隨機(jī)選取2013年-2015年在筆者所在醫(yī)院進(jìn)行治療的牙周炎伴冠心病患者60例,30例對(duì)照組患者中男14例,女16例,年齡48~67周歲,平均(59.32+12.11)周歲;30例研究組患者中男15例,女15例,年齡46~69周歲,平均(59.66+10.37)周歲。兩組患者年齡、性別、牙周基礎(chǔ)狀況及病史等一般資料比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。此外,研究人員均向納入本次研究的所有患者詳細(xì)解釋本次研究的目的、意義及內(nèi)容,并且在征得患者同意的前提下,進(jìn)行本次研究。
1.2 方法
兩組患者均在進(jìn)行治療后的第12周,于清晨空腹條件取靜脈血3.0 ml,離心取上層血清,通過全自動(dòng)生化分析儀對(duì)患者血清中的CRP、IL-6及TNF-ɑ進(jìn)行測(cè)定,然后通過全自動(dòng)生化分析儀對(duì)患者血液總膽固醇含量(TC)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL-C)以及低密度脂蛋白膽固醇進(jìn)行測(cè)定(LDL-C)。
1.3 統(tǒng)計(jì)學(xué)處理
選用統(tǒng)計(jì)學(xué)軟件SPSS 19.0進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料以(x±s)表示,采用t檢驗(yàn);計(jì)數(shù)資料以率(%)表示,采用字2檢驗(yàn),P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2 結(jié)果
兩組患者治療前血清CRP、IL-6及TNF-ɑ等血清炎癥因子和TC、TG、HDL-C、LDL-C及FG等血脂水平比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05);治療后,研究組患者血清CRP、IL-6及TNF-ɑ等血清炎癥因子均較治療前顯著降低,并且低于對(duì)照組患者,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);治療后,對(duì)照組患者血清C反應(yīng)蛋白、炎癥因子及血脂水平與治療前比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05),見表1。
3 討論
本文研究發(fā)現(xiàn),對(duì)牙周炎合并冠心病患者進(jìn)行牙周基礎(chǔ)治療可以顯著降低患者血清中CRP、IL-6及TNF-ɑ的含量。而高敏C反應(yīng)蛋白(hypersensitive C-reactive protein,Hs-CRP)是血漿中的一種C反應(yīng)蛋白,是人類重要的急性期反應(yīng)蛋白,急性期濃度可升高上千倍,Hs-CRP是人類急性反應(yīng)蛋白,沒有特異性,目前已經(jīng)作為醫(yī)院常規(guī)檢測(cè)項(xiàng)目,可以在很多疾病診斷上作為輔助判斷依據(jù)[2-3]。另外,越來越多的證據(jù)表明Hs-CRP不僅是炎癥標(biāo)志物,而且本身直接參與炎癥過程[4]。IL-6是趨化因子家族的一種細(xì)胞因子,具有刺激活化B細(xì)胞增殖、分泌抗體,刺激T細(xì)胞增殖及CTL活化和刺激肝細(xì)胞合成急性期蛋白,參與炎癥反應(yīng)的功能[5]。羅菲等[6]研究表明,IL-6可以通過過STAT3/miR-21對(duì)炎癥反應(yīng)進(jìn)行調(diào)控。腫瘤壞死因子-α(Tumor Necrosis Factor,簡(jiǎn)寫TNF)是一種能夠直接殺傷腫瘤細(xì)胞而對(duì)正常細(xì)胞無明顯毒性的細(xì)胞因子,是迄今為止所發(fā)現(xiàn)的直接殺傷腫瘤作用最強(qiáng)的生物活性因子之一。
冀元元等[7]研究發(fā)現(xiàn),阿托伐他汀可以顯著降低冠心病患者血清hs-CRP、TNF-α和IL- 6水平,對(duì)于冠心病的防治具有重要意義。結(jié)合本文研究可以得出,對(duì)于牙周炎伴冠心病治療可以顯著降低其血清中CRP、IL-6以及TNF-ɑ的含量,有助于后期冠心病的治療,值得進(jìn)行臨床推廣。
參考文獻(xiàn)
[1] Bagavad G,Chandrasekaran S,Preethi P.Are lipid profiles true surrogate biomarkers of coronary heart disease in periodontitis patients?: A case-control study in a south Indian population[J].Journal of Indian Society of Periodontology, 2012, 16(1):32-36.
[2]戴青原,郭濤.牙周炎與冠心病關(guān)系的研究進(jìn)展[J].實(shí)用心腦肺血管病雜志,2012,20(3):395-396.
[3]華關(guān)民,唐榮德,梁劍寧,等.血清CRP與hs-CRP檢測(cè)值比較與相關(guān)性分析[J].中國(guó)醫(yī)學(xué)創(chuàng)新,2014,11(3):32-34.
[4]吳旋,汪欣,陳云歡,等.補(bǔ)陽(yáng)還五湯對(duì)腦缺血大鼠血清TNF-ɑ、IL-6、CRP的影響研究[J].中國(guó)醫(yī)學(xué)創(chuàng)新,2015,12(12):30-32.
[5] Grivennikov S,Karin E,Terzic J,et al.IL-6 and Stat3 Are Required for Survival of Intestinal Epithelial Cells and Development of Colitis-Associated Cancer[J].Cancer Cell,2009, 15(2):103-113.
[6]羅菲,徐媛,趙越,等.IL-6通過STAT3/miR-21調(diào)控炎癥反應(yīng)在亞砷酸鈉所致HBE細(xì)胞惡性轉(zhuǎn)化中的作用[C]//中國(guó)毒理學(xué)會(huì)全國(guó)毒理學(xué)大會(huì).2013.
[7]冀元元,李綱,劉志遠(yuǎn),等.阿托伐他汀對(duì)冠心病炎癥因子hs-CRP、TNF-α和IL-6水平的干預(yù)作用[J].中國(guó)生化藥物雜志, 2014,34(7):147-150.
(收稿日期:2016-09-12)