辅以抗生素的牙周干预对合并2型糖尿病的牙周炎大鼠血清超敏C反应蛋白及颈动脉血管影响的研究
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摘要
目的:探讨牙周炎及其干预措施对合并2型糖尿病(diabetes mellitus,DM)的慢性牙周炎(chronic periodontitis,CP)大鼠血管病变的影响。方法:35只SD大鼠随机分为A(对照组,7只)、B(DM组,7只)和C(CP+DM组,21只)。根据不同干预措施将C组随机分为C1(自然进程组)、C2(机械治疗+抗生素组)、C3(拔牙+抗生素组),7只/组。通过酶联免疫吸附法检测血清hsCRP含量,HE染色后光镜观察颈动脉血管病变。结果:在所有采血时间点,血清hsCRP含量C组显著高于A、B两组(P<0.05);随时间延长C1组一直呈现上升趋势;在第一次干预后1周,C2和C3组均达到峰值,后开始下降(C2组在第5个时间点T5突然回升)。组织病理学显示C1组内膜不完整,中膜平滑肌组织局部坏死,呈无定形颗粒,管壁增厚;C2、C3组内膜完整,中膜部分平滑肌细胞空泡变性,管壁未见明显增厚;B组内膜表面粗糙,中膜平滑肌细胞空泡变性,管壁增厚;A组血管壁未见明显异常。结论:对于合并DM的CP大鼠,若不施加任何干预措施可能会因牙周炎症持续发展而导致血清炎症因子水平不断升高,从而增加糖尿病血管病变发生的机率;机械治疗和拔牙两种有创治疗措施在短时间内仍可能导致炎症因子水平升高,从长远效果来看,拔牙组通过拔除患牙消除感染源而降低了炎症因子水平,血管病变也有所改善。
Objective: To investigate the effect of periodontitis and its intervention on vascular changes in rats with chronic periodontitis complicated with type 2 diabetes mellitus. Methods: Thirty-five male SD rats were randomly divided into three groups: group A(control group, 7 rats), group B(DM group, 7 rats), and group C(CP + DM group, 21 rats). Then group C was randomly divided into three groups: group C1(natural process), group C2(mechanical therapy plus antibiotics), group C3(tooth extraction plus antibiotics), and 7 rats in each group. The levels of serum hsCRP were detected by enzyme-linked immunosorbent assay(ELISA). The pathological changes of the vessels were observed under light microscope after HE staining. Results: The levels of serum hsCRP in group C were significantly higher than those in group A and B at all time points(P<0.05). The levels of serum hsCRP in group C1 became higher gradually with time. One week after the first intervention, the levels of serum hsCRP in group C2 and C3 reached a peak and then began to decrease(group C2 suddenly recovered at the fifth time points). Histopathology showed that in group C1, the intima was incomplete and the smooth muscle tissue of the middle membrane was necrotic, showing amorphous granules and the vessel wall was thickened. In group C2 and C3, the intima was complete and the smooth muscle cells of the middle membrane were vacuolated. There was no obvious thickening of the vessel wall.In group B,the surface of intima was rough and the smooth muscle cells of the middle membrane were vacuolated.The vessel wall was thickened.In group A,there was no obvious abnormality about the vessel wall.Conclusions:For CP rats with DM,if no intervention is applied,the serum levels of inflammatory factors may be elevated due to the persistent development of periodontal inflammation and thus increasing the risk of diabetic angiopathy.Mechanical therapy and tooth extraction may increase the risk of carotid artery disease due to elevated levels of inflammatory factors in a short period of time.But in the long term effect,tooth extraction reduces levels of inflammatory factors and improves vascular disease by removing infected teeth.
Objective: To investigate the effect of periodontitis and its intervention on vascular changes in rats with chronic periodontitis complicated with type 2 diabetes mellitus. Methods: Thirty-five male SD rats were randomly divided into three groups: group A(control group, 7 rats), group B(DM group, 7 rats), and group C(CP + DM group, 21 rats). Then group C was randomly divided into three groups: group C1(natural process), group C2(mechanical therapy plus antibiotics), group C3(tooth extraction plus antibiotics), and 7 rats in each group. The levels of serum hsCRP were detected by enzyme-linked immunosorbent assay(ELISA). The pathological changes of the vessels were observed under light microscope after HE staining. Results: The levels of serum hsCRP in group C were significantly higher than those in group A and B at all time points(P<0.05). The levels of serum hsCRP in group C1 became higher gradually with time. One week after the first intervention, the levels of serum hsCRP in group C2 and C3 reached a peak and then began to decrease(group C2 suddenly recovered at the fifth time points). Histopathology showed that in group C1, the intima was incomplete and the smooth muscle tissue of the middle membrane was necrotic, showing amorphous granules and the vessel wall was thickened. In group C2 and C3, the intima was complete and the smooth muscle cells of the middle membrane were vacuolated. There was no obvious thickening of the vessel wall.In group B,the surface of intima was rough and the smooth muscle cells of the middle membrane were vacuolated.The vessel wall was thickened.In group A,there was no obvious abnormality about the vessel wall.Conclusions:For CP rats with DM,if no intervention is applied,the serum levels of inflammatory factors may be elevated due to the persistent development of periodontal inflammation and thus increasing the risk of diabetic angiopathy.Mechanical therapy and tooth extraction may increase the risk of carotid artery disease due to elevated levels of inflammatory factors in a short period of time.But in the long term effect,tooth extraction reduces levels of inflammatory factors and improves vascular disease by removing infected teeth.
引文
[1] L?e H.Periodontal disease.The sixth complication of diabetes mellitus [J].Diabetes Care,1993,16(1):329-334.
[2] Tasdemir Z,Ozsari Tasdemir F,Kocyigit I,et al.The clinical and systemic effects of periodontal treatment in diabetic and non-diabetic obese patients [J].J Oral Sci,2016,58(4):523-531.
[3] 任秀云,王冲,刘欣,等.伴糖尿病牙周炎大鼠模型的建立及其颈动脉血管的病理特点[J].中华口腔医学杂志,2017,52(12):747-752.
[4] Held C,White HD,Stewart R,et al.Inflammatory biomarkers interleukin-6 and C-reactive protein and outcomes in stable coronary heart disease:experiences from the STABILITY trial [J].J Am Heart Assoc,2017,6(10):e005077.
[5] Slomka T,Drelich-Zbroja A,Jarzabek M,et al.Intima-media complex thickness and carotid atherosclerotic plaque formation in Lublin's population in the context of selected comorbidities [J].J Ultrason,2018,18(73):133-139.
[6] Artese HP,Foz AM,Rabelo Mde S,et al.Periodontal therapy and systemic inflammation in type 2 diabetes mellitus:a meta-analysis [J].PLoS One,2015,10(5):e0128344.
[7] Mohan M,Jhingran R,Bains VK,et al.Impact of scaling and root planing on C-reactive protein levels in gingival crevicular fluid and serum in chronic periodontitis patients with or without diabetes mellitus [J].J Periodontal Implant Sci,2014,44(4):158-168.
[8] 肖燕,刘冰,朱娟芳,等.牙周治疗对伴慢性牙周炎冠心病患者血清C反应蛋白的影响—循证医学分析[J].口腔医学研究,2015,31(3):242-246.
[9] Llambés F,Silvestre FJ,Hernández-Mijares A,et al.Effect of periodontal disease and non surgical periodontal treatment on C-reactive protein.Evaluation of type 1 diabetic patients [J].Med Oral Patol Oral Cir Bucal,2012,17(4):e562-e568.
[10] Correa FO,Goncalves D,Figueredo CM,et al.Effect of periodontal treatment on metabolic control,systemic inflammation and cytokines in patients with type 2 diabetes [J].J Clin Periodontol,2010,37(1):53-58.
[11] Tonetti MS,D’Aiuto F,Nibali L,et al.Treatment of periodontitis and endothelial function [J].N Engl J Med,2007,356(9):911-920.
[12] 任秀云,常乐,岳姿洁,等.辅以抗生素的牙周机械治疗对伴动脉粥样硬化牙周炎大鼠的颈动脉及血清超敏C-反应蛋白的影响[J].华西口腔医学杂志,,2013,31(5):504-508.
[13] 王冲,刘欣,李豪,等.牙周基础治疗对伴高脂血症牙周炎大鼠血清IL-6及牙槽骨吸收影响的研究[J].口腔医学研究,2016,32(8):785-788.
[2] Tasdemir Z,Ozsari Tasdemir F,Kocyigit I,et al.The clinical and systemic effects of periodontal treatment in diabetic and non-diabetic obese patients [J].J Oral Sci,2016,58(4):523-531.
[3] 任秀云,王冲,刘欣,等.伴糖尿病牙周炎大鼠模型的建立及其颈动脉血管的病理特点[J].中华口腔医学杂志,2017,52(12):747-752.
[4] Held C,White HD,Stewart R,et al.Inflammatory biomarkers interleukin-6 and C-reactive protein and outcomes in stable coronary heart disease:experiences from the STABILITY trial [J].J Am Heart Assoc,2017,6(10):e005077.
[5] Slomka T,Drelich-Zbroja A,Jarzabek M,et al.Intima-media complex thickness and carotid atherosclerotic plaque formation in Lublin's population in the context of selected comorbidities [J].J Ultrason,2018,18(73):133-139.
[6] Artese HP,Foz AM,Rabelo Mde S,et al.Periodontal therapy and systemic inflammation in type 2 diabetes mellitus:a meta-analysis [J].PLoS One,2015,10(5):e0128344.
[7] Mohan M,Jhingran R,Bains VK,et al.Impact of scaling and root planing on C-reactive protein levels in gingival crevicular fluid and serum in chronic periodontitis patients with or without diabetes mellitus [J].J Periodontal Implant Sci,2014,44(4):158-168.
[8] 肖燕,刘冰,朱娟芳,等.牙周治疗对伴慢性牙周炎冠心病患者血清C反应蛋白的影响—循证医学分析[J].口腔医学研究,2015,31(3):242-246.
[9] Llambés F,Silvestre FJ,Hernández-Mijares A,et al.Effect of periodontal disease and non surgical periodontal treatment on C-reactive protein.Evaluation of type 1 diabetic patients [J].Med Oral Patol Oral Cir Bucal,2012,17(4):e562-e568.
[10] Correa FO,Goncalves D,Figueredo CM,et al.Effect of periodontal treatment on metabolic control,systemic inflammation and cytokines in patients with type 2 diabetes [J].J Clin Periodontol,2010,37(1):53-58.
[11] Tonetti MS,D’Aiuto F,Nibali L,et al.Treatment of periodontitis and endothelial function [J].N Engl J Med,2007,356(9):911-920.
[12] 任秀云,常乐,岳姿洁,等.辅以抗生素的牙周机械治疗对伴动脉粥样硬化牙周炎大鼠的颈动脉及血清超敏C-反应蛋白的影响[J].华西口腔医学杂志,,2013,31(5):504-508.
[13] 王冲,刘欣,李豪,等.牙周基础治疗对伴高脂血症牙周炎大鼠血清IL-6及牙槽骨吸收影响的研究[J].口腔医学研究,2016,32(8):785-788.
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