咀嚼对脑血流动力学影响的初步研究
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摘要
咀嚼是消化过程的起始阶段, 是复杂的生理过程。咀嚼对全身有着直接或间接的影响，对脑功能也有一定的影响。
目的：通过对牙列完整及无牙颌患者咀嚼运动前后脑血流流速改变的观察，探讨咀嚼对脑血流动力学的影响，并探讨这些变化的意义，为进一步研究口腔功能与脑功能之间关系提供实验依据。
方法：（1）人员选择：选择10名牙列完整志愿者，其中男、女各5名，年龄22—26岁，平均年龄24.44岁。无全身神经系统等系统疾病，口腔检查除第三磨牙外无牙齿缺失，无颞下颌关节疾病；从我院门诊选择7名无牙颌患者，其中男4名、女3名，年龄50—79岁，平均年龄66.43岁。无全身神经系统等系统疾病，口腔检查均为无牙颌，口腔软硬组织情况良好（已全口义齿修复1月—3月），无颞下颌关节疾病。（2）应用经颅彩色多谱勒超声扫描仪(Transcranial Color Doppler ,TCCD)探测牙列完整受试者及无牙颌患者在安静状态下和咀嚼无糖口香糖10分钟后脑血流速的改变，对大脑中动脉收缩期峰流速(systolic peak flow velocity ,Vs)、舒张期末峰流速(enddiastolic peak flow velocity ,Vd)、平均峰流速(mean peak flow velocity ,Vm)进行统计分析。
结果：1 经两样本均数t检验可知咀嚼前后大脑中动脉收缩期峰流速(Vs)、舒张期末峰流速(Vd)、平均峰流速(Vm)的结果在男性与女性之间均无显著性差异（p>0.05），
故将男性与女性资料合并统计。 2 10名牙列完整受试者咀嚼前后脑血流速值及其均数（单位：cm/s）见table 1。咀嚼前均数：收缩期峰流速（Vs）--91.785,舒张期末峰流速（Vd）--39.385，平均峰流速（Vm）--55.735；咀嚼后均数：收缩期峰流速（Vs）--103.030,舒张期末峰流速（Vd）--46.015，平均峰流速（Vm）--64.090。 3 7名无牙颌患者戴用及不戴用全口义齿咀嚼前后脑血流速值及其均数（单位：cm/s）见table 2。咀嚼前均数：收缩期峰流速（Vs）--80.34,舒张期末峰流速（Vd）--30.30，平均峰流速（Vm）--48.61；戴用全口义齿咀嚼后均数：收缩期峰流速（Vs）--89.54,舒张期末峰流速（Vd）--34.51，平均峰流速（Vm）--53.70；不戴义齿咀嚼后均数：收缩期峰流速（Vs）--93.01,舒张期末峰流速（Vd）--37.30，平均峰流速（Vm）--57.03。 4 t检验统计结果：4.1 牙列完整受试者与无牙颌患者咀嚼前后两样本均数t检验结果见table 3。结果显示，咀嚼前大脑中动脉收缩期峰流速（Vs）、平均峰流速（Vm）在牙列完整受试者与无牙颌患者之间无显著性差异（p>0.05），但舒张期末峰流速（Vd）对比统计学分析有显著性差异（p<0.05）；咀嚼后大脑中动脉收缩期峰流速（Vs）在牙列完整受试者与无牙颌患者（戴全口义齿）之间无显著性差异（p>0.05），而舒张期末峰流速（Vd）及平均峰流速（Vm）有显著性差异（p<0.05）；咀嚼后大脑中动脉平均峰流速（Vm）、收缩期峰流速（Vs）在牙列完整受试者与无牙颌患者（不戴全口义齿）之间无显著性差异（p>0.05），而舒张期末峰流速（Vd）对比统计学分析有显著性差异（p<0.05）。4.2 牙列完整受试者咀嚼前后及无牙颌患者咀嚼前后配对t检验结果见table 4。
结果显示，牙列完整受试者咀嚼后大脑中动脉收缩期峰流速（Vs）、舒张期末峰流速（Vd）及平均峰流速（Vm）与咀嚼前相比均有显著性差异（p<0.05）；无牙颌患者无论戴全口义齿还是不戴义齿咀嚼后大脑中动脉收缩期峰流速（Vs）、舒张期末峰流速（Vd）及平均峰流速（Vm）与咀嚼前相比均有显著性差异（p<0.05）；无牙颌患者戴用全口义齿与不戴义齿咀嚼后大脑中动脉平均峰流速（Vm）有显著性差异（p<0.05），而大脑中动脉收缩期峰流速（Vs）、舒张期末峰流速（Vd）无显著性差异（p>0.05）。
结论：（1）咀嚼可使大脑中动脉血管充盈度增加，血流速度显著加快；（2）牙列完整受试者咀嚼后大脑中动脉血流速度加快较无牙颌患者戴全口义齿咀嚼后的更明显；（3）无牙颌患者无论是否戴用全口义齿，都可以通过咀嚼运动使大脑中动脉各期血流速度明显加快。
Masticatory function is one of hunman’basic functions , the beginning of the digestion and also is a complicated physiological process . Oral diseases will affect the masticatory function at first , have an direct or indirect effect on the body including the brain . At present , we didn’t know the relationship between them completely .
Objective: Our goal was to observe the change of cerebral blood flow before and after mastication in humans and discuss the significance of the change .
method:(1) Subjects were 10 normal volunteers ( 5 men , 5 women , 22—26 years old , mean 24.44 years ) and 7 patients with edentulous jaw ( 4 men ,3 women , 50—79 years old ,mean 66.43 years ) . Each volunteer was healthy and had similar oral status , not having TMD in every team . The patients have used their full dentures for 1—3 months . (2) With the use of transcranial color Doppler analyzer the blood flow in the brain was measured before and 10 minutes after mastication in 17 subjects . The changes of the cerebral blood flow , including systolic peak flow velocity (Vs) , enddiastolic peak flow velocity (Vd) and mean peak flow velocity (Vm) of middle cerebral artery were analysed .
Result : (1) Two-sample t-test results indicate that there are not significant difference of blood velocity before and after mastication between male and female .So we can combine these data together. (2) The data of the blood velocity of the MCA of all subjects before and after mastication are shown in the table 1 and 2 ( unit : cm/s ) . The mean velocity of the MCA of the normal volunteers before mastication (unit:cm/s) : Vs=91.785, Vd=39.385, Vm=55.735; The mean velocity of the MCA of the normal volunteers after mastication (unit:cm/s) : Vs=103.03, Vd=46.015, Vm=64.090; The mean velocity of the MCA of the patients with edentulous jaw before mastication (unit:cm/s): Vs=80.34, Vd=30.30, Vm=48.61; The mean velocity of the MCA of the patients with the full denture after mastication (unit:cm/s):Vs=89.54,Vd=34.51, Vm=53.70; The mean velocity of the MCA of the The patients without the full denture after mastication (unit:cm/s) : Vs=93.01, Vd=37.30, Vm=57.03. (3) The findings of Two-sample t-test for independent samples are shown in the table 3. The results indicate that there are significant difference of enddiastolic peak flow velocity (Vd) (p<0.05) , not significant difference of systolic peak flow velocity (Vs) and mean peak flow velocity (Vm) before and after mastication between the subjects with natural teeth and the patients without full denture (p>0.05) . It also indicate that there are significant difference of enddiastolic peak flow velocity (Vd) and mean peak flow velocity (Vm) (p<0.05) , not significant difference of systolic peak flow
velocity (Vs) (p>.05) after mastication between the subjects with natural teeth and the patients with full denture . (4) The findings of paired t-test for dependent samples are shown in the table 4. The results indicate that there are significant difference of systolic peak flow velocity (Vs) , enddiastolic peak flow velocity (Vd) and mean peak flow velocity (Vm) between before and after mastication in all subjects (p<0.05) . It also indicate that there are significant difference of mean peak flow velocity (Vm) in the patients with edentulous jaw between using and not using full denture (p<0.05) , not significant difference of systolic peak flow velocity (Vs) and enddiastolic peak flow velocity (Vd) (p>0.05).
Conclusion : Our studies indicate that : (1) Mastication can make the blood velocity of the MCA increase obviously. (2) The blood velocity of the MCA of the subjects with natural teeth increase more than that of the patients with full denture . (2) The obvious variation of the cerebral blood flow can be obtained in the patients ,who have the edentulous jaw , no matter they use full denture or not .
目的：通过对牙列完整及无牙颌患者咀嚼运动前后脑血流流速改变的观察，探讨咀嚼对脑血流动力学的影响，并探讨这些变化的意义，为进一步研究口腔功能与脑功能之间关系提供实验依据。
方法：（1）人员选择：选择10名牙列完整志愿者，其中男、女各5名，年龄22—26岁，平均年龄24.44岁。无全身神经系统等系统疾病，口腔检查除第三磨牙外无牙齿缺失，无颞下颌关节疾病；从我院门诊选择7名无牙颌患者，其中男4名、女3名，年龄50—79岁，平均年龄66.43岁。无全身神经系统等系统疾病，口腔检查均为无牙颌，口腔软硬组织情况良好（已全口义齿修复1月—3月），无颞下颌关节疾病。（2）应用经颅彩色多谱勒超声扫描仪(Transcranial Color Doppler ,TCCD)探测牙列完整受试者及无牙颌患者在安静状态下和咀嚼无糖口香糖10分钟后脑血流速的改变，对大脑中动脉收缩期峰流速(systolic peak flow velocity ,Vs)、舒张期末峰流速(enddiastolic peak flow velocity ,Vd)、平均峰流速(mean peak flow velocity ,Vm)进行统计分析。
结果：1 经两样本均数t检验可知咀嚼前后大脑中动脉收缩期峰流速(Vs)、舒张期末峰流速(Vd)、平均峰流速(Vm)的结果在男性与女性之间均无显著性差异（p>0.05），
故将男性与女性资料合并统计。 2 10名牙列完整受试者咀嚼前后脑血流速值及其均数（单位：cm/s）见table 1。咀嚼前均数：收缩期峰流速（Vs）--91.785,舒张期末峰流速（Vd）--39.385，平均峰流速（Vm）--55.735；咀嚼后均数：收缩期峰流速（Vs）--103.030,舒张期末峰流速（Vd）--46.015，平均峰流速（Vm）--64.090。 3 7名无牙颌患者戴用及不戴用全口义齿咀嚼前后脑血流速值及其均数（单位：cm/s）见table 2。咀嚼前均数：收缩期峰流速（Vs）--80.34,舒张期末峰流速（Vd）--30.30，平均峰流速（Vm）--48.61；戴用全口义齿咀嚼后均数：收缩期峰流速（Vs）--89.54,舒张期末峰流速（Vd）--34.51，平均峰流速（Vm）--53.70；不戴义齿咀嚼后均数：收缩期峰流速（Vs）--93.01,舒张期末峰流速（Vd）--37.30，平均峰流速（Vm）--57.03。 4 t检验统计结果：4.1 牙列完整受试者与无牙颌患者咀嚼前后两样本均数t检验结果见table 3。结果显示，咀嚼前大脑中动脉收缩期峰流速（Vs）、平均峰流速（Vm）在牙列完整受试者与无牙颌患者之间无显著性差异（p>0.05），但舒张期末峰流速（Vd）对比统计学分析有显著性差异（p<0.05）；咀嚼后大脑中动脉收缩期峰流速（Vs）在牙列完整受试者与无牙颌患者（戴全口义齿）之间无显著性差异（p>0.05），而舒张期末峰流速（Vd）及平均峰流速（Vm）有显著性差异（p<0.05）；咀嚼后大脑中动脉平均峰流速（Vm）、收缩期峰流速（Vs）在牙列完整受试者与无牙颌患者（不戴全口义齿）之间无显著性差异（p>0.05），而舒张期末峰流速（Vd）对比统计学分析有显著性差异（p<0.05）。4.2 牙列完整受试者咀嚼前后及无牙颌患者咀嚼前后配对t检验结果见table 4。
结果显示，牙列完整受试者咀嚼后大脑中动脉收缩期峰流速（Vs）、舒张期末峰流速（Vd）及平均峰流速（Vm）与咀嚼前相比均有显著性差异（p<0.05）；无牙颌患者无论戴全口义齿还是不戴义齿咀嚼后大脑中动脉收缩期峰流速（Vs）、舒张期末峰流速（Vd）及平均峰流速（Vm）与咀嚼前相比均有显著性差异（p<0.05）；无牙颌患者戴用全口义齿与不戴义齿咀嚼后大脑中动脉平均峰流速（Vm）有显著性差异（p<0.05），而大脑中动脉收缩期峰流速（Vs）、舒张期末峰流速（Vd）无显著性差异（p>0.05）。
结论：（1）咀嚼可使大脑中动脉血管充盈度增加，血流速度显著加快；（2）牙列完整受试者咀嚼后大脑中动脉血流速度加快较无牙颌患者戴全口义齿咀嚼后的更明显；（3）无牙颌患者无论是否戴用全口义齿，都可以通过咀嚼运动使大脑中动脉各期血流速度明显加快。
Masticatory function is one of hunman’basic functions , the beginning of the digestion and also is a complicated physiological process . Oral diseases will affect the masticatory function at first , have an direct or indirect effect on the body including the brain . At present , we didn’t know the relationship between them completely .
Objective: Our goal was to observe the change of cerebral blood flow before and after mastication in humans and discuss the significance of the change .
method:(1) Subjects were 10 normal volunteers ( 5 men , 5 women , 22—26 years old , mean 24.44 years ) and 7 patients with edentulous jaw ( 4 men ,3 women , 50—79 years old ,mean 66.43 years ) . Each volunteer was healthy and had similar oral status , not having TMD in every team . The patients have used their full dentures for 1—3 months . (2) With the use of transcranial color Doppler analyzer the blood flow in the brain was measured before and 10 minutes after mastication in 17 subjects . The changes of the cerebral blood flow , including systolic peak flow velocity (Vs) , enddiastolic peak flow velocity (Vd) and mean peak flow velocity (Vm) of middle cerebral artery were analysed .
Result : (1) Two-sample t-test results indicate that there are not significant difference of blood velocity before and after mastication between male and female .So we can combine these data together. (2) The data of the blood velocity of the MCA of all subjects before and after mastication are shown in the table 1 and 2 ( unit : cm/s ) . The mean velocity of the MCA of the normal volunteers before mastication (unit:cm/s) : Vs=91.785, Vd=39.385, Vm=55.735; The mean velocity of the MCA of the normal volunteers after mastication (unit:cm/s) : Vs=103.03, Vd=46.015, Vm=64.090; The mean velocity of the MCA of the patients with edentulous jaw before mastication (unit:cm/s): Vs=80.34, Vd=30.30, Vm=48.61; The mean velocity of the MCA of the patients with the full denture after mastication (unit:cm/s):Vs=89.54,Vd=34.51, Vm=53.70; The mean velocity of the MCA of the The patients without the full denture after mastication (unit:cm/s) : Vs=93.01, Vd=37.30, Vm=57.03. (3) The findings of Two-sample t-test for independent samples are shown in the table 3. The results indicate that there are significant difference of enddiastolic peak flow velocity (Vd) (p<0.05) , not significant difference of systolic peak flow velocity (Vs) and mean peak flow velocity (Vm) before and after mastication between the subjects with natural teeth and the patients without full denture (p>0.05) . It also indicate that there are significant difference of enddiastolic peak flow velocity (Vd) and mean peak flow velocity (Vm) (p<0.05) , not significant difference of systolic peak flow
velocity (Vs) (p>.05) after mastication between the subjects with natural teeth and the patients with full denture . (4) The findings of paired t-test for dependent samples are shown in the table 4. The results indicate that there are significant difference of systolic peak flow velocity (Vs) , enddiastolic peak flow velocity (Vd) and mean peak flow velocity (Vm) between before and after mastication in all subjects (p<0.05) . It also indicate that there are significant difference of mean peak flow velocity (Vm) in the patients with edentulous jaw between using and not using full denture (p<0.05) , not significant difference of systolic peak flow velocity (Vs) and enddiastolic peak flow velocity (Vd) (p>0.05).
Conclusion : Our studies indicate that : (1) Mastication can make the blood velocity of the MCA increase obviously. (2) The blood velocity of the MCA of the subjects with natural teeth increase more than that of the patients with full denture . (2) The obvious variation of the cerebral blood flow can be obtained in the patients ,who have the edentulous jaw , no matter they use full denture or not .
引文
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26 Henry MA .Johnson LR .Nousek GN .Light microscopic localization of caalcitonin gene-related peptide in the normal feline tregeminal system and following retrogaserian rhizotomy .J Comp Neurol ,1996,365(4):526
27 朱美铃、赵皿、胡三觉.牙髓损伤刺激对三叉神经节中前速激肽原等mRNA的影响[J].牙体牙髓牙周病学杂志，1999，9（2）：130—132
28 郝作琦、刘洪臣、朱美玲.咬合创伤牙髓组织中CGRP免疫阳性纤维的变化.口腔颌面修复学杂志，2001，2：43—45
29 段利军、刘洪臣、朱美玲.咬合创伤牙周组织中CGRP免疫阳性纤维的影响.口腔颌面修复学杂志，2001，2：46—48
30 朱美玲、刘洪臣、郝作琦等.咬合创伤大鼠三叉神经中PPTAmRNA表达的变化. （J）口腔颌面修复学杂志 2002，3（1）：18—21
31 Kvsar E, Schwartz GJ. Cortical unit responses to chemical
stimulation of the oral cavity in the rat (J). Brain Research, 1990,513(2):212—214
32 Kemppainen P, Forster C, Hand werker HO . The importance of stimulus site and intensity in differences of pain induced vascular reflexes in human orofacial region (J). Pain , 2001, 91(3): 331—338.
33 Kobayashi Y, Matsumoto T, Ishigami K, et al. The relationship between occlusion and body function. J Jpn prosthodont soc 1996 40:1—23(in Japanese with english abstract).
34 Takeda Y. Studies of bruxism during sleep-comparisons of electromyogram ,electroencepharogram, lectro-oculogram, electrocardiogram, respirogram, psycheendocrine responses, and clinical findings taken before, during and after experimental occlusal interference, Odontology 1983 71:276—337.
35 张桂云，王雅北，张艺权.重度牙合 磨耗重建患者的牙合力与肌力研究.实用口腔医学杂志，1998，14（4）：305—306
36 李波，易新竹.牙列重度磨耗的研究现状.日本医学介绍，2001，22（7）：327—329
37 王敬卿，徐伟.血管性痴呆的脑血流及代谢研究进展.内蒙古医学杂志，2000，32（4）：299—302