糖尿病患者牙周状况及唾液葡萄糖、钙、镁含量分析
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摘要
目的：研究糖尿病患者唾液中葡萄糖、钙、镁含量的改变，并观察唾液糖与血糖的关系，研究糖尿病患者牙周病的发病率，旨在研究糖尿病与牙周病的密切关系。方法： 实验组为60例糖尿病人，对照组为60例正常人。对实验组及对照组行口腔检查，记录牙周病指数(PDI)，观察牙周病发病率；收集清晨非刺激状态下自然分泌的全唾液，进行葡萄糖、Ca++、Mg++ 含量分析，同时行空腹血糖分析。结果：糖尿病组的牙周病发病率为70%，明显高于对照组38.33%，二者有显著性差异（P<0.05〉。糖尿病组的唾液葡萄糖含量为1.950±0.179mmol/L，高于对照组的0.953±0.124mmol/L，二者有显著性差异P<0.01。糖尿病组的唾液钙含量为1.868±0.193mmol/L，高于对照组的0.959±0.127mmol/L，二者有显著性差异P<0.01。糖尿病组的唾液镁含量为0.551±0.093mmol/L，高于对照组的0.204±0.037mmol/L，二者有显著性差异P<0.01。糖尿病组的唾液葡萄糖含量与血糖浓度有显著直线相关性P<0.05。但是糖尿病组的唾液葡萄糖含量与牙周病指数（PDI）之间未发现明显相关性P>0.05。结论：1.糖尿病患者唾液中的葡萄糖、钙、镁含量明显增加，说明唾液腺分泌功能发生改变，这可能是机体在长期高血糖状态下对唾液腺的损害，唾液成分含量的改变对牙及牙周组织的破坏起了一定的作用。2.糖尿病患者的牙周病发病率明显高于正常人，说明在高血糖状态下牙周组织易于受到破坏，这与糖尿病人本身的代谢异常有关。糖尿病是造成牙周病多发的一个重要的危险因素。以上两点也可视为糖尿病这一全身性代谢疾病的口腔局部表现。
Department of stomatology , Medical College, Qingdao University
Postgraduate Sun Huibin
Tutor Li Ningyi Professor
Object To analysis the high level of glucose ,calcium and magnesium concentration in salivary, In order to study the relationship between the level of blood glucose and salivary glucose. To study the percentage of periodontal diseases in patients with diabetes mellitus. In order to study the relationship between diabetes and periodontal disease. Method The experiment group is 60 patients with diabetes mellitus;The control group is 60 healthy subjects. The condition of oral health is examined to find the percentage of periodontal disease. Blood glucose levels and the glucose, calcium and magnesium concentration in unstimulated mixed salivary taken from testee are measured. Results The percentage of periodontal disease in diabetes group is 70%, in control group is 38.33%. The percentage of periodontal diseases is statistically significant in experimental and control group. The average values of salivary glucose concentration in experimental group is 1.950±0.179mmol/L,in control group is 0.953±0.124 mmol/L. The salivary glucose concentration is statistically significant in experimental and control group. The average values of salivary calcium concentration in experimental group is 1.868±0.193 mmol/L, in control group is 0.959±0.127mmol/L. The salivary calcium concentration is statistically significant in experimental and control group. The average values of salivary magnesiumconcentration in experimental group is 0.551±0.093mmol/L, in control group is 0.204±0.037mmol/L. The salivary magnesium concentration is statistically significant in experimental and control group. Linear regression of salivary glucose on blood glucose gives a statistically significant correlation coefficient of 0.210(P<0.05). But linear regression of PDI on salivary glucose gives a simple correlation coefficient of 0.7873(P>0.05). Conclusion The salivary glucose, calcium and magnesium concentration in patients with DM is significant higher than the levels of healthy subjects. It indicates the secretion function of salivary gland may be destroyed under the status of high blood glucose. The percentage of periodontal disease in patients with DM is higher than in healthy subjects. It indicates the diabetes is one of the dangerous factors in the development of periodontal disease.
Department of stomatology , Medical College, Qingdao University
Postgraduate Sun Huibin
Tutor Li Ningyi Professor
Object To analysis the high level of glucose ,calcium and magnesium concentration in salivary, In order to study the relationship between the level of blood glucose and salivary glucose. To study the percentage of periodontal diseases in patients with diabetes mellitus. In order to study the relationship between diabetes and periodontal disease. Method The experiment group is 60 patients with diabetes mellitus;The control group is 60 healthy subjects. The condition of oral health is examined to find the percentage of periodontal disease. Blood glucose levels and the glucose, calcium and magnesium concentration in unstimulated mixed salivary taken from testee are measured. Results The percentage of periodontal disease in diabetes group is 70%, in control group is 38.33%. The percentage of periodontal diseases is statistically significant in experimental and control group. The average values of salivary glucose concentration in experimental group is 1.950±0.179mmol/L,in control group is 0.953±0.124 mmol/L. The salivary glucose concentration is statistically significant in experimental and control group. The average values of salivary calcium concentration in experimental group is 1.868±0.193 mmol/L, in control group is 0.959±0.127mmol/L. The salivary calcium concentration is statistically significant in experimental and control group. The average values of salivary magnesium
引文
参考文献
1． 蒋国彦 实用糖尿病学 北京 科学技术出版社，1993， 2-4
2． Loe H.et al The sixth complication of diabeyes mellitus. Diabetes Care,1993,16:239
3． Emrich LJ,SchlossmanM, Genco RJ,et al.Periodontal diseases in non-insulin dependent diabetes mellitus.J Periodontal.1991,62:123
4． Chavada MG,Shah HM,Jethal BS.Influence of diabetes on periodontal disease.Indian J Dent Res,1993,4:55.
5． Iacopino AM.Diabetic periodontitis:possible lipid-induced defect in tissue repair through alteration of macrophage phenotype and function. Oral Dis 1995 Dec;1(4):214-29.
6． Reterving CO, Reuterving G, Hagg E, et al. Salivary flow rate and salivary glucose concentration in patients with diabetes mellitus influence of severity of diabetes. Diabete Metab 1987 Jul-Aug;13(4):457-62
7． 陈灏珠，李宗明 内科学第三版 北京 人民卫生出版社 1995， 274-276
8． 郑麟藩，张震康 实用口腔医学 北京 人民卫生出版社 1995，122
9． 岳松龄 口腔内科学第三版北京 人民卫生出版社 1991，256
10． 沈稚舟 糖尿病的慢性并发症 上海 上海科学技术出版社 1999，2-4
11． 蒋国彦 实用糖尿病学 北京 科学技术出版社，1993， 272--274
12． Darwazeh AMG,Maifarlan TW,McCuish A,et,al.Mixed salivary glucose levels and candidal carriage in patients with diabetes mellitus. J Oral Pathol1991;20:280
13． Marchetti P, Tognarelli M, Giannarelli R,et al.Decreased salivary glucose secretory rate:usefulness for detection of diabetic patients with autonomio neuropathy. Diabetes Res Clin Pract 1989 Sep 18;7(3):181-6.
14． Darwazeh AM,Macfarlane TW, McCuish A, et al. Mixed salivary glucose levels and candidal carriage in patients with diabetes mellitus. J Oral Pathor Meb 1991 Jul;20(6);280-3
15． Karjalainen KM,Knuuttila ML, Kaar ML, et al. Salivary factors in children and adolescents with insulin-dependent diabetes mellitus. Pediatr Dent 1996 Jul-Aug;18(4);306-11
16． Thorstensson H, Falk H, Hugoson A,et al. Some salivary factors in insulin-dependent diabetics. Acta Odotol Scand 1989 Jun; 47(3):175-83.29
17． Ben-Aryeh H, Cohen M, Kanter Y, et al. Salivary composition in diabetic patients.HNO 1988 Apr-Jun;2(2):96-9. 21
18． Forbat LN,Collions RE,Maskell GK,et al.Glucose concentration in parotid fluid and venous blood of patients attending a diabetic clinic.J R Soc Med 1981 Oct;74(10):725-8
19． Swanljung O, Meurman JH, Torkkl H, Sandholm L, Kaprio E, Maenpaa J.Caries and saliva in 12-18 year-old diabetics and controls. Scand J Dent Res 1992 Dec; 100(6): 310-3.
20． Cherry-Peppers G, Sorkin J, Andres R, et al.Salivarygland function and glucose metabolic status. J Gerontol 1992 Jul; 47(4):M130-4.
21． Reuterving CO.Pilocarpine-stimuliated salivary fliw rate and salivary glucose concentration in alloxan diabetic rats.Influence of severity and duration of diabetes.Acta Physiol Scand 1986 Apr;126(4):511-5
22． 唐国瑶,许国祺,吴万龄 糖尿病患者唾液与血液葡萄糖浓度相关性分析 临床口腔医学杂志 1999,15（4）：235-236
23． Kjellman O.The presence of glucose in gingival exudate and resting saliva of subjects with insulin-treated diabetes mellitus.Swed Dent J 1970;63:11
24． Reuterving CO,Hagg E,Henriksson R,et al.Salivary glands in long-term alloxan-diabetric rats.Aquantitative light and electron-microscopic study.Acta Pathol Microbiol Immunol Scand [A] 1987May;93):131-6
25． Murran VA,Crusson JT,Sauk JJ.Partoid gland basement membrane in diabetes mellitus.J Oral Pathol 1985;14:236
26． Forbat LN,Collions RE,Maskell GK,et al.Glucose concentration in parotid fluid and venous blood of patients attending a diabetic clinic.J R Soc Med 1981 Oct;74(10):725-8
27． Streckfus CF，Welsh S，Brown Rh，et al。Partiod function and composition of partiod salivia among elderly edentulous African-Amerrican diabetes。 J Oral Pathol 1994；23：277
28． 罗泊，赵兰声，赵文峰 腮腺唾液收集器的制作和使用 中华口腔医学杂志 1991；26：38
29． Canepari P, Zerman N,Cavalleri G, et al. Lack ofcorrelation between salivary Streptococcus and lactobacilli counts and caries in IDDM children.Minerva Stomatol 1994 Nov;43(11);501-5.
30． Canepari P, Zerman N,Cavalleri G, et al. Lack of correlation between salivary Streptococcus and lactobacilli counts and caries in IDDM children.Minerva Stomatol 1994 Nov;43(11);501-5.
31． Tenovuo J,Alanen P,Larjava H,et al.Oraql health of patients with Insulin-dependent diabetes mellitus.Scand J Dent Res 1986 Aug;94(4):338-46
32． 刘巨涛，华瑞年，朱志国 重症糖尿病患者血清中金属元素钾、镁、钙、钠的分析 广东微量元素科学 1998，5（11）55-57
33． 张新宇，斯琴高娃，孙逊 糖尿病患者血清中钙镁锌铜锰含量的研究 广东微量元素科学 1998，5（12）：20-22
34． 侯俊秀，李雪 低镁血症与糖尿病 内蒙古医学杂志 1998，30（5）：311-312
35． 游苏，徐晨，冯心光 糖代谢对糖尿病患者尿钙和镁排泄的影响 微量元素与健康研究 1998；15（3）17-19
36． Iughetti L,Marino R, Bertolani MF, Bernasconi S.Oral health in children and adolescents with IDDM-a review.J Pediatr Endocrinol Metab 1999;12(5 Supp12):603-10.
37． 王昆润 关于糖尿病骨病的发病机制 国外医学内分泌分册，1989；16（4）213
38． 张震康 郑麟藩，实用口腔医学 北京 人民卫生出版社， 1995 ，1174
39． 赵文杰，栾向萍，刘志华 糖尿病治疗后血清镁的变化 中国厂矿医学 1998，11（4）：274-275
40． Emrich LT,Shlossman M,Genco Rj.Periodontal disease innon-insulin diabetes mellitus. J Periodontal,1991;26(2):123
41． Gottsegen R. Diabetes and periodontal disedse. J Periodontal,1991;26(3):161
42． 刘菊英 糖尿病患者口腔牙周状态观察 实用口腔医学杂志，1987，3（2）：110-112
43． 李伟成，杜桂书，赵淑蓉 糖尿病患者的口腔表现（附30例调查报告）现代口腔医学杂志 1989，3（4）：234-235
44． 刘秀丽，张平，陈曦 糖尿病患者牙周病323例临床分析 西安医科大学学报，1999，20（1）：103-105
45． Kawamura M, Fukuda S, Kawabata K, et al.Comparison of health behaviour and oral/medical conditions in non-insulin-dependent (type II) diabetics and non-diabetics.Aust Dent J 1998 Oct;43(5):315-20.
46． Genco RJ.Current view of risk favtors for periodontal diseases. J Periodontol 1996 Oct;67(10 Suppp1):1041-9
47． Thorsensson H.Periodontal disease in adult insulin-dependent diabetics.Swed Dent J Supppl 1995;107:1-68.
48． Iughetti L, Marino R, Bertolani MF, et al. Oral health in children and adolescents with IDDM-a review. J Peciatr Endocrinol Metab 1999;12(5 Supp12):603-10.
49． Seppala B, Sorsa T, Ainamo J.Morphometric analysis of cellular and vascular changes in gingival connective tissue in long-term insulin-dependent diabetes.J Periodontol 1997 Dec; 68(12):1237-45
50． Dennison DK，Gottsegen R，Rode LF，et al.Diabetes and periodontal diseases.Jperiodontal,1996;67:166
51． Chavada MG，Shah HM，Jethal BS。Influence of diabetes mellitus on periodontal disease.Indian J DentRes,1993,4:55
52． Sorsa T, Ingman T, Suomalainen K, et al. Cellular source and tetracycline-inhibition of gingival crevivular fluid collagenase of patients with labille diabetes mellitus.J Clin Periodontal 1992Feb;19(2):146-9
53． Krause S,Brachmann P, Losche W, et al. Defective function of blood granulocytes in patients with diabetes mellitus-associated marginal periodontitis. Folia Biol (Praha)1992;38(6):358-63.
54． 沈稚舟 糖尿病的慢性并发症 上海 上海科学技术出版社 1999，32-34
55． Nishimura F, Takahashi K, Kurihara M, et al.Periodontal disease as a complication of diabetes mellitus. Ann Periodontol 1998 Jul;3(1):20-9.
1． 蒋国彦 实用糖尿病学 北京 科学技术出版社，1993， 2-4
2． Loe H.et al The sixth complication of diabeyes mellitus. Diabetes Care,1993,16:239
3． Emrich LJ,SchlossmanM, Genco RJ,et al.Periodontal diseases in non-insulin dependent diabetes mellitus.J Periodontal.1991,62:123
4． Chavada MG,Shah HM,Jethal BS.Influence of diabetes on periodontal disease.Indian J Dent Res,1993,4:55.
5． Iacopino AM.Diabetic periodontitis:possible lipid-induced defect in tissue repair through alteration of macrophage phenotype and function. Oral Dis 1995 Dec;1(4):214-29.
6． Reterving CO, Reuterving G, Hagg E, et al. Salivary flow rate and salivary glucose concentration in patients with diabetes mellitus influence of severity of diabetes. Diabete Metab 1987 Jul-Aug;13(4):457-62
7． 陈灏珠，李宗明 内科学第三版 北京 人民卫生出版社 1995， 274-276
8． 郑麟藩，张震康 实用口腔医学 北京 人民卫生出版社 1995，122
9． 岳松龄 口腔内科学第三版北京 人民卫生出版社 1991，256
10． 沈稚舟 糖尿病的慢性并发症 上海 上海科学技术出版社 1999，2-4
11． 蒋国彦 实用糖尿病学 北京 科学技术出版社，1993， 272--274
12． Darwazeh AMG,Maifarlan TW,McCuish A,et,al.Mixed salivary glucose levels and candidal carriage in patients with diabetes mellitus. J Oral Pathol
13． Marchetti P, Tognarelli M, Giannarelli R,et al.Decreased salivary glucose secretory rate:usefulness for detection of diabetic patients with autonomio neuropathy. Diabetes Res Clin Pract 1989 Sep 18;7(3):181-6.
14． Darwazeh AM,Macfarlane TW, McCuish A, et al. Mixed salivary glucose levels and candidal carriage in patients with diabetes mellitus. J Oral Pathor Meb 1991 Jul;20(6);280-3
15． Karjalainen KM,Knuuttila ML, Kaar ML, et al. Salivary factors in children and adolescents with insulin-dependent diabetes mellitus. Pediatr Dent 1996 Jul-Aug;18(4);306-11
16． Thorstensson H, Falk H, Hugoson A,et al. Some salivary factors in insulin-dependent diabetics. Acta Odotol Scand 1989 Jun; 47(3):175-83.29
17． Ben-Aryeh H, Cohen M, Kanter Y, et al. Salivary composition in diabetic patients.HNO 1988 Apr-Jun;2(2):96-9. 21
18． Forbat LN,Collions RE,Maskell GK,et al.Glucose concentration in parotid fluid and venous blood of patients attending a diabetic clinic.J R Soc Med 1981 Oct;74(10):725-8
19． Swanljung O, Meurman JH, Torkkl H, Sandholm L, Kaprio E, Maenpaa J.Caries and saliva in 12-18 year-old diabetics and controls. Scand J Dent Res 1992 Dec; 100(6): 310-3.
20． Cherry-Peppers G, Sorkin J, Andres R, et al.Salivary
21． Reuterving CO.Pilocarpine-stimuliated salivary fliw rate and salivary glucose concentration in alloxan diabetic rats.Influence of severity and duration of diabetes.Acta Physiol Scand 1986 Apr;126(4):511-5
22． 唐国瑶,许国祺,吴万龄 糖尿病患者唾液与血液葡萄糖浓度相关性分析 临床口腔医学杂志 1999,15（4）：235-236
23． Kjellman O.The presence of glucose in gingival exudate and resting saliva of subjects with insulin-treated diabetes mellitus.Swed Dent J 1970;63:11
24． Reuterving CO,Hagg E,Henriksson R,et al.Salivary glands in long-term alloxan-diabetric rats.Aquantitative light and electron-microscopic study.Acta Pathol Microbiol Immunol Scand [A] 1987May;93):131-6
25． Murran VA,Crusson JT,Sauk JJ.Partoid gland basement membrane in diabetes mellitus.J Oral Pathol 1985;14:236
26． Forbat LN,Collions RE,Maskell GK,et al.Glucose concentration in parotid fluid and venous blood of patients attending a diabetic clinic.J R Soc Med 1981 Oct;74(10):725-8
27． Streckfus CF，Welsh S，Brown Rh，et al。Partiod function and composition of partiod salivia among elderly edentulous African-Amerrican diabetes。 J Oral Pathol 1994；23：277
28． 罗泊，赵兰声，赵文峰 腮腺唾液收集器的制作和使用 中华口腔医学杂志 1991；26：38
29． Canepari P, Zerman N,Cavalleri G, et al. Lack of
30． Canepari P, Zerman N,Cavalleri G, et al. Lack of correlation between salivary Streptococcus and lactobacilli counts and caries in IDDM children.Minerva Stomatol 1994 Nov;43(11);501-5.
31． Tenovuo J,Alanen P,Larjava H,et al.Oraql health of patients with Insulin-dependent diabetes mellitus.Scand J Dent Res 1986 Aug;94(4):338-46
32． 刘巨涛，华瑞年，朱志国 重症糖尿病患者血清中金属元素钾、镁、钙、钠的分析 广东微量元素科学 1998，5（11）55-57
33． 张新宇，斯琴高娃，孙逊 糖尿病患者血清中钙镁锌铜锰含量的研究 广东微量元素科学 1998，5（12）：20-22
34． 侯俊秀，李雪 低镁血症与糖尿病 内蒙古医学杂志 1998，30（5）：311-312
35． 游苏，徐晨，冯心光 糖代谢对糖尿病患者尿钙和镁排泄的影响 微量元素与健康研究 1998；15（3）17-19
36． Iughetti L,Marino R, Bertolani MF, Bernasconi S.Oral health in children and adolescents with IDDM-a review.J Pediatr Endocrinol Metab 1999;12(5 Supp12):603-10.
37． 王昆润 关于糖尿病骨病的发病机制 国外医学内分泌分册，1989；16（4）213
38． 张震康 郑麟藩，实用口腔医学 北京 人民卫生出版社， 1995 ，1174
39． 赵文杰，栾向萍，刘志华 糖尿病治疗后血清镁的变化 中国厂矿医学 1998，11（4）：274-275
40． Emrich LT,Shlossman M,Genco Rj.Periodontal disease in
41． Gottsegen R. Diabetes and periodontal disedse. J Periodontal,1991;26(3):161
42． 刘菊英 糖尿病患者口腔牙周状态观察 实用口腔医学杂志，1987，3（2）：110-112
43． 李伟成，杜桂书，赵淑蓉 糖尿病患者的口腔表现（附30例调查报告）现代口腔医学杂志 1989，3（4）：234-235
44． 刘秀丽，张平，陈曦 糖尿病患者牙周病323例临床分析 西安医科大学学报，1999，20（1）：103-105
45． Kawamura M, Fukuda S, Kawabata K, et al.Comparison of health behaviour and oral/medical conditions in non-insulin-dependent (type II) diabetics and non-diabetics.Aust Dent J 1998 Oct;43(5):315-20.
46． Genco RJ.Current view of risk favtors for periodontal diseases. J Periodontol 1996 Oct;67(10 Suppp1):1041-9
47． Thorsensson H.Periodontal disease in adult insulin-dependent diabetics.Swed Dent J Supppl 1995;107:1-68.
48． Iughetti L, Marino R, Bertolani MF, et al. Oral health in children and adolescents with IDDM-a review. J Peciatr Endocrinol Metab 1999;12(5 Supp12):603-10.
49． Seppala B, Sorsa T, Ainamo J.Morphometric analysis of cellular and vascular changes in gingival connective tissue in long-term insulin-dependent diabetes.J Periodontol 1997 Dec; 68(12):1237-45
50． Dennison DK，Gottsegen R，Rode LF，et al.Diabetes and periodontal diseases.Jperiodontal,1996;67:166
51． Chavada MG，Shah HM，Jethal BS。Influence of diabetes mellitus on periodontal disease.Indian J Dent
52． Sorsa T, Ingman T, Suomalainen K, et al. Cellular source and tetracycline-inhibition of gingival crevivular fluid collagenase of patients with labille diabetes mellitus.J Clin Periodontal 1992Feb;19(2):146-9
53． Krause S,Brachmann P, Losche W, et al. Defective function of blood granulocytes in patients with diabetes mellitus-associated marginal periodontitis. Folia Biol (Praha)1992;38(6):358-63.
54． 沈稚舟 糖尿病的慢性并发症 上海 上海科学技术出版社 1999，32-34
55． Nishimura F, Takahashi K, Kurihara M, et al.Periodontal disease as a complication of diabetes mellitus. Ann Periodontol 1998 Jul;3(1):20-9.