【摘要】：目的：檢測牙周炎患者相關體液中褪黑素(melatonin, MT)、中瘤壞死因子-α (tumor necrosis factor-α, TNF-α)、白細胞介素-1β (interleukin-1β,IL-1β)表達水平并觀察齦下刮治對其表達水平的影響,結合牙周臨床指標,探討褪黑素在牙周炎發(fā)病機制中的可能作用。方法：根據(jù)rmitage的牙周炎診斷標準納入牙周炎初診患者27例。同時納入無系統(tǒng)疾病且牙周健康者18例作為健康對照組。收集患者病史資料及曲面斷層片,進行牙周�？茩z查確定取樣牙位,并進行齦上潔治,1周后行齦下刮治,4周后復診。分別于齦下刮治前及刮治后4周復診時,記錄臨床指標并采集血液、唾液及取樣牙牙位齦溝液(gingival crevicular fluid, GCF)。記錄健康對照組牙周臨床指標并采集血液和唾液。采用酶聯(lián)免疫吸附試驗(enzyme-linked immunosorbent assay, ELISA)檢測樣本中MT、TNF-α及IL-1β的濃度,應用秩和檢驗比較其在牙周炎組與健康對照組中的表達差異,并比較牙周炎組齦下刮治前后其表達水平的變化,運用Spearman秩相關檢驗分析樣本中MT、TNF-α、IL-1β與牙周臨床指標探診深度(probing depth, PD)、探診出血(bleeding on probing, BOP)、附著喪失(clinical attachment level, CAL)的相關關系。結果：1、牙周炎組患者血液中MT水平刮治前低于刮治后(Z=-2.186,P=0.029),且均低于健康對照組(P0.001);牙周炎組患者唾液中MT水平在刮治前、后和健康對照組三組間相比差異均無統(tǒng)計學意義(P0.05)；牙周炎組患者GCF中MT水平刮治前高于刮治后(Z=-2.667,P0.001)。2、刮治前,牙周炎組患者血液、唾液與GCF中MT水平無明顯相關性；健康對照組中血液和唾液MT水平無明顯相關性。3、牙周炎組患者IL-1β、TNF-α與牙周臨床指標的關系：刮治前唾液中IL-1β、TNF-α與牙周臨床指標無明顯相關性；GCF中IL-1β水平與取樣牙PD成正相關(r=0.350,P=0.041),與取樣牙BOP陽性率成正相關(r=0.514,P=0.011),TNF-α水平與取樣牙PD成正相關(r=0.304,P=0.045),與取樣牙BOP陽性率成正相關(r=0.427,P=-0.036)。其余指標無明顯相關性。4、牙周炎組患者MT與牙周臨床指標的關系：刮治前血液MT水平與全口PD (r=-0.465, P=0.034)、BOP (r=-0.466, P=0.025)均成負相關；唾液MT水平與全口BOP陽性率成負相關(r=0.401,P=0.021)；GCF中MT水平與取樣牙PD成正相關(r=0.465,P=0.045)。其余指標無明顯相關性。5、牙周炎組患者MT與IL-1β,TNF-α的關系：刮治前唾液中MT與IL-1β,TNF-α無明顯相關；GCF中MT水平與IL-1β水平呈正相關(r=0.442,P=0.015),與TNF-α無明顯相關。6、Logistic回歸分析結果顯示血液MT水平與牙周炎OR值為0.756(B=-0.280,P=0.030,95%CI：0.587-0.974),提示高水平血液MT為牙周炎的保護因素。結論：1、牙周炎患者GCF中MT水平與IL-1β水平正相關,且與PD成正相關,提示MT與牙周炎癥嚴重程度正相關。2、牙周炎患者血液中MT呈低表達水平,在GCF中MT可能為局部誘導上調表達。
[Abstract]:Objective: to detect the expression of tumor necrosis factor- 偽 (TNF- 偽) and interleukin-1 尾 (interleukin-1 尾 -IL-1 尾) in melatonin (melatonin, MT), and observe the effect of subgingival curettage on the expression of melatonin (melatonin, MT), in patients with periodontitis. To explore the possible role of melatonin in the pathogenesis of periodontitis. Methods: according to the rmitage criteria of periodontitis, 27 patients with periodontitis were included. At the same time, 18 patients with no systemic disease and periodontal health were included as healthy control group. Collect the patient's medical history and curved surface tomograph, make periodontal examination to determine the position of the sampled teeth, and do the supragingival scaling for 1 week and then the subgingival curettage for 4 weeks. Before and 4 weeks after subgingival curettage, clinical data were recorded and (gingival crevicular fluid, GCF). Was collected from blood, saliva and gingival crevicular fluid. The periodontal clinical indexes were recorded and blood and saliva were collected in healthy control group. Enzyme linked immunosorbent assay (enzyme-linked immunosorbent assay, ELISA) was used to detect the concentration of MT,TNF- 偽 and IL-1 尾 in the samples. The expression of MT,TNF- 偽 and IL-1 尾 in periodontitis group was compared with that in healthy control group by rank sum test, and the expression level of MT,TNF- 偽 and IL-1 尾 in periodontitis group was compared before and after subgingival curettage. Spearman rank correlation test was used to analyze the relationship between MT,TNF- 偽 IL-1 尾 and periodontal clinical index, the depth of (probing depth, PD), probing bleeding, (bleeding on probing, BOP), attachment and loss of (clinical attachment level, CAL). Results the blood MT level in the periodontitis group was lower than that in the control group before and after curettage (P0. 001) and was lower than that in the healthy control group (P0. 001), but there was no significant difference between the three groups before and after the curettage (P0.05). The level of MT in GCF of periodontitis group was higher than that after curettage (ZP0.001). Before curettage, there was no significant correlation between blood, saliva and MT level in GCF in periodontitis group. There was no significant correlation between MT level in blood and saliva in healthy control group. The relationship between IL-1 尾 TNF- 偽 and periodontal clinical index in periodontitis group: there was no significant correlation between IL-1 尾 -TNF- 偽 in saliva and periodontal clinical index before curettage. The level of IL-1 尾 in GCF was positively correlated with the PD of sampled teeth (r = 0.350), and with the positive rate of BOP in sampled teeth (r = 0.514). There was a positive correlation between the level of TNF- 偽 and the PD of sampled teeth (r = 0.304), and a positive correlation with the positive rate of BOP in sampled teeth (r ~ (0.427) P ~ (-0.036). There was no significant correlation between other indexes. The relationship between MT and periodontal clinical indexes in periodontitis group: before curettage, there was a negative correlation between MT level in blood and PD (r-0.466, P0. 025) in the whole mouth, and there was a negative correlation between MT level in saliva and the positive rate of BOP in the whole mouth (r0. 401, P0. 021). There was a positive correlation between MT level in GCF and PD in sampled teeth (r = 0.465, P = 0.045). There was no significant correlation between MT and IL-1 尾 TNF- 偽 in periodontitis patients. There was no significant correlation between MT and IL-1 尾 TNF- 偽 in saliva before curettage. There was a positive correlation between MT level and IL-1 尾 level in GCF (r = 0.442 P 0.015), but no significant correlation with TNF- 偽. Logistic regression analysis showed that the serum MT level and OR value of periodontitis were 0.756 (BM-0.280), suggesting that the high level of blood MT was the protective factor of periodontitis. Conclusion MT level in GCF of periodontitis patients is positively correlated with IL-1 尾 level, and is positively correlated with PD, suggesting that MT is positively correlated with the severity of periodontitis, and MT expression is low in the blood of periodontitis patients. In GCF, MT may be locally induced and up-regulated.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R781.42

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