低强度激光联合FM-SRP治疗对慢性牙周炎患者龈沟液中TGF-β1、t-AP和PAI-1水平的影响

doi:10.13701/j.cnki.kqyxyj.2022.09.019

摘要/Abstract

摘要： 目的: 探讨低强度激光联合全口刮治和根面平整(full-mouth scaling and root planning,FM-SRP)治疗对慢性牙周炎患者龈沟液中转化生长因子β1(transforming growth factor β1, TGF-β1)、组织纤溶酶原激活物(tissue plasminogen activator, t-AP)和纤溶酶原激活物抑制剂1 (plasminogen activators-1, PAI-1)水平的影响。方法: 选择2019年10月~2021年8月本院收治的28例慢性牙周炎患者,本文为前瞻性研究,随机数表法将患者分成观察组和对照组,对照组患者行FM-SRP治疗,观察组患者行FM-SRP治疗辅以低强度激光。比较两组患者疼痛评分,炎性因子,牙周状态指标,血管内皮功能,龈沟液TGF-β1、t-AP和PAI-1及不良反应等参数。结果: 观察组患者治疗后3 d疼痛评分明显低于对照组。治疗后,观察组患者牙龈出血指数、牙周袋探诊深度、牙周附着丧失距离和菌斑指数明显低于对照组;观察组患者白细胞介素-8、基质金属蛋白酶-7和高迁移率族蛋白B1等炎性因子水平明显低于对照组,观察组患者血管扩张功能和血管舒张功能等血管内皮功能明显高于对照组;观察组患者龈沟液转化生长因子β1和t-AP明显高于对照组,观察组患者龈沟液PAI-1水平明显低于对照组。结论: 低强度激光联合FM-SRP应用于慢性牙周炎疾病的治疗,可有效缓解疼痛程度,消除炎症反应,提高血管内皮功能,改善牙周状态指标,可能与降低龈沟液转化生长因子和t-AP、提高PAI-1水平,安全性高,值得临床推广。

关键词: 慢性牙周炎, 低强度激光照射, 全口刮治和根面平整术, 转化生长因子β1, 组织纤溶酶原激活物, 纤溶酶原激活物抑制剂1

Abstract: Objective: To explore the effects of low intensity laser combined with FM-SRP on the levels of TGF-β1, t-AP, and PAI-1 in gingival crevicular fluid of patients with chronic periodontitis. Methods: In this prospective study, 28 patients with chronic periodontitis admitted to our hospital from October 2019 to August 2021 were selected and divided into observation group and control group by random number table method. Patients in the control group received FM-SRP treatment, and patients in the observation group received FM-SRP treatment supplemented by low-intensity laser. Pain score, periodontal clinical indicators, inflammatory factors, vascular endothelial function, GCF transforming growth factor, t-AP, PAI-1, and adverse reactions were compared between two groups. Results: The pain score in the observation group was significantly lower than that of control group at 3d after treatment. After treatment, gingival bleeding index, probing depth, clinical attachment loss, and plaque index in the observation group, were significantly lower than those in the control group. Interleukin-8, matrix metalloproteinase-7, and high mobility group protein B1 in the observation group were significantly lower than those in the control group. The FMD and NMD in the observation group were significantly higher than those in the control group ingival crevice fluid transforming growth factor β1 and t-AP in the observation group were significantly higher than those in the control group, and the PAI-1 of gingival crevicular fluid in the observation group was significantly lower than that in the control group. Conclusion: Low intensity laser combined with FM-SRP in the treatment of chronic periodontitis can effectively relieve pain, eliminate inflammation, improve vascular endothelial function, improve periodontal status indicators, and may be associated with the reduction of gingival crevicular fluid transforming growth factor and t-AP and improvement of PAI-1 level, which is safe and worthy of clinical promotion.

Key words: chronic periodontitis, low intensity laser, full-mouth scaling and root planning, transforming growth factor β1, tissue plasminogen activator, plasminogen activators-1

姚玲玲, 黄满英, 熊际文. 低强度激光联合FM-SRP治疗对慢性牙周炎患者龈沟液中TGF-β1、t-AP和PAI-1水平的影响[J]. 口腔医学研究, 2022, 38(9): 887-891.

YAO Lingling, HUANG Manying, XIONG Jiwen. Effects of Low Intensity Laser Combined with FM-SRP on Levels of TGF-β1, t-AP, and PAI-1 in Gingival Crevicular Fluid of Patients with Chronic Periodontitis[J]. Journal of Oral Science Research, 2022, 38(9): 887-891.

参考文献

[1] Hoare A, Soto C, Rojas-Celis V, et al. Chronic inflammation as a link between periodontitis and carcinogenesis [J]. Mediators Inflamm, 2019, 2019: 1029857.
[2] 张荷馨,李新月.重度牙周炎拔牙后位点保存不同膜覆盖技术的疗效评价[J].口腔医学研究,2020,36(10):962-967.
[3] Fu E, Cheng CM, Chung CH, et al. Association of chronic periodontitis with prostatic hyperplasia and prostatitis: A population-based cohort study in Taiwan [J]. J Periodontol, 2021, 92(1):72-86.
[4] Roman-Torres CVG, Bryington MS, Kussaba ST, et al. Comparison of full-mouth scaling and quadrant-wise scaling in the treatment of adult chronic periodontitis [J]. Braz Dent J, 2018, 29(3):296-300.
[5] Rosa CDDRD, Gomes JML, Moraes SLD, et al. Use of chlorhexidine chip after scaling and root planning on periodontal disease: A systematic review and meta-analysis [J]. Saudi Dent J, 2021, 33(1):1-10.
[6] Matos AL, Silva PU, Paranhos LR, et al. Efficacy of the laser at low intensity on primary burning oral syndrome: a systematic review [J]. Med Oral Patol Oral Cir Bucal, 2021, 26(2): e216-e225.
[7] 赵玥,陶李明.低强度激光照射对正畸治疗慢性牙周炎患者疼痛及牙周健康状况的影响[J].安徽医学,2021,42(6):624-627.
[8] Heidari Z, Moudi B, Mahmoudzadeh-Sagheb H. Immunomodulatory factors gene polymorphisms in chronic periodontitis: an overview [J]. BMC Oral Health, 2019, 19(1):29.
[9] Chiarotto A, Maxwell LJ, Ostelo RW, et al. Measurement properties of visual analogue scale, numeric rating scale, and pain severity subscale of the brief pain inventory in patients with low back pain: a systematic review [J]. J Pain, 2019, 20(3):245-263.
[10] 苏哲君,王鹏,霍峰,等.老年中重度牙周炎伴2型糖尿病患者种植前牙周炎控制效果的分析[J].口腔医学研究,2018,34(11):1196-1199.
[11] 陈斌,李丽丽,张倩,等.侵袭性牙周炎,慢性牙周炎与牙周健康者龈下菌群的差异研究[J].中华口腔医学杂志,2020,55(7):466-474.
[12] 刘志勇.齿痛消炎灵颗粒联合多西环素治疗慢性牙周炎的临床研究[J].现代药物与临床,2021,36(12):2583-2586.
[13] Oliveira AMSD, Costa FO, Nogueira LMR, et al. Azithromycin and full-mouth scaling for the treatment of generalized stage iii and iv periodontitis: a 6-month randomized comparative clinical trial [J]. Braz Dent J, 2019, 30(5):429-436.
[14] Abuderman AWA, Muzaheed. Antibacterial effectiveness of scaling and root planing with and without photodynamic therapy against Campylobacter rectus counts in the oral biofilm of patients with periodontitis [J]. Photodiagnosis Photodyn Ther, 2021, 33: 102170.
[15] Abudukeyoumu A, Li MQ, Xie F. Transforming growth factor-beta1 in intrauterine adhesion [J]. Am J Reprod Immunol, 2020, 84(2): e13262.
[16] Pekpak E, ince E, Ertem M, et al. Tissue plasminogen activator use in pediatric patients: a single center experience [J]. J Pediatr Hematol Oncol, 2021, 43(5): e648-e651.
[17] 胡婷婷,姚佳倩,邹小炎,等.甘氨酸喷砂辅助龈下刮治和根面平整术治疗慢性牙周炎效果及对龈沟液量和白介素-6水平的影响[J].实用口腔医学杂志,2020,36(4):643-646.
[18] Naruseviciute D, Kubilius R. The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: randomized participant blind controlled trial [J]. Clin Rehabil, 2020, 34(8):1072-1082.