2018 年第 6 期 第 13 卷

牙周激光治疗对慢性肾病伴慢性牙周炎患者龈沟液及尿液中部分炎性因子水平的影响

Effect of laser assisted periodontal initial therapy on inflammatory factors in gingival crevicular fluid and urine in chronic kidney disease patients with chronic periodontitis

作者：彭莉刘春兰

英文作者：

单位：037008山西省大同市第三人民医院口腔科

英文单位：

关键词：慢性肾病；慢性牙周炎；牙周激光治疗；白细胞介素6；C反应蛋白

英文关键词：

• 摘要：

• 【摘要】目的    探讨激光辅助的牙周基础治疗对慢性肾病伴慢性牙周炎患者牙周状况、龈沟液及尿液中白细胞介素6（IL-6）和C反应蛋白（CRP）水平的影响。方法    选取2013年1月至2016年12月于山西省大同市第三人民医院确诊为慢性肾病伴慢性牙周炎的患者77例。采用随机数字表法分为空白对照组（31例）、单纯牙周治疗组（23例）和牙周激光治疗组（23例）。空白对照组不做特殊治疗处理；单纯牙周治疗组行超声和手动龈下刮治及根面平整；牙周激光治疗组采用Nd:YAG激光处理牙周袋内壁后进行超声和手动龈下刮治及根面平整。治疗前及治疗后1、3个月时进行牙周检查，检测牙周探诊深度、附着丧失水平、出血指数；采用酶联免疫吸附法检测龈沟液和24 h尿液中IL-6和CRP的水平。结果    单纯牙周治疗组和牙周激光治疗组治疗1、3个月后的探诊深度、附着丧失及出血指数较治疗前和空白对照组均明显降低（均P＜0.05）；单纯牙周治疗组和牙周激光治疗组间比较差异均无统计学意义（均P＞0.05）。单纯牙周治疗组和牙周激光治疗组治疗1、3个月后龈沟液及尿液中的IL-6、CRP水平较治疗前和空白对照组均明显降低（均P＜0.05）；牙周激光治疗组治疗3个月后龈沟液及尿液中的IL-6、CRP水平明显低于单纯牙周治疗组［IL-6：（3.6±1.4）μg/L比（5.1±1.3）μg/L、（10.7±3.0）pg/mg比（12.2±3.1）pg/mg，CRP：（43±14）ng/L比（51±15）ng/L、（0.7±0.4）mg/d比（0.9±0.5）mg/d］，差异均有统计学意义（均P＜0.05）。结论    牙周治疗可改善慢性肾病伴慢性牙周炎患者局部和全身炎性因子水平，激光辅助牙周治疗的炎症控制效果较单纯牙周治疗维持时间长，可能更有利于慢性肾病伴慢性牙周炎患者微炎症状态的控制。

• 【Abstract】Objective    To explore the effect of laser assisted periodontal initial therapy on levels of interleukin-6（IL-6） and C-reactive protein（CRP） in gingival crevicular fluid and urine in chronic kidney disease patients with chronic periodontitis. Methods    Seventy-seven patients with chronic kidney disease accompanied by chronic periodontitis from January 2013 to December 2016 in the Third People′s Hospital of Datong City were randomly divided into blank control group（n＝31）, simple periodontal therapy group（n＝23） and laser assisted periodontal therapy group（n＝23）. The blank control group had no special treatment. The simple periodontal therapy group was treated with ultrasonic and manual subgingival scaling and root planning. The laser assisted periodontal therapy group was treated with Nd:YAG laser at the unattached wall of periodontal pocket before scaling and root planning. Probing depth（PD）, attachment loss（AL） and bleeding index（BI） were assessed before and 1, 3 months after therapy. Levels of IL-6 and CRP in gingival crevicular fluid and urine were tested by the enzyme linked immunosorbent assay. Results    One and 3 months after treatment, PD, AL and BI in simple periodontal therapy group and laser assisted periodontal therapy group were significantly lower than those before treatment and those in blank control group（P＜0.05）; there were no significant differences of PD, AL and BI between simple periodontal therapy group and laser assisted periodontal therapy group（P＞0.05）. Levels of IL-6 and CRP in gingival crevicular fluid and urine 1, 3 months after treatment in simple periodontal therapy group and laser assisted periodontal therapy group were significantly lower than those before treatment and those in blank control group（P＜0.05）; levels of IL-6 and CRP in gingival crevicular fluid and urine 3 months after treatment in laser assisted periodontal therapy group were significantly lower than those in simple periodontal therapy group［IL-6： （3.6±1.4）μg/L vs（5.1±1.3）μg/L, （10.7±3.0）pg/mg vs（12.2±3.1）pg/mg; CRP： （43±14）ng/L vs（51±15）ng/L, （0.7±0.4）mg/d vs（0.9±0.5）mg/d］（P＜0.05）. Conclusions    Periodontal initial therapy can effectively reduce local and systemic inflammatory cytokines in patients with chronic kidney disease and periodontitis. Laser assisted periodontal therapy shows better inflammation-control effect than simple periodontal therapy.