慢性牙周炎和慢性阻塞性肺疾病急性加重患者血清PCT水平及其与疾病关系探讨

摘要/Abstract

摘要： 目的通过比较慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）患者和稳定期患者的牙周、肺功能状况及血清降钙素原（serum procalcitonin，PCT）水平，探究AECOPD和牙周炎的内在联系。方法选择AECOPD、慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）稳定期共90例患者为研究对象，根据患者的牙周炎分期分为8组：AECOPD伴Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期牙周炎和COPD稳定期伴Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期牙周炎。对各组患者的一般信息、牙周袋探诊深度（pocket probing depth，PPD）、临床附着丧失（clinical attachment loss，CAL）、菌斑指数（plaque index，PLI）、龈沟出血指数（sulcus bleeding index，SBI）、第1秒用力呼气容积占用力肺活量百分比（percentage of 1 second expiratory volume to forced vital capacity，FEV1/FVC%）、第1秒用力呼气的容积占预计值的百分比（percentage of the estimated volume of forced exhalation in the first second，FEV1%pred）以及血清降钙素原水平进行统计分析。结果 AECOPD和稳定期患者年龄、性别、BMI、吸烟状况均无统计学意义（P>0.05）；AECOPD患者Ⅲ期、Ⅳ期牙周炎比例明显高于稳定期患者（P＜0.05）；Ⅰ期牙周炎患者中AECOPD组PPD、SBI显著高于稳定期组；Ⅱ期牙周炎患者中AECOPD组PPD、CAL显著高于稳定期组；Ⅲ期牙周炎患者中AECOPD组SBI、CAL显著高于稳定期组；Ⅳ期牙周炎患者中AECOPD组PLI、CAL显著高于稳定期组（P＜0.05）。AECOPD及稳定期患者随着牙周炎严重程度增加，FEV1/FVC%、FEV1%pred依次降低（P＜0.01）。AECOPD组患者血清中不同牙周状况下PCT水平均显著高于稳定期组患者（P＜0.01）；血清中的PCT水平与PPD（r=0.60，P＜0.01）、CAL（r=0.58，P＜0.01）、SBI（r=0.31，P=0.03）成显著正相关，与FEV1/FVC%（r=-0.79，P＜0.01）、FEV1%pred（r=-0.80，P＜0.01）成显著负相关。结论本研究结果提示牙周炎与AECOPD可能存在相互促进作用，血清PCT可能在一定程度上反映COPD患者牙周炎严重程度及急性加重风险。

关键词: 慢性阻塞性肺疾病急性加重, 慢性阻塞性肺疾病, 牙周炎, 血清降钙素原

Abstract: Objective: To investigate the relationship between AECOPD and periodontitis by Objective By comparing periodontal, pulmonary function and serum procalcitonin (PCT) levels in patients with AECOPD and patients in stable phase, to explore the internal relationship between AECOPD and periodontitis. Methods A total of 90 patients with AECOPD and chronic obstructive pulmonary disease (COPD) were selected as subjects. According to their periodontitis stage, the patients were divided into 8 groups:AECOPD associated with Ⅰ stage periodontitis, Ⅱ stage periodontitis，Ⅲ stage periodontitis and Ⅳ stage periodontitis and COPD stable periodontitis with Ⅰstage periodontitis, Ⅱ stage periodontitis，Ⅲ stage periodontitis and Ⅳstage periodontitis. The general information, pocket probing depth (PPD), clinical attachment loss (CAL), plaque index (PLI)and sulcus bleeding index (SBI)were analyzed. Percentage of 1 second expiratory volume to forced vital capacity(FEV1/FVC%), percentage of the estimated volume of forced exhalation in the first second (FEV1%pred) and serum procalcitonin levels were analyzed. Results There was no significant difference in age, gender, BMI and smoking status between patients with AECOPD and at stable stage (P>0.05). The proportion of AECOPD patients with Ⅲ， Ⅳ stage periodontitis was significantly higher than that in patients at stable stage (P＜0.05). In Ⅰ stage periodontitis patients, PPD and SBI in AECOPD group were significantly higher than those in stable periodontitis group. PPD and CAL in Ⅱ stage periodontitis patients were significantly higher in AECOPD group than in stable group. SBI and CAL in Ⅲ stage periodontitis patients in AECOPD group were significantly higher than the stable stage group; PLI and CAL in Ⅳ stage periodontitis patients in AECOPD group were significantly higher than the stable stage patients (P＜0.05). As the severity of periodontitis increased, FEV1/FVC% and FEV1%pred decreased successively in patients with AECOPD and at stable stage (P＜0.01). The serum PCT level in AECOPD group under different periodontal conditions was significantly higher than that in stable stage group (P＜0.01). The serum PCT level was positively correlated with PPD (r=0.60, P＜0.01), CAL (r=0.58, P＜0.01), SBI (r=0.31, P=0.03), and significantly negatively correlated with FEV1/FVC% (r=-0.79, P＜0.01) and FEV1%pred (r=-0.80, P＜0.01). Conclusion Results of this study suggest that periodontitis and AECOPD may have a mutual promoting effect, and serum PCT may reflect the severity of periodontitis and the risk of acute exacerbation in COPD patients to some extent.

Key words: chronic obstructive pulmonary disease acute exacerbation, chronic obstructive pulmonary disease, periodontitis, serum procalcitonin

中图分类号:

R781.4

周政权周勇闫梦琪刘雪威齐帅林晓萍. 慢性牙周炎和慢性阻塞性肺疾病急性加重患者血清PCT水平及其与疾病关系探讨[J]. 口腔医学, 2021, 41(9): 793-796.

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