不同程度颈动脉狭窄患者动脉粥样硬化斑块中牙周致病菌的分布研究

doi:10.13591/j.cnki.kqyx.2024.01.007

摘要/Abstract

摘要：

目的检测不同程度颈动脉狭窄患者动脉粥样硬化斑块与龈下菌斑中的牙周致病菌分布。方法选取需要进行颈动脉内膜剥脱术的患者50例,按照颈动脉狭窄程度分为重度狭窄组(36例)和完全闭塞组(14例)。收集术中分离的颈动脉粥样硬化斑块和龈下菌斑,采用16S rRNA PCR检测伴放线聚集杆菌(Actinobacillus actinomycetemcomitans, A.actinomycetemcomitans)、福赛坦纳菌(Tanerella forsythia, T.forsythia)、齿垢密螺旋体(Treponema denticola, T.denticola)、具核梭杆菌(Fusobacterium nucleatum, F.nucleatum)和牙龈卟啉单胞菌(Porphyromonas gingivalis, P.gingivalis)5种牙周致病菌的分布。结果 P.gingivalis、T.denticola、T.forsythia、F.nucleatum在完全闭塞组颈动脉粥样硬化斑块的检出率分别为71.4%、64.3%、42.9%和14.3%,高于在重度狭窄患者中的检出率,其中两组间P.gingivalis、T.denticola检出率差异具有统计学意义(P<0.05);A.actinomycetemcomitans在完全闭塞组斑块中未检出,低于在重度狭窄组的检出率,但差异无统计学意义。P.gingivalis、T.denticola、T.forsythia在完全闭塞组患者龈下菌斑中的检出率分别为85.7%、71.4%和64.3%,同样高于在重度狭窄患者中的检出率,但差异无统计学意义(P>0.05)。此外,P.gingivalis、T.denticola、T.forsythia在颈动脉粥样硬化斑块和龈下菌斑中的检出率均显著高于F.nucleatum和A.actinomycetemcomitans(P<0.05)。结论在颈动脉粥样硬化斑块和龈下菌斑中P.gingivalis、A.actinomycetemcomitans、F.nucleatum、T.denticola、T.forsythia分布具有差异性。P.gingivalis和T.denticola在颈动脉完全闭塞患者的颈动脉粥样硬化斑块中检出率明显较高,可能与颈动脉粥样硬化的严重程度密切相关。

关键词: 颈动脉粥样硬化, 牙周致病菌, 牙周炎, 龈下菌斑, 斑块

Abstract:

Objective To detect the distribution of periodontal pathogens in atherosclerotic plaque and subgingival plaque in patients with different degrees of carotid artery stenosis. Methods Fifty patients requiring carotid endarterectomy were selected and divided into severe stenosis group (36 cases) and complete occlusion group (14 cases) according to the degree of carotid artery stenosis. The distribution of five periodontal pathogens Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), Tanerella forsythia (T. forsythia),Treponema denticola (T. denticola), Fusobacterium nucleatum (F. nucleatum), Porphyromonas gingivalis (P. gingivalis) was detected by 16S rRNA PCR. Results The detection rates of P. gingivalis, T. denticola,T. forsythia and F.nucleatum in carotid atherosclerotic plaques in patients with complete occlusion were 71.4%, 64.3%, 42.9% and 14.3%, which were higher than those in patients with severe stenosis, and there were significant differences in the detection rates of P.gingivalis and T.denticola(P<0.05). A.actinomycetemcomitans was not detected in the plaques of the complete occlusion group, which was lower than that in the severe stenosis group, but the difference was not statistically significant. The detection rates of P. gingivalis, T. denticola and T. forsythia in subgingival plaque in patients with complete occlusion were 85.7%, 71.4% and 64.3%, which were also higher than those in patients with severe stenosis, but there was no statistical significance (P>0.05). In addition, the detection rates of P.gingivalis, T.denticola, and T.forsythia in carotid atherosclerotic plaques and subgingival plaques were significantly higher than those of F.nucleatum and A.actinomycetemcomitans (P<0.05). Conclusion The distribution of P.gingivalis, A.actinomycetemcomitans, F.nucleatum, T.denticola, and T.forsythia is different in carotid atherosclerotic plaque and subgingival plaque. The detection rates of P.gingivalis and T.denticola in carotid atherosclerotic plaques in patients with total carotid artery occlusion are significantly higher, which may be closely related to the severity of carotid atherosclerosis.

Key words: carotid atherosclerosis, periodontal pathogens, periodontitis, subgingival plaque, plaque

中图分类号:

R54
R781.4

唐路, 薛栋, 杨文文, 张献丽, 陆夏, 赵颖. 不同程度颈动脉狭窄患者动脉粥样硬化斑块中牙周致病菌的分布研究[J]. 口腔医学, 2024, 44(1): 31-35.

TANG Lu, XUE Dong, YANG Wenwen, ZHANG Xianli, LU Xia, ZHAO Ying. Distribution of periodontal pathogens in carotid atherosclerotic plaques with different degrees of carotid artery stenosis[J]. Stomatology, 2024, 44(1): 31-35.

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特异性引物	序列5'—3'	大小/bp
A.actinomycetemcomitansF:AGAGTTTGATCCTGGCTCAG R:CACTTAAAGGTCCGCCTACGTGCC593
T.forsythiaF:GCGTATGTAACCTGCCCGCA R:TGCTTCAGTGTCAGTTATACCT641
T.denticolaF:TAATACCGAATGTGCTCATTTACAT R:CTGCCATATCTCTATGTCATTGCTCTT860
F.nucleatumF:GGCCACAAGGGGACTGAGACA R:TTTAGCCGTCACTTCTTCTGTTGG183
P.gingivalisF:TGTAGATGACTGATGGTGAAAACC R:ACGTCATCCCCACCTTCCTC197

细菌	重度狭窄组	完全闭塞组	总检出
P.gingivalis	12(33.3)	10(71.4)^*	22(44.0)^#
A.actinomycetemcomitans	1(2.8)	0(0)	1(2.0)
F.nucleatum	4(11.1)	2(14.3)	6(12.0)
T.denticola	10(27.8)	9(64.3)^*	19(38.0)^#
T.forsythia	7(19.4)	6(42.9)	13(26.0)^#

细菌	重度狭窄组	完全闭塞组	总检出
P.gingivalis	22(61.1)	12(85.7)	34(68.0)^#
A.actinomycetemcomitans	4(11.1)	1(7.1)	5(10.0)
F.nucleatum	11(30.6)	2(14.3)	13(26.0)
T.denticola	18(50.0)	10(71.4)	28(56.0)^#
T.forsythia	14(38.9)	9(64.3)	23(46.0)^#