阿奇霉素辅助Ⅲ/Ⅳ期牙周炎患者非手术治疗的临床疗效及其对唾液微生物群落的影响

doi:10.13591/j.cnki.kqyx.2022.07.007

摘要/Abstract

摘要： 目的评价全身应用阿奇霉素辅助治疗对Ⅲ/Ⅳ期牙周炎患者非手术治疗的临床疗效及其对唾液微生物群落的影响。方法纳入40例Ⅲ/Ⅳ期牙周炎患者作为研究对象,随机分为常规非手术治疗组(SRP组)和阿奇霉素辅助非手术治疗组(AZI组)。在基线、SRP后第3天和第6周3个时点进行临床检查和唾液采集。通过临床检查分析两组患者临床治疗效果;通过16S rRNA测序分析唾液微生物组,确定各分类单元丰富度、多样性和相对丰度的差异。结果与基线相比,两组患者治疗后所有临床指数均显著改善(P<0.001)。与SRP组相比,在治疗后第3天和第6周,AZI组的临床附着丧失(clinical attachment loss,CAL)和探诊出血(bleeding on probing,BOP)的改善更显著(P<0.05),但探诊深度(probing depth,PD)的改善仅在治疗后第6周时更明显(P<0.05)。位点水平分层统计结果显示,AZI组治疗后位点水平牙周指标优于SRP组。AZI组治疗后所有α多样性指数均显著降低(P<0.05),而SRP组仅Sobs指数治疗后第3天有短暂降低。治疗后,两组乳杆菌菌群比例均有所增加,但AZI组较高。AZI组密螺旋体和梭杆菌比例显著降低(P<0.05);治疗后第3天,卟啉单胞菌的比例显著降低,普雷沃菌的比例显著增加(P<0.05),但在治疗后第6周,两者占比均回归接近基线水平(P>0.05)。结论阿奇霉素结合常规的牙周非手术治疗,能改善Ⅲ/Ⅳ期牙周炎患者的临床治疗效果,改变其唾液微生物菌群的组成,抑制牙周红、橙复合体中的密螺旋体、梭杆菌和卟啉单胞菌。

关键词: 阿奇霉素, 龈下刮治及根面平整, 牙周炎, 16S rRNA测序

Abstract: Objective To evaluate the clinical and microbiological effects of systemic azithromycin (AZI) as an adjunct to scaling and root planing (SRP) in the treatment of stage Ⅲ/Ⅳ periodontitis. Methods Forty patients were randomized into SRP group and AZI group. Clinical examinations and saliva collection were performed at baseline, 3 days and 6 weeks after SRP. Clinical examinations analyzed the treatment effects. Salivary microbiomes were analyzed through 16S rRNA sequencing, and the differences in richness, diversity, and relative abundance of each taxon were determined. Results All the clinical parameters were significantly improved after treatment in both groups compared to baseline(P<0.001). Greater clinical attachment loss(CAL)and bleeding on probing (BOP) improvements were found in the AZI group at 3 days and 6 weeks after treatment (P<0.05); improvement in probing depth (PD)was only found at the 6^th week(P<0.05). Results of site-level stratified statistics showed that periodontal indexes at the site level in the AZI group after treatment were better than those in the SRP group. All the alpha diversity indices were significantly reduced after treatment in the AZI group(P<0.05), while in SRP group, only Sobs index had a transient reduction 3 days after treatment. The proportion of Lactobacillus microbiota increased in both groups post-SRP, and was higher in the AZI group. Besides, the proportion of Treponema, and Fusobacterium decreased significantly in AZI group (P<0.05); at 3 days after treatment, the proportion of Porphyromonas decreased significantly (P<0.05), while the proportion of Prevotella increased significantly (P<0.05). However, at 6 weeks after treatment, the proportion of both regressed close to the baseline level (P>0.05). Conclusion AZI combined with non-surgical periodontal therapy, can improve clinical outcomes of severe periodontitis, change flora composition, and inhibit Treponema, Fusobacterium and Porphyromonas in periodontal red and orange pathogenic complexes.

Key words: azithromycin, scaling and root planing, periodontitis, 16S rRNA sequencing

中图分类号:

R781.4

杨若渠, 霍芃呈, 胡琮佼, 施明妍, 罗礼君. 阿奇霉素辅助Ⅲ/Ⅳ期牙周炎患者非手术治疗的临床疗效及其对唾液微生物群落的影响[J]. 口腔医学, 2022, 42(7): 609-616.

YANG Ruoqu, HUO Pengcheng, HU Congjiao, SHI Mingyan, LUO Lijun. Microbiological and clinical effects of adjunctive azithromycin on non-surgical periodontal therapy of patients with stage Ⅲ/Ⅳ periodontitis[J]. Stomatology, 2022, 42(7): 609-616.

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