目的:分析甲酸的浓度,Ⅲ、Ⅳ期牙周炎患者龈沟液(GCF)中的丙酸和丁酸,以及它们与牙周炎的关系。
方法:该研究招募了37名健康的牙周炎患者和19名健康的对照者,北京大学口腔医院2008年2月至2011年5月。他们的GCF是从每个象限的一个磨牙或门牙的近颊侧位置收集的。牙周临床参数,包括菌斑指数(PLI),探测深度(PD),出血指数(BI),和附件丢失(AL)。甲酸的浓度,通过高效毛细管电泳(HPCE)分析了GCF上清液中的丙酸和丁酸。甲酸的预测能力,分析丙酸和丁酸与牙周炎的风险以及B级和C级牙周炎之间的差异。
结果:在这项研究中,选择Ⅲ期患者32例,Ⅳ期患者5例,其中B级患者9例,C级患者28例。牙周炎患者的临床牙周变量明显高于对照组(P<0.001)。牙周炎中甲酸明显低于对照组[5.37(3.39,8.49)mmol/Lvs.12.29(8.35,16.57)mmol/L,P<0.001]。丙酸和丁酸在牙周炎中明显高于对照组:10.23(4.28,14.90)mmol/Lvs.2.71(0.00,4.25)mmol/L,P<0.001;丁酸,2.63(0.47,3.81)mmol/Lvs.0.00(0.00,0.24)mmol/L,P<0.001。甲酸没有显著差异,丙酸和丁酸浓度在B级和C级牙周炎之间(P>0.05)。深口袋中的丙酸和丁酸明显高于浅口袋,甲酸浓度随PD的增加而降低。丙酸(OR=1.51,95CI:1.29-1.75)和丁酸(OR=3.72,95CI:1.93-7.17)是牙周炎的危险因素,而甲酸(OR=0.87,95CI:0.81-0.93)可能是牙周炎的保护因素。丙酸(AUC=0.852,95CI:0.805-0.900),丁酸(AUC=0.889,95CI:0.841-0.937),f(甲酸,AUC=0.844,95CI:0.793-0.895)证明了牙周炎风险的良好预测能力。
结论:牙周炎患者GCF中甲酸浓度降低,这是牙周炎的保护因素,其倒数具有良好的预测能力。然而,丙酸和丁酸增加,是牙周炎的危险因素,具有良好的预测能力。甲酸的浓度,丙酸,丁酸随探测深度而变化,但B级和C级牙周炎无明显差别。
OBJECTIVE: To analyze the concentration of formic acid, propionic acid and butyric acid in gingival crevicular fluid (GCF) of patients with stages Ⅲ and Ⅳ periodontitis, and their relationship with periodontitis.
METHODS: The study enrolled 37 systemically healthy patients with periodontitis and 19 healthy controls who visited Department of Periodontology, Peking University School and Hospital of Stomatology from February 2008 to May 2011. Their GCFs were collected from the mesial-buccal site of one molar or incisor in each quadrant. Periodontal clinical parameters, including plaque index(PLI), probing depth(PD), bleeding index(BI), and attachment loss(AL). Concentrations of formic acid, propionic acid and butyric acid in the supernatant of the GCFs were analyzed by high-performance capillary electrophoresis (HPCE). The prediction ability of formic acid, propionic acid and butyric acid with the risk of periodontitis and the differences between grade B and grade C periodontitis were analyzed.
RESULTS: In this study, 32 patients with stage Ⅲ and 5 patients with stage Ⅳ were enrolled, including 9 patients with grade B and 28 patients with grade C. Clinical periodontal variables in the patients with periodontitis were significantly higher than those in the control group (P<0.001). Formic acid was significantly lower in periodontitis than that in the control group [5.37 (3.39, 8.49) mmol/L vs. 12.29 (8.35, 16.57) mmol/L, P<0.001]. Propionic acid and butyric acid in periodontitis were significantly higher than those in the control group: Propionic acid, 10.23 (4.28, 14.90) mmol/L vs. 2.71 (0.00, 4.25) mmol/L, P < 0.001; butyric acid, 2.63 (0.47, 3.81) mmol/L vs. 0.00 (0.00, 0.24) mmol/L, P<0.001. There was no significant difference in formic acid, propionic acid and butyric acid concentrations between grade B and grade C periodontitis (P>0.05). Propionic acid and butyric acid in the deep pocket were significantly higher than in the shallow pocket, while the concentration of formic acid decreased with the increase of PD. Propionic acid (OR=1.51, 95%CI: 1.29-1.75) and butyric acid (OR=3.72, 95%CI: 1.93-7.17) were risk factors for periodontitis, while formic acid (OR=0.87, 95%CI: 0.81-0.93) might be a protective factor for periodontitis. Propionic acid (AUC=0.852, 95%CI: 0.805-0.900), butyric acid (AUC=0.889, 95%CI: 0.841-0.937), f (formic acid, AUC=0.844, 95%CI: 0.793-0.895) demonstrated a good predictive capacity for the risk of periodontitis.
CONCLUSIONS: The concentration of formic acid decrease in the GCF of periodontitis patients, which is a protective factor for periodontitis, its reciprocal have good predictive capacity. However, propionic acid and butyric acid increase, which are risk factors for periodontitis and have good predictive capacity. The concentration of formic acid, propionic acid, and butyric acid vary with probing depth, but there is no significant difference between grade B and grade C periodontitis.