摘要
目的分析本院成人牙周炎患者龈沟液分离厌氧菌分布特点及口腔卫生护理效果。方法选取76例于本院就诊,由厌氧菌感染引发的牙周炎患者为本次研究对象。治疗前采集患者龈沟液,接种厌氧菌培养基中进行培养分离专性厌氧菌,采用API20a厌氧菌鉴定条鉴定菌种。琼脂稀释法检测临床常用8种抗菌药物对普雷沃菌属厌氧菌的最低抑菌浓度;采用酶联免疫吸附法检测龈沟液白细胞介素-10(IL-10)、白细胞介素-23(IL-23)水平。随机选取同期30例牙周健康者为健康对照组,将76例牙周炎患者可分为轻中度牙周炎组和重度牙周炎组。将76例牙周炎患者随机分为对照组和口腔卫生护理组,对照组患者进行牙周系统治疗,口腔卫生护理组同时进行口腔护理,对比两组患者治疗3、6个月后的探针出血百分率(BOPR)、菌斑指数(PLI)。结果共分离出76株厌氧菌,以中间普雷沃菌(30.26%)、变黑普雷沃菌(18.42%)、牙龈卟啉单胞菌(13.16%)为主。37株普雷沃菌属厌氧菌对阿莫西林、阿莫西林/克拉维酸、克林霉素的耐药率高于20%,对头孢曲松、头孢哌酮、甲硝唑的耐药率低于10%,对头孢吡肟、亚胺培南全部敏感。健康对照组、轻中度牙周炎组、重度牙周炎组龈沟液IL-10水平分别为(729.45±26.30)μg/L、(650.56±15.71)μg/L、(555.86±17.34)μg/L,IL-23水平分别为(6.25±0.27)μg/L、(8.05±0.33)μg/L、(12.35±0.23)μg/L,各组患者龈沟液IL-10、IL-23水平差异有统计学意义(P<0.05)。护理组与对照组患者治疗前BOPR分别为(60.44±3.81)%、(59.87±2.28)%,治疗前PLI分别为(2.87±0.84)分、(2.82±0.15)分,治疗前差异无统计学意义(P>0.05)。两组患者治疗3、6个月后BOPR、PLI差异均有统计学意义(均P<0.05)。结论由厌氧菌引发的成人牙周炎患者龈沟液分离厌氧菌主要为中间普雷沃菌,普雷沃菌属厌氧菌对多种抗菌药物的耐药率均较低。重度牙周炎患者龈沟液IL-10水平呈低表达,IL-23水平呈高表达,牙周炎患者基础治疗上进行口腔卫生护理可以有效提升治疗效果。
Objective The distribution characteristics of anaerobic bacteria isolated from gingival crevicular fluid of adult periodontitis patients in our hospital and the effectiveness of oral hygiene care were analyzed.Methods 76 patients with periodontitis caused by anaerobic bacterial infection who were treated at the Affiliated Stomatological Hospital of Anhui Medical University were selected as the subjects of this study.Before treatment,the patient's gingival crevicular fluid was collected and inoculated into anaerobic culture medium for cultivation and isolation of specific anaerobic bacteria.The strain was identified using API20a anaerobic bacteria identification strip.The agar dilution method was used to detect the minimum inhibitory concentration of 8 commonly used antibiotics against anaerobic bacteria of the Prevotella genus in clinical practice.The levels of interleukin-10(IL-10)and interleukin-23(IL-23)in the gingival crevicular fluid were detected by enzyme-linked immunosorbent assay.Randomly select 30 healthy individuals with periodontitis during the same period as the healthy control group.According to relevant standards,76 patients with periodontitis can be divided into mild to moderate periodontitis group and severe periodontitis group.76 patients with periodontitis were randomly divided into a control group and an oral hygiene care group.The control group received periodontal system treatment,while the oral hygiene care group also received oral care.The probe bleeding percentage(BOPR)and plaque index(PLI)of the two groups of patients were compared after 3 and 6 months of treatment.Results 76 strains of anaerobes were isolated,mainly Prevotella intermedia(30.26%),Prevotella nigricans(18.42%)and Porphyromonas gingivalis(13.16%).37 strains of Prevotella anaerobes were more than 20%resistant to amoxicillin,amoxicillin/clavulanic acid and clindamycin,less than 10%resistant to ceftriaxone,cefoperazone and metronidazole,and all were sensitive to cefepime and imipenem.The levels of IL-10 in gingival crevicular fluid of the healthy control group,mild to moderate periodontitis group,and severe periodontitis group were(729.4526.30)μg/L,(650.56±15.71)μg/L,(555.86±17.34)μg/L,The levels of IL-23 were(6.25±0.27)μg/L,(8.05±0.33)μg/L,(12.35±0.23)μg/L.The levels of IL-10 and IL-23 in the gingival crevicular fluid of patients in each group showed statistically significant differences(P<0.05).The pretreatment BOPR of patients in the nursing group and the control group were(60.44±3.81)%and(59.87±2.28)%,respectively,and the pretreatment PLI was(2.87±0.84)points and(2.82±0.15)points,respectively.There was no statistically significant difference before treatment(P>0.05).There was a statistically significant difference in BOPR and PLI between the two groups of patients after 3 and 6 months of treatment(P<0.05).Conclusion The anaerobic bacteria isolated from the gingival crevicular fluid of adult periodontitis patients caused by anaerobic bacteria were mainly intermediate Prevotella,and the resistance rate of Prevotella anaerobic bacteria to various antibiotics was relatively low.Patients with severe periodontitis have low levels of IL-10 expression and high levels of IL-23 expression in the gingival crevicular fluid.Oral hygiene care in addition to basic treatment for periodontitis patients can effectively improve their treatment effectiveness.
作者
王云
陈叶俊
刘佳佳
张鸢
孙慧
WANG Yun;CHEN Ye-jun;LIU Jiajia;ZHANG Yuan;SUN Hui(Affiliated Stoma to logical Hospital Of An hui Medical University,Hefei 230032,China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2023年第7期844-847,共4页
Journal of Pathogen Biology
基金
安徽医科大学校科研基金立项资助项目(No.2020xkj149)。
关键词
牙周炎
龈沟液
厌氧菌
耐药性
口腔卫生护理
periodontitis
gingival crevicular fluid
anaerobic bacteria
drug resistance
oral health care
