种植体周围炎患者MMP-7、MUC-4的表达水平及其与牙周健康状况的相关性.pdf

Hainan Med J,Aug.2023,Vol.34,No.15海南医学2023年8月第34卷第15期种植体周围炎患者MMP-7、MUC-4的表达水平及其与牙周健康状况的相关性张琳，何祥一，李欣忆西安市红会医院口腔科，陕西西安710061【摘要】目的探讨种植体周围炎患者基质金属蛋白酶7(MMP-7)、黏蛋白4(MUC-4)的表达水平及其与牙周健康状况的相关性。方法选择2021年6月至2022年1月西安市红会医院接诊的45例种植体周围炎患者作为观察组，选择同期在本院行口腔检查健康的人群45例作为对照组。比较两组受检者的牙周状况和血清MMP-7、MUC-4水平；采用Pearson相关分析法分析血清MMP-7、MUC-4水平与牙周探诊深度(PD)、临床附着丧失(CAL)、牙龈指数(GI)、菌斑指数(PLI)的相关性。结果观察组患者血清MMP-7水平为(21.705.08)ng/mL，明显高于对照组的(16.183.15)ng/mL，MUC-4水平为(3.100.58)ng/mL，明显低于对照组的(6.021.04)ng/mL，PD、CAL、GI、PLI水平分别为(3.650.73)mm、(4.450.97)mm、(2.300.25)分、(2.370.63)分，明显高于对照组的(2.030.27)mm、(1.170.15)mm、(0.580.14)分、(0.500.12)分，差异均有统计学意义(P0.05)；经Pearson相关分析结果显示，血清MMP-7与PD、CAL、GI、PLI均呈正相关(r=0.565、0.730、0.306、0.788，P0.05)，MUC-4与PD、CAL、GI、PL均呈负相关(r=-0.537、-0.359、-0.921、-0.811，P0.05)。结论种植体周围炎患者的MMP-7、MUC-4表达水平与牙周健康状况密切相关，临床上联合检测这些指标可为临床的治疗方案提供参考。【关键词】种植体周围炎；基质金属蛋白酶7；黏蛋白4；牙周探诊深度；菌斑指数；相关性【中图分类号】R781.4【文献标识码】A【文章编号】10036350（2023）15219503Expression levels of matrix metalloproteinase 7 and mucin 4 in patients with periimplantitis and their correlationwith periodontal health conditions.ZHANG Lin,HE Xiang-yi,LI Xin-yi.Xian Honghui Hospital,Xian 710061,Shaanxi,CHINA【Abstract】ObjectiveTo investigate the expression levels of matrix metalloproteinase 7(MMP-7)and mucin4(MUC-4)in patients with periimplantitis and their correlation with periodontal health conditions.MethodsForty-fivepatients with periimplantitis admitted to Xian Honghui Hospital from June 2021 to January 2022 were selected as the ob-servation group,and 45 healthy individuals who underwent oral examinations in the hospital during the same period wereselected as the control group.The periodontal status and changes in serum MMP-7 and MUC-4 levels were compared be-tween the two groups.Pearson correlation analysis was used to analyze the correlation between serum MMP-7,MUC-4and periodontal condition periodontal probing depth(PD),clinical attachment loss(CAL),gingival index(GI),and plaqueindex(PLI).ResultsThe serum MMP-7 level of the observation group was(21.705.08)ng/mL,which was significant-ly higher than(16.183.15)ng/mL of the control group;MUC-4 level was(3.100.58)ng/mL,which was significantlylower than(6.021.04)ng/mL of the control group;PD,CAL,GI,PLI levels were(3.650.73)mm,(4.450.97)mm,(2.300.25)points,(2.370.63)points,which were significantly higher than(2.030.27)mm,(1.170.15)mm,(0.580.14)points,(0.500.12)points of the control group;the differences were statistically significant(P0.05).According toPearson correlation analysis,serum MMP-7 was positively correlated with PD,CAL,GI,and PLI(r=0.565,0.730,0.306,0.788,P0.05),while MUC-4 was negatively correlated with PD,CAL,GI,and PL(r=-0.537,-0.359,-0.921,-0.811,P0.05)，具有可比性，见表1。本研究经医院医学伦理委员会批准，两组受检者均知情并签署同意书。1.2观察指标与检测方法(1)血清 MMP-7、MUC-4水平：两组受检者分别抽取空腹 5 mL 静脉晨血，静置 20 min 后，离心半径 10 cm 的离心机在3 000 r/min转速的状态下离心20 min，提取待检血清，使用酶联免疫吸附法检测MMP-7 和 MUC-4 水平。(2)牙周健康状况：检查并记录两组受检者的牙周探诊深度(PD)、临床附着丧失(CAL)、牙龈指数(GI)、菌斑指数(PLI)。其中PD采用牙周探针对龈缘至龈沟底的距离进行测定。CAL为探诊深度减占釉牙骨质界至龈缘的距离。GI的评分标准：3分，牙龈存在溃疡、红肿和出血的症状，具有严重的炎症状态；2分，牙龈有中度的炎症，探诊会出血，牙龈色红，伴有光亮的水肿；1分，牙龈伴有轻度的炎症和水肿，牙龈的色泽有轻微改变；0分，牙龈健康。PLI的评分标准：3分，龈缘区域菌斑分布多且广；2分，龈缘区域存在中等体量的菌斑；1分，借用探针可刮出龈缘区域有轻微的菌斑；0分，健康无菌斑6。1.3统计学方法应用SPSS25.0统计软件进行数据分析。计量资料以均数标准差(x-s)表示，组间比较采用 t 检验，计数资料比较采用2检验，采用Pearson相关分析法分析血清MMP-7、MUC-4水平与PD、CAL、GI、PLI的相关性。以P0.05为差异具有统计学意义。2结果2.1两组受检者的血清MMP-7、MUC-4水平比较观察组患者的血清 MMP-7水平明显高于对照组，MUC-4水平明显低于对照组，差异均有统计学意义(P0.05)，见表2。2.2两组受检者的牙周状况比较观察组患者的PD、CAL水平明显高于对照组，GI、PLI评分明显高于对照组，差异均有统计学意义(P0.05)，见表3。2.3血清MMP-7、MUC-4水平与PD、CAL、GI、PLI 的相关性经 Pearson 相关分析结果显示，血清MMP-7 与 PD、CAL、GI、PLI均呈正相关(P0.05)，而MUC-4与PD、CAL、GI、PL均呈负相关(P0.05)，见表4。3讨论种植体即种植义齿，由两部分组成，一部分为种植体，是要植入颌骨里，相当于正常牙齿的牙根部分，另一部分为义齿，相当于假牙部分。主要影响种植体存活的疾病是种植体周围炎，包括口腔内部的黏膜炎、颌骨内部的种植体周围炎7-8。种植体周围炎的主要病因可能有细菌感染，这已经得到广泛认证。有炎症感染的细菌明显能够影响种植体的存活，种植体周围清洁不够或口腔里原本就有牙周炎，还有牙龈炎病史患者伴发种植体周围炎的可能性较大。种植体与颌骨的结合叫骨结合，骨结合之间无牙周膜，无本体感受器，如果咬合力过大能够感受到种植体与颌骨直接结合。在受到过大力的情表1两组受检者的一般资料比较x-s，例(%)Table 1Comparison of general information between the two groupsof subjects x-s,n(%)组别观察组对照组2/t值P值例数4545男性23(51.11)21(46.67)女性22(48.89)24(53.33)0.1780.673年龄(岁)45.492.8145.522.800.0510.960体质量(kg)61.054.3761.204.410.1620.872性别表2两组受检者的血清MMP-7、MUC-4水平比较(x-s，ng/mL)Table 2Comparison of serum MMP-7 and MUC-4 levels betweenthe two groups of subjects(x-s,ng/mL)组别观察组对照组t值P值例数4545MMP-721.705.0816.183.156.1950.001MUC-43.100.586.021.0416.4490.001表3两组受检者牙周状况比较(x-s)Table 3Comparison of periodontal status between the two groups ofsubjects(x-s)组别观察组对照组t 值P值例数4545PD(mm)3.650.732.030.2713.9620.001CAL(mm)4.450.971.170.1522.4170.001GI(分)2.300.250.580.1440.2680.001PLI(分)2.370.630.500.1219.5600.001表4血清MMP-7、MUC-4水平与PD、CAL、GI、PLI的相关性Table 4Correlation analysis of serum MMP-7 and MUC-4 levelswith PD,CAL,GI,and PLI指标MMP-7MUC-4r值0.565-0.537P值0.050.05r值0.730-0.359P值0.050.05r值0.306-0.921P值0.050.05r值0.788-0.811P值0.050.05PDCALGIPLI2196Hainan Med J,Aug.2023,Vol.34,No.15海南医学2023年8月第34卷第15期况下，易造成种植体、颌骨脱离，形成一个比较大的缝隙，叫种植体袋，细菌菌斑容易侵入，使种植体发生炎症，然后脱落。若有牙周炎的病史或者吸烟史的患者更容易诱使炎症加重，以上就是种植体周围炎发作的原因9-10。MMP-7属于基质金属蛋白酶家族，主要作用是通过降解、重塑细胞外基质的蛋白酶和细胞因子，达到保护中性粒细胞弹性蛋白酶的活性和增强胶原细胞的运动的目的11。MUC-4是由唾液腺分泌的蛋白之一，在机体免疫中具有重要作用，可与口腔中的细菌、病毒、真菌等结合，具有较强的亲和力，可以有效清除不利于口腔健康的微生物12。本研究结果显示，种植体周围炎患者的血清MMP-7水平，牙周健康指标PD、CAL、GI、PLI均明显高于对照组受检者，MUC-4水平明显低于对照组，差异均有统计学意义(P0.05)，且经Pearson相关分析结果显示，血清MMP-7与PD、CAL、GI、PLI均呈正相关，MUC-4与PD、CAL、GI、PL均呈负相关。由于种植体周围炎患者牙周骨质的破坏和吸收与炎症反应密切相关，牙周组织的被破坏后诱发炎症因子的合成与分泌，并释放大量炎症介质，促进基质金属蛋白酶的生成，导致MMP-7升高13-14。种植体周围炎症状态下，唾液、龈沟液中的溶解酶、纤维连接蛋白能改变口腔黏膜，利于病原菌的黏附及定植，导致 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