妊娠期牙周临床指标和龈沟液生物标记物与早产相关性的巢式病例对照研究

doi:10.7518/hxkq.2021.01.009

华西口腔医学杂志 ›› 2021, Vol. 39 ›› Issue (1): 58-63.doi: 10.7518/hxkq.2021.01.009

妊娠期牙周临床指标和龈沟液生物标记物与早产相关性的巢式病例对照研究

叶婵娟¹(), 吴敏¹(), 陈少武¹, 杨秀巧¹, 李蕙君¹, 朱素君², 周方明³, 郝颖³

^1.南方医科大学附属深圳妇幼保健院口腔病防治中心，深圳 518048
^2.南方医科大学附属深圳妇幼保健院妇产科，深圳 518048
^3.南方医科大学附属深圳妇幼保健院检验科，深圳 518048

收稿日期:2020-03-14 修回日期:2020-10-25 出版日期:2021-02-01 发布日期:2021-03-02
通讯作者: 吴敏 E-mail:415066325@qq.com;szwumin1998@126.com
作者简介:叶婵娟，住院医师，硕士，E-mail：415066325@qq.com
基金资助:
深圳市科技创新委员会基础研究项目(JCYJ20160427-191204874)

Association between periodontal indexes and biomarkers in gingival crevicular fluid and preterm birth in pregnancy: a nested case-control study

Ye Chanjuan¹(), Wu Min¹(), Chen Shaowu¹, Yang Xiuqiao¹, Li Huijun¹, Zhu Sujun², Zhou Fangming³, Hao Ying³

^1.Dept. of Stomatology, The Affiliated Shenzhen Maternity and Child Healthcare Hospital of the South Medical University, Shenzhen 518048, China
^2.Dept. of Obstetrics and Gynecology, The Affiliated Shenzhen Maternity and Child Healthcare Hospital of the South Medical University, Shenzhen 518048, China
^3.Clinical Laboratory, The Affiliated Shenzhen Maternity and Child Healthcare Hospital of the South Medical University, Shenzhen 518048, China

Received:2020-03-14 Revised:2020-10-25 Online:2021-02-01 Published:2021-03-02
Contact: Wu Min E-mail:415066325@qq.com;szwumin1998@126.com
Supported by:
Shenzhen Science and Technology Plan Projects(JCYJ20160427191204874)

摘要/Abstract

摘要： 目的

探讨妊娠妇女牙周临床指标和龈沟液（GCF）生物标记物水平与早产的相关性，评价何种指标作为预测早产的可能性。

方法

采用巢式病例对照研究，纳入300例无系统疾病的妊娠36周以内的妇女，并按纳入时孕周数分组，检查牙周临床指标：探诊深度（PD）、出血指数（BI）、牙龈指数（GI）；采用酶联免疫吸附测定法检测GCF生物标记物：前列腺素E2（PGE2）、白细胞介素（IL）-1β、IL-6、肿瘤坏死因子α（TNF-α）和8-羟基-2-脱氧鸟苷（8-OHdG），随访其妊娠结局。

结果

经1∶4配比，妊娠24~28周孕妇中，早产组的GI、BI以及8-OHdG显著高于巢式对照组（P<0.05）。经Logistic回归分析，BI和8-OHdG水平是早产的危险因素（OR=5.90，P=0.034；OR=1.18，P=0.045）；绘制接受者操作特性曲线（ROC），BI、8-OHdG水平单项预测时ROC曲线下面积分别为0.80、0.69，二者联合检测的ROC曲线下面积为0.82，二者联合检测ROC曲线下面积大于单一检测，但差异无统计学意义（P>0.05）。

结论

妊娠24~28周BI和8-OHdG水平升高是早产的危险因素，二者联合检测可能对早产的预测有一定的价值，但需要进一步扩大样本进行研究，从而建立牙周病患者早产预警体系。

关键词: 早产, 牙周指标, 龈沟液, 炎症介质, 预测

Abstract: Objective

This study aimed to investigate the association between periodontal indexes and biomarkers in gingival crevicular fluid (GCF) and preterm birth (PTB) in pregnancy, as well as to assess the clinical value of these indexes as predictors of PTB.

Methods

A nested case-control study was conducted. A total of 300 systematically healthy pregnant women were selected within 36 weeks of gestation and grouped according to the enrolled weeks. Periodontal indexes, including probing depth (PD), bleeding index (BI), gingival index (GI), and five biomarkers in GCF, including interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α), prostaglandin E2 (PGE2), and 8-hydroxy-2-deoxyguanosine (8-OHdG) were measured at the enrolled date. The detailed birth outcome was recorded.

Results

Only women at 24-28 weeks of gestation per PTB case (four full-term births) were selected as controls subjects, PTB displayed significantly greater GI, BI, and 8-OHdG (P<0.05). Logistic regression analysis revealed that BI and 8-OHdG were the dependent risk factors of PTB (OR=5.90, P=0.034; OR=1.18, P=0.045, respectively). The areas under the receiver operating characteristic curve (ROC) of BI and 8-OHdG were 0.80 and 0.69, and that of the combined detection was 0.82, which was larger than the individual detection, although the differences were not significant (P>0.05).

Conclusion

Increased BI and 8-OHdG at 24-28 weeks of gestation are risk factors for PTB. Their combined detection may have some value in the prediction of PTB, but further studies with a larger sample size are needed to explore it and thus provide experiment evidence for establishing an early warning system for PTB in pregnant women with periodontal disease.

Key words: preterm birth, periodontal index, gingival crevicular fliud, inflammatory mediators, prediction

中图分类号:

R 781.4

叶婵娟, 吴敏, 陈少武, 杨秀巧, 李蕙君, 朱素君, 周方明, 郝颖. 妊娠期牙周临床指标和龈沟液生物标记物与早产相关性的巢式病例对照研究[J]. 华西口腔医学杂志, 2021, 39(1): 58-63.

Ye Chanjuan, Wu Min, Chen Shaowu, Yang Xiuqiao, Li Huijun, Zhu Sujun, Zhou Fangming, Hao Ying. Association between periodontal indexes and biomarkers in gingival crevicular fluid and preterm birth in pregnancy: a nested case-control study[J]. West China Journal of Stomatology, 2021, 39(1): 58-63.

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参考文献 20

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因素	足月组（n=281）	早产组（n=19）	P值
年龄/岁	30.47±3.91	31.16±3.82	0.46
检测时孕周/周	18.97±7.05	19.16±7.24	0.91
分娩孕周/周	39.35±1.02	35.47±1.17	<0.01**
BMI/（kg·m^-2）	22.04±2.99	21.53±2.70	0.47
初产妇	198（70.5%）	14（73.7%）	0.80
职业（有）	239（85.1%）	8（42.1%）	<0.01**
学历（大专及以上）	231（82.2%）	16（84.2%）	0.54
民族（汉族）	260（92.5%）	19（100%）	0.51
医保	275（97.9%）	19（100%）	0.56
偶尔饮酒	15（5.3%）	1（5.3%）	1.00
刷牙次数≥2次·d^-1	246（87.5%）	16（84.2%）	0.13
刷牙时间>3 min	27（9.6%）	3（15.8%）	0.45
使用牙线	75（26.7%）	6（31.6%）	0.77
洁牙史	116（41.3%）	6（31.6%）	0.47
孕前牙周（牙龈出血）	140（49.8%）	8（42.1%）	0.36
孕期牙周（牙龈出血）	152（54.1%）	13（68.4%）	0.35

指标	巢式对照组（n=20）	早产组（n=5）	P值
PD/mm	2.69±0.60	2.22±0.66	0.14
PD≥4 mm位点/%	14.14±18.57	5.62±8.39	0.33
BI	2.01±0.76	1.70±0.73	0.42
GI	1.55±0.31	1.47±0.46	0.65
TNF-α/（pg·mL^-1）	10.35±2.47	12.49±2.86	0.11
IL-1β/（pg·mL^-1）	12.30±3.44	10.59±2.20	0.30
PGE2/（pg·mL^-1）	109.99±47.78	109.45±10.43	0.98
IL-6/（pg·mL^-1）	2.69±1.05	2.13±0.92	0.29
8-OHdG/（pg·mL^-1）	43.79±13.28	48.45±18.26	0.52

指标	巢式对照组（n=24）	早产组（n=6）	P值
PD/mm	2.41±0.66	2.36±0.66	0.89
PD≥4 mm位点/%	10.30±14.53	8.75±6.68	0.80
BI	1.95±0.92	1.75±0.50	0.61
GI	1.47±0.35	1.31±0.20	0.31
TNF-α/（pg·mL^-1）	10.76±2.81	9.84±1.48	0.45
IL-1β/（pg·mL^-1）	12.64±4.50	13.56±5.26	0.67
PGE2/（pg·mL^-1）	114.87±44.30	109.60±19.81	0.78
IL-6/（pg·mL^-1）	2.67±0.86	2.83±0.80	0.68
8-OHdG/（pg·mL^-1）	39.62±8.07	32.55±5.40	0.05

指标	巢式对照组（n=28）	早产组（n=7）	P值
PD/mm	2.51±0.56	2.78±0.38	0.23
PD≥4 mm位点/%	9.85±15.22	19.20±12.49	0.15
BI	1.66±0.64	2.35±0.69	0.02*
GI	1.41±0.30	1.68±0.19	0.04*
TNF-α/（pg·mL^-1）	10.61±2.34	11.28±1.91	0.49
IL-1β/（pg·mL^-1）	12.43±4.84	10.57±1.88	0.33
PGE2/（pg·mL^-1）	101.95±27.95	114.07±27.24	0.31
IL-6/（pg·mL^-1）	2.56±1.27	2.55±1.16	0.99
8-OHdG/（pg·mL^-1）	34.57±5.21	41.11±10.58	0.02*

指标	PD	BI	GI	TNF-α	IL-1β	PGE2	IL-6	8-OHdG
PD≥4 mm位点	0.86*	0.72*	0.67*	0.01	-0.002	-0.07	0.02	0.02
PD	—	0.67*	0.65*	-0.02	-0.01	-0.05	-0.04	0.004
BI		—	0.86*	0.05	0.07	-002	-0.03	0.06
GI			—	0.07	0.03	-0.03	0.002	0.10
TNF-α				—	0.20*	0.18*	0.15*	0.08
IL-1β					—	-0.03	-0.06	-0.08
PGE2						—	0.10	0.17*
IL-6							—	0.21*

妊娠期牙周临床指标和龈沟液生物标记物与早产相关性的巢式病例对照研究

Association between periodontal indexes and biomarkers in gingival crevicular fluid and preterm birth in pregnancy: a nested case-control study

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Metrics

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指标	ROC曲线下面积	敏感度/%	特异性/%	准确度/%	阳性预测值/%	阴性预测值/%
BI	0.80	85.7	71.4	77.1	46.7	95.2
8-OHdG	0.69	71.4	64.3	65.7	33.3	90.0
BI+8-OHdG	0.82	85.7	64.3	68.6	37.5	94.7

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