慢性歯周炎を有する喫煙者と非喫煙者における乳頭歯肉血管の評価。臨床的研究

Evaluation of the Papillary Gingival Vasculature in Smokers and Nonsmokers with Chronic Periodontitis: A Clinical Study.

抄録

研究目的:

喫煙は歯周病の重要なリスクファクターとして認識されている。この背景には，ニコチンが微小循環を変化させ，歯周組織の血管収縮と血流低下を引き起こすというメカニズムが示唆されている．しかし，喫煙に伴う微小血管の変化や，歯肉組織の各部位における毛細血管の分布に関する情報はほとんど得られていない．本研究の目的は，ヒトの歯間部歯肉生検において，歯周病に罹患した喫煙者と非喫煙者の歯肉毛細血管の数と直径を CD34 免疫組織化学染色法を用いて評価することである．また、歯肉組織の異なる部位における血管の分布パターンを評価した。

AIM: Cigarette smoking has been recognized as an important risk factor in periodontal diseases. One of the suggested mechanisms behind this association is that nicotine alters the microcirculation and causes vasoconstriction and reduced blood flow through the periodontal tissues. Scarce information is currently available relative to the microvascular alterations associated with smoking and the distribution of capillaries through the various areas of the gingival tissues. The aims of this study were to assess, in human interproximal gingival biopsies, the number and diameter of gingival capillaries in periodontally affected smokers and nonsmokers using the CD34 immunohistochemical staining method. The pattern of distribution of vessels in the different areas of the gingival tissues was also assessed.

材料と方法:

レバノン大学ベイルート歯学部歯周病科に通う30歳から60歳の中等度の慢性歯周炎を有する全身的に健康な患者を本研究のために募集した。患者は、喫煙者（過去10年間、タバコ10本/日以上）の患者10人のグループ（グループSP）と、非喫煙の歯周病患児からなる第2グループ（グループNP）に選別された。最初の調製から3～4週間後に、各患者から1回ずつ近位歯肉生検を行った。CD34マウスモノクローナル抗体による免疫組織化学的染色により、各試料内の血管内皮細胞を同定した。12個の生検サンプル（NP群5個、SP群7個）を選び、盲検下で生検の結合組織の3つの領域における血管の数と直径を測定した。

MATERIALS AND METHODS: Systemically healthy patients with moderate chronic periodontitis and ranging in age between 30 and 60 years were recruited for the study from the patient population attending the Periodontology Department of the Faculty of Dental Medicine at the Lebanese University of Beirut. The patients were selected to have a group of 10 patients (Group SP) of smokers (>10 cigarettes/day for the last 10 years) and a second group (Group NP) consisting of nonsmoking periodontally affected patients. Three to four weeks following initial preparation, one interproximal gingival biopsy was obtained from each patient. Immunohistochemical staining with CD34 mouse monoclonal antibody was used to identify the endothelial cells of the blood vessels within each sample. Twelve biopsy samples (five in Group NP and seven in Group SP) were chosen for the measurement of the number and diameter of vessels in three regions of the connective tissue of the biopsy under a blinded protocol.

結果:

両群とも、小、中、大血管の量的分布は類似の傾向を示し、小血管の数は中、大血管より有意に多かった。小血管は末梢部に多く、大血管は結合組織深部に多く見られた。血管の総数は、両群とも生検領域全体および結合組織領域において、慢性喫煙の影響を受けていないようであった。歯肉毛細血管の総数の定量的変化は慢性喫煙者では観察されなかった．歯周病患者の喫煙により，歯肉乳頭の表層および深層の結合組織領域における大小血管の再分布が認められた．

RESULTS: In the two groups, the quantitative distribution of small, medium, and large vessels followed a similar trend with the number of small vessels being significantly greater than both medium and large vessels. Small vessels prevailed in the peripheral regions, whereas large vessels were more abundant in the deeper connective tissue areas. The total number of vessels seemed unaffected by chronic cigarette smoking in both groups in the entire biopsy area and in the separate connective tissue regions. Quantitative alteration in the total number of gingival capillaries was not observed in chronic smokers. A redistribution of small and large vessels in the superficial and deeper connective tissue areas of the gingival papilla was noted as a result of smoking in periodontal patients.

結論:

小・中・大血管の量的分布は類似の傾向を示し，小血管の含有量は中・大血管よりも有意に重要であった．喫煙と歯周炎は，非喫煙の歯周病患者に比べ，歯肉乳頭の表層と深層の結合組織領域で小血管と大血管の再分布をもたらす．このような歯肉組織内の血管の再配列の意義と臨床的意義は，今後さらに検討される必要がある．

CONCLUSION: The quantitative distribution of small, medium, and large vessels follows a similar trend with the content in small vessels being significantly more important than both medium and large vessels. Smoking and periodontitis result in a redistribution of small and large vessels in the superficial and deeper connective tissue areas of the gingival papilla compared to nonsmoking periodontal patients. The significance and clinical implications of such rearrangement of vasculature within the gingival tissue need to be further investigated.