膵臓・腎臓同時移植後の1型糖尿病患者は、インスリン投与後の腎臓移植患者に比べ、歯周病の炎症が軽微であった

Type 1 Diabetic Patients After Simultaneous Pancreas and Kidney Transplantation Have Less Intense Periodontal Inflammation Compared to Kidney Recipients Treated with Insulin.

抄録

背景 長期にわたる糖尿病は歯周組織の病理学的変化を引き起こしやすい．膵臓移植を受けた患者では，この点の改善が期待される．本研究の目的は、1型糖尿病患者の腎移植（KTx）後および膵腎同時移植（SPK）後の歯周病変の強さと歯肉溝液（GCF）中の炎症マーカー濃度を評価し比較することにある。本研究では，SPK 後の T1D 患者 20 例と KTx 後の 16 例，および非糖尿病腎移植者（対照）15 例を対象とした．歯周病の臨床パラメータとGCFにおける炎症の生化学マーカーの濃度を評価した。統計学的データ解析には以下の検定が用いられた．Shapiro-Wilk test, t test, Mann-Whitney U test, Tukey's post hoc testを伴うone-way ANOVA, and χ² test (also with Yate's correction)．さらに、線形回帰とPearsonまたはSpearmanの相関係数を用いた。結果 SPK群とコントロール群ではmodified Sulcus Bleeding Index（mSBI）とGCF量に差がなかったが、KTx群ではSPK群とコントロール群に比べこれらのパラメーターの値が高かった。最大臨床付着量損失とポケット深さおよびPeriotest値は、糖尿病レシピエントがコントロールと比較して高く、SPKとKTxの間で差はなかった。KTx群におけるGCF中のIL-1ß、MMP-8、レジスチン、TNFα、YKL40の濃度はSPK群およびコントロール群に比べ高値であった。T1D患者の複合群では、血中HbA1cとmSBI、GCF量とレジスチン、TNF-α、YKL40濃度、レジスチン濃度とmSBIの間に相関があった。結論 T1D患者は、インスリン治療を受けた腎臓提供者と比較して、GCFの炎症マーカーレベルが低く、歯周炎の強度が低下していることが示された。KTxまたはSPK後のT1D患者の歯周組織の形態学的変化の重症度は、非糖尿病腎臓レシピエントに比べて高い。

BACKGROUND Long-term diabetes predisposes to pathological changes in periodontal tissues. Improvement in this respect can be expected in patients after pancreas transplantation. The aim of this study was to assess and compare the intensity of periodontium pathological lesions and inflammation markers concentration in gingival crevicular fluid (GCF) in patients with type 1 diabetes (T1D) after kidney (KTx) or simultaneous pancreas and kidney transplantation (SPK). MATERIAL AND METHODS The study included 20 T1D patients after SPK and 16 after KTx, and 15 non-diabetic kidney recipients (control). Periodontal clinical parameters and concentration of selected biochemical markers of inflammation in GCF were assessed. The following tests were used in statistical data analysis: Shapiro-Wilk test, the t test, the Mann-Whitney U tests, one-way ANOVA with Tukey's post hoc test, and χ² test (also with Yate's correction). Moreover, linear regression and Pearson or Spearman correlation coefficient was used. RESULTS There were no differences in modified Sulcus Bleeding Index (mSBI) and GCF volume between the SPK group and control group, whereas values of these parameters in the KTx group were higher than in the SPK and control groups. Maximal clinical attachment loss and pocket depth and Periotest values were higher in diabetic recipients compared to controls, and did not differ between SPK and KTx. The concentration of IL-1ß, MMP-8, resistin, TNFalpha, and YKL40 in the GCF in the KTx group was higher than in the SPK and control groups. In the combined group of T1D patients, there was a correlation between blood HbA1c and mSBI, GCF volume, and resistin, TNF-alpha and YKL40 concentrations, and between resistin concentration and mSBI. CONCLUSIONS T1D patients after SPK show lower levels of inflammatory markers in GCF and present reduced intensity of periodontitis compared to kidney recipients treated with insulin. The severity of morphological changes in periodontium in T1D patients after KTx or SPK is higher than in non-diabetic kidney recipients.