[Study on the dynamic changes of oral microbiota in type 2 diabetes patients with periodontitis after initial periodontal therapy].

抄録

To clarify the effect of initial periodontal therapy on the dynamic changes of oral (saliva, dorsal tongue and subgingival plaque) microbiota in periodontitis patients with or without type 2 diabetes mellitus (T2DM). A total of 14 patients with chronic periodontitis (CP group) and 14 CP patients with T2DM (CP-T2DM group) were included from Department of Periodontology, School and Hospital of Stomatology,Cheeloo College of Medicine, Shandong University. The microbial samples were collected from saliva, dorsal tongue and subgingival plaque of first molars at baseline, 1.5 and 3 months after initial periodontal therapy, and were detected by 16S rRNA (V3-V4 region) gene sequencing. The sequencing data were analyzed to obtain microbial distribution and community structure information. The same professional periodontist evaluated the periodontal status of patients according to periodontitis detection indices before and after initial periodontal therapy. Meanwhile, patients' blood samples were collected and related metabolic indices were evaluated. After initial periodontal therapy, the glycosylated hemoglobin levels [(7.46±1.69)%] in CP-T2DM group were significantly improved than that at baseline [(7.65±1.34)%] (0.52,=0.610). The probing depth of the sampling sites [CP group: (2.94±0.46) mm, CP-T2DM group: (2.95±0.35) mm] and bleeding index (CP group: 1.91±0.42, CP-T2DM group: 1.67±0.49) at 3 months after treatment were significantly decreased than the probing depth [CP group: (3.99±0.77) mm, CP-T2DM group: (3.80±0.76) mm] (25.61, 0.001; 17.63, 0.001) and bleeding index (CP group: 3.03±0.52, CP-T2DM group: 2.54±0.65) (28.43, 0.001; 20.21, 0.001) at baseline. The flora analysis showed that the α and β diversity indices of the same sites in the CP and CP-T2DM groups did not change significantly before and after the initial therapy, but the bacterial abundance at each site changed. There were commonalities and differences in the microbial composition of each site in the CP and CP-T2DM groups. Among them, the relative abundance of in saliva and dorsal tongue samples of the two groups after treatment was basically consistent with the change trend in the subgingival plaque microbes. In the subgingival plaque of the CP group, the relative abundance of showed a gradual increase with the prolongation of initial periodontal therapy; while in the CP-T2DM group, it showed a trend of first increase and then decrease. , and TG5 in CP and CP-T2DM groups were all significantly dominant bacteria in subgingival plaque at baseline (0.05). Moreover, in the CP-T2DM group also showed a significant advantage. At 1.5 months after treatment, , etc. were dominant in subgingival plaque (0.05). , and showed significant differences at 3 months (0.05). Plaques in saliva and tongue dorsal could reflect the effects of initial periodontal therapy on the dynamic changes of microorganisms to a certain extent. CP and CP-T2DM patients had differences in microbial composition and responses to initial periodontal therapy.

阐明牙周基础治疗对伴或不伴2型糖尿病（type 2 diabetes mellitus，T2DM）的牙周炎患者口腔微生态菌群动态变化的影响。 收集来自山东大学齐鲁医学院口腔医学院·口腔医院牙周科的14例单纯慢性牙周炎（chronic periodontitis，CP组）患者和14例伴T2DM的CP（CP-T2DM组）患者，采集所有患者基线、牙周基础治疗后1.5和3个月的唾液、舌背及4个象限第一磨牙近中颊侧的龈下菌斑样本，利用16S rRNA（V3-V4区）基因测序方法检测样本内微生物。对测序数据进行分析获得两组患者的微生物分布和群落结构信息。牙周基础治疗前后均由同一名牙周主治医师根据牙周检测指标对患者牙周状况进行评估，同时收集患者血液，并对其相关代谢指标进行评估。 牙周基础治疗后3个月CP-T2DM组糖化血红蛋白［（7.46±1.69）%］与基线［（7.65±1.34）%］相比差异无统计学意义（=0.52，=0.610），治疗后3个月CP组及CP-T2DM组探诊深度［CP组：（2.94±0.46）mm，CP-T2DM组：（2.95±0.35）mm］及出血指数（CP组：1.91±0.42，CP-T2DM组：1.67±0.49）均较基线时的探诊深度［CP组：（3.99±0.77）mm，CP-T2DM组：（3.80±0.76）mm］（=25.61，<0.001；=17.63，<0.001）和出血指数（CP组：3.03±0.52，CP-T2DM组：2.54±0.65）（=28.43，<0.001；=20.21，<0.001）显著下降。菌群分析显示，基础治疗前后CP及CP-T2DM组内相同位点α及β多样性指数变化差异均无统计学意义（>0.05）。治疗前后CP及CP-T2DM组各位点微生物组成相似，但各位点菌群丰度发生改变，治疗后CP及CP-T2DM组唾液和舌背样本中变形菌门相对丰度与各自组内龈下菌斑变化趋势基本一致，在CP组龈下菌斑中变形菌门相对丰度随牙周基础治疗时间延长呈逐渐上升趋势，在CP-T2DM组龈下菌斑中，变形菌门相对丰度随牙周基础治疗时间的延长呈先上升后下降的趋势。CP及CP-T2DM组基线龈下菌斑中互养菌门、脱硫代硫酸盐弧菌科、甲烷短杆菌属、TG5菌属较基础治疗后3个月均呈现为特征优势菌（<0.05），此外螺旋体在CP-T2DM组基线呈现显著优势，CP-T2DM组治疗后1.5个月根瘤菌目、产碱杆菌科、丛毛单胞菌科、代尔夫特菌属、布劳特氏菌属等在龈下菌斑中呈现显著差异优势（<0.05），治疗后3个月时厚壁菌门、梭菌纲/目、肠球菌科、瘤胃球菌科等呈现显著差异优势（<0.05）。 除龈下菌斑外，唾液和舌背菌斑可在一定程度上反映牙周基础治疗对口腔菌群微生物动态变化的影响；CP及CP-T2DM组患者在微生物组成及对治疗的反应上均存在差异。.