[Influences of leukocytes in patients with type 2 diabetes and periodontitis to the effects of periodontal treatment on glycemic control].

抄録

To analyze the influences of leukocytes on improving blood glucose control in patients with type 2 diabetes mellitus (T2DM) and periodontitis after periodontal mechanical therapy. Thirty-five patients visiting Peking University Third Hospital from March 2011 to August 2012, as well as thirty-four patients visiting Peking University Hospital of Stomatology from March 2011 to August 2012 and December 2016 to December 2018 were selected in this research. These subjects were non-smokers, and with moderate to severe chronic periodontitis and T2DM. The full set of periodontal examinations including probing depth (PD), attachment loss (AL), bleeding index (BI) and plaque index (PLI) were conducted. Besides, counts of white blood cells (WBC), parameters of glucose and lipids metabolites such as fasting blood glucose (FBG), glycosylated hemoglobin (HbA), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) in serum were examined before treatment. Then, oral hygiene instruction, scaling and root planing (SRP) were carried out. Three months after SRP, the baseline examinations were repeated in all patients. According to the baseline leukocyte counts, the patients were divided into subgroups: low WBC group (WBC<6.19×10/L) and high WBC group (WBC≥6.19×10/L). Paired -test for comparison of changes after treatment, analysis of co-variance for comparing the intervention effects between subgroups, and multifactor Iogistic regression analysis were performed. Three months after SRP, all periodontal indexes were significantly improved in both groups. Leukocyte counts decreased significantly in high WBC group (7.64±1.51 . 6.89±1.53, 0.008). In high WBC group, HbA (7.67±1.35 . 7.18±1.09, 0.001) and LDL (3.28±0.76 . 2.67±0.85, 0.042) decreased significantly, while there were no such differences in low WBC group. Influence of leukocyte level on HbA (0.12, 0.038) and LDL (0.15, 0.001) improvement was statistically significant. Hierarchical analysis showed such improvement notably perform in female [HbA (0.30, 0.021), LDL (0.34, 0.001)] and severe periodontitis group [HbA (0.15, 0.025), LDL (0.24, 0.017)]. Through interaction test, female and leukocyte counts at baseline had relative excess risk affecting the effect of periodontal intervention on HbA (0.036) and LDL (0.005). SRP could significantly improve the blood glucose and lipid control in patients who had T2DM and chronic periodontitis with relative higher leukocytes level. Female patients with severe periodontitis showed more obviously effects.

分析伴2型糖尿病（type 2 diabetes，T2DM）牙周炎患者基线时白细胞水平对牙周治疗后糖脂代谢指标的影响。 于2011年3月至2012年8月北京大学第三医院口腔科，2011年3月至2012年8月、2016年12月至2018年12月北京大学口腔医学院·口腔医院牙周科的就诊患者中选取69例不吸烟、伴T2DM的中重度慢性牙周炎患者。治疗前对其全口探诊深度、附着丧失、出血指数、菌斑指数等指标进行检查，同时检测血液指标包括白细胞水平、空腹血糖、糖化血红蛋白（glycosylated hemoglobin，HbA）、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白（low density lipoprotein，LDL）。随后进行全口洁治、刮治和根面平整（scaling and root planing，SRP），治疗后3个月重复基线检查。以基线时白细胞水平中位数（6.19×10/L）为界限，将白细胞计数低于中位数的患者作为白细胞低组（33例），其余患者作为白细胞高组（36例）。对治疗后糖脂代谢指标变化进行Logistic回归分析，并对性别进行交互作用检验。 SRP治疗后3个月，两组患者各项牙周指标与基线相比均显著改善。与基线相比，白细胞高组白细胞计数显著下降（7.64±1.51对比6.89±1.53，=0.008），HbA（7.67±1.35对比7.18±1.09，=0.001）和LDL（3.28±0.76对比2.67±0.85，=0.042）也均显著下降。回归分析结果显示，基线白细胞水平与HbA（=0.12，=0.038）和LDL（=0.15，=0.001）下降程度呈正相关；进一步分层分析显示，这一相关性在女性［HbA（=0.30，=0.021）、LDL（=0.34，=0.001）］和重度牙周炎患者［HbA（=0.15，=0.025）、LDL（=0.24，=0.017）］中表现显著。交互作用检验显示，女性与基线白细胞水平共同影响HbA（=0.036）和LDL（=0.005）下降水平，其交互作用具有相对超额风险。 白细胞水平较高的伴T2DM牙周炎患者SRP后3个月可显著改善糖脂代谢水平，在女性重度牙周炎人群中更明显。.