Grbic J T, Lamster I B, Fine J B, Lam K S, Celenti R S, Herrera-Abreu M, Singer R E
Division of Periodontics, School of Dental and Oral Surgery, Columbia University, New York, NY 10032, USA.
J Periodontol. 1999 Oct;70(10):1221-7. doi: 10.1902/jop.1999.70.10.1221.
In previous studies, we demonstrated that increased levels of immunoglobulin A (IgA) in gingival crevicular fluid (GCF) may be "protective", while increased levels of the polymorphonuclear lysosomal enzyme, beta-glucuronidase, in GCF were associated with increased risk of disease activity. In this study, we examined the effect of scaling and root planing (SRP) on the levels of beta-glucuronidase, IgG, and IgA in GCF over a 24-week period and compared these to clinical attachment loss (CAL).
Twenty-nine patients with periodontal disease were examined for attachment level, probing depth, plaque, and bleeding on probing at 6 sites per tooth. GCF was collected from the mesial aspect of all teeth excluding third molars and analyzed for beta-glucuronidase, IgG, and IgA. After baseline data were collected, each patient received SRP, and GCF was collected again at 2, 4, 6, 8, 12, and 24 weeks post-SRP while clinical data were obtained at 4, 8, 12, and 24 weeks. In addition, we analyzed whether the magnitude of the IgA response to SRP would affect the rate of periodontal disease progression by examining GCF IgA levels at 2 time intervals: 2 to 4 weeks post-SRP and 6 to 12 weeks post-SRP.
Seventeen patients (58.6%) exhibited at least 1 site losing > or =2.5 mm of CAL during the 24-week study. Beta-glucuronidase in GCF was significantly decreased at 2 weeks following SRP and then demonstrated a gradual increase throughout the study period. Levels of IgA in GCF significantly increased following SRP, reaching a peak at 6 weeks and then gradually decreasing throughout the study. Furthermore, we found an inverse relationship between GCF IgA levels at 6 to 12 weeks post-SRP and the occurrence of CAL.
These results support the hypothesis that maintenance of high levels of IgA in GCF may be "protective" against periodontal attachment loss. Furthermore, levels of beta-glucuronidase appear to be a more sensitive indicator of gingival inflammation than clinical measures.
在之前的研究中，我们证明龈沟液（GCF）中免疫球蛋白A（IgA）水平升高可能具有“保护作用”，而GCF中多形核白细胞溶酶体酶β-葡萄糖醛酸酶水平升高与疾病活动风险增加相关。在本研究中，我们在24周的时间内检查了龈下刮治和根面平整（SRP）对GCF中β-葡萄糖醛酸酶、IgG和IgA水平的影响，并将这些结果与临床附着丧失（CAL）进行比较。
对29例牙周病患者的每颗牙齿的6个部位进行附着水平、探诊深度、菌斑和探诊出血情况检查。从除第三磨牙外的所有牙齿的近中面收集GCF，并分析其中的β-葡萄糖醛酸酶、IgG和IgA。在收集基线数据后，每位患者接受SRP治疗，并在SRP治疗后的第2、4、6、8、12和24周再次收集GCF，同时在第4、8、12和24周获取临床数据。此外，我们通过检查SRP治疗后2个时间间隔（2至4周和6至12周）的GCF IgA水平，分析了SRP后IgA反应的幅度是否会影响牙周病进展速度。
在24周的研究期间，17例患者（58.6%）至少有1个部位的CAL丧失≥2.5 mm。SRP治疗后2周，GCF中的β-葡萄糖醛酸酶显著降低，然后在整个研究期间逐渐升高。SRP治疗后，GCF中的IgA水平显著升高，在6周时达到峰值，然后在整个研究期间逐渐下降。此外，我们发现SRP治疗后6至12周的GCF IgA水平与CAL的发生呈负相关。
这些结果支持以下假设，即GCF中高水平IgA的维持可能对牙周附着丧失具有“保护作用”。此外，β-葡萄糖醛酸酶水平似乎比临床指标更能敏感地反映牙龈炎症。
