龈沟天冬氨酸转氨酶水平与牙周病进展的关系。

Relationship between crevicular aspartate aminotransferase levels and periodontal disease progression.

作者信息

Oringer R J, Howell T H, Nevins M L, Reasner D S, Davis G H, Sekler J, Fiorellini J P

机构信息

Department of Periodontics, State University of New York at Stony Brook, 11794-8703, USA.

出版信息

J Periodontol. 2001 Jan;72(1):17-24. doi: 10.1902/jop.2001.72.1.17.

DOI:10.1902/jop.2001.72.1.17

PMID:11210069

Abstract

BACKGROUND

Aspartate aminotransferase (AST), an enzyme released from necrotic cells, has been identified in gingival crevicular fluid (GCF), and elevated levels are associated with periodontal tissue destruction. The aim of this study was to examine the relationship between elevated GCF levels of AST and periodontal disease progression.

METHODS

Over a 12-month period, 8 to 10 interproximal sites in 41 periodontitis subjects (PS) and 15 healthy subjects (HS) were monitored. Clinical measurements included relative attachment level (RAL), probing depth, and bleeding on probing (BOP). Semiquantitative levels of GCF AST (< 800 microIU, > or = 800 microIU, and > or = 1,200 microIU) were determined using a chairside assay. At the 6- and 12-month visits, scaling and root planing and prophylaxis were performed in the PS and HS, respectively. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated for 2 diagnostic criteria (AST > or = 800 microIU, AST > or = 1,200 microIU) utilizing 4 thresholds of disease progression as determined by 2 methods (absolute change in relative attachment level and cumulative sum [CUSUM]).

RESULTS

The percentage of sites exhibiting AST > or = 800 microIU, AST > or = 1,200 microIU, and BOP in the PS was significantly (P<0.02) lower at 6 and 12 months compared to baseline. The use of crevicular AST activity to monitor periodontal disease progression was associated with many false-positive results. Overall, low specificities, PPV, and odds ratios were demonstrated by the assay when using 2 diagnostic criteria and 4 thresholds of disease progression. The high NPV suggest that a negative AST test result was indicative of a periodontally stable site.

CONCLUSIONS

These results demonstrate that elevated levels of AST were present at sites that did not subsequently exhibit disease progression. The high prevalence of AST-positive sites due to gingival inflammation diminished the test's ability to discriminate between progressive and stable, but inflamed, sites.

摘要

背景

天冬氨酸转氨酶（AST）是一种从坏死细胞中释放出来的酶，已在龈沟液（GCF）中被检测到，其水平升高与牙周组织破坏有关。本研究的目的是探讨龈沟液中AST水平升高与牙周疾病进展之间的关系。

方法

在12个月的时间里，对41名牙周炎患者（PS）和15名健康受试者（HS）的8至10个邻面部位进行了监测。临床测量包括相对附着水平（RAL）、探诊深度和探诊出血（BOP）。使用椅旁检测法测定龈沟液AST的半定量水平（<800微国际单位、≥800微国际单位和≥1200微国际单位）。在第6个月和第12个月的随访中，分别对牙周炎患者和健康受试者进行了龈下刮治和根面平整以及预防性治疗。利用两种方法（相对附着水平的绝对变化和累积和[CUSUM]）确定的4个疾病进展阈值，计算了两种诊断标准（AST≥800微国际单位，AST≥1200微国际单位）的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。

结果

与基线相比，牙周炎患者在第6个月和第12个月时，AST≥800微国际单位、AST≥1200微国际单位和探诊出血部位的百分比显著降低（P<0.02）。利用龈沟AST活性监测牙周疾病进展会出现许多假阳性结果。总体而言，在使用两种诊断标准和4个疾病进展阈值时，该检测方法的特异性、PPV和优势比均较低。高NPV表明AST检测结果为阴性表明该部位牙周状况稳定。