Levine M, LaPolla S, Owen W L, Socransky S S
Department. Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
J Clin Periodontol. 2002 Oct;29(10):935-43. doi: 10.1034/j.1600-051x.2002.291009.x.
About 10-15% of US adults are 'refractory' to therapy for chronic periodontitis. Recently, studies suggest that these patients have elevated lysine decarboxylase activity in the sulcular microbiota. The aim of this study was to determine whether an elevated IgG antibody response to lysine decarboxylase, alone or with antibody to other bacterial antigens and baseline clinical measurements, would predict 'refractory' patients with high accuracy.
Chronic periodontitis patients were treated using scaling and root planing (SRP) followed by maintenance SRP and 3-monthly re-examinations. If there was a loss of mean full mouth attachment or more than three sites appeared with > 2.5 mm new loss within a year, the subjects were re-treated (modified Widman flap surgery and systemically administered tetracycline). If attachment loss as above recurred, the subjects were 'refractory'. Baseline clinical measurements and specific antibody responses were used in a logistic regression model to predict 'refractory' subjects.
Antibody to a peptide portion of lysine decarboxylase (HKL-Ab) and baseline bleeding on probing (BOP) prevalence measurements predicted attachment loss 3 months after initial therapy [pIAL = loss (0) or gain (1)]. IgG antibody contents to a purified antigen from Actinomyces spp. (A-Ab) and streptococcal d-alanyl glycerol lipoteichoic acid (S-Ab) were related in 'refractory' patients (R2 = 0.37, p < 0.01). From the regression equation, the relationship between the antibodies was defined as linear (pLA/S-Ab = 0) or non-linear pLA/S-Ab = 1). Using pLA/S-Ab, pIAL and age, a logistic regression equation was derived from 48 of the patients. Of 59 subjects, 37 had 2-4 mm attachment loss and were assigned as 'refractory' or successfully treated with 86% accuracy.
HKL-Ab facilitated an accurate prediction of therapeutic outcome in subjects with moderate periodontitis.
约10% - 15%的美国成年人对慢性牙周炎治疗呈“难治性”。最近，研究表明这些患者龈沟微生物群中的赖氨酸脱羧酶活性升高。本研究的目的是确定单独针对赖氨酸脱羧酶的IgG抗体反应升高，或与针对其他细菌抗原的抗体及基线临床测量值相结合，是否能高精度地预测“难治性”患者。
慢性牙周炎患者接受龈上洁治和根面平整（SRP）治疗，随后进行维持性SRP治疗并每3个月复查一次。如果一年内平均全口附着丧失，或出现超过三个部位有> 2.5 mm的新附着丧失，则对受试者进行再次治疗（改良Widman翻瓣术并全身应用四环素）。如果再次出现上述附着丧失，则该受试者为“难治性”。将基线临床测量值和特异性抗体反应用于逻辑回归模型，以预测“难治性”受试者。
针对赖氨酸脱羧酶肽段的抗体（HKL - Ab）和基线探诊出血（BOP）患病率测量值可预测初始治疗3个月后的附着丧失情况[pIAL = 附着丧失（0）或增加（1）]。在“难治性”患者中，针对放线菌属纯化抗原的IgG抗体含量（A - Ab）与链球菌D - 丙氨酰甘油脂磷壁酸的IgG抗体含量（S - Ab）相关（R2 = 0.37，p < 0.01）。根据回归方程，抗体之间的关系定义为线性（pLA/S - Ab = 0）或非线性（pLA/S - Ab = 1）。利用pLA/S - Ab、pIAL和年龄，从48例患者中得出一个逻辑回归方程。在59名受试者中，37名有2 - 4 mm的附着丧失，被判定为“难治性”或成功治疗，准确率为86%。
HKL - Ab有助于准确预测中度牙周炎患者的治疗结果。
