Alpagot T, Suzara V, Bhattacharyya M
Department of Periodontics, University of the Pacific Aurthur A Dugoni School of Dentistry, San Francisco, CA 94115, USA.
J Periodontal Res. 2006 Dec;41(6):491-7. doi: 10.1111/j.1600-0765.2006.00887.x.
The study aimed to determine whether matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in gingival crevice fluid could serve as prognostic factors for the progression of periodontitis in human immunodeficiency virus (HIV) -positive patients. Activated inflammatory cells produce inflammatory mediators, which stimulate the production of MMPs and their inhibitors. It is likely that the compromised immune system contributes to the pathogenesis of periodontitis in HIV-positive patients.
Clinical measurements including gingival index, plaque index, bleeding index, probing depth, attachment loss, and gingival crevice fluid samples were taken from two healthy sites (including sites with gingival recession, gingival index = 0; probing depth < or = 3 mm; attachment loss < or = 2 mm), three gingivitis sites (gingival index > 0; probing depth < or = 3 mm; attachment loss = 0) and three periodontitis sites (gingival index > 0; probing depth > or = 5 mm; attachment loss > or = 3 mm) of each of the 35 patients at baseline visits and 6-month visits by means of paper strips. Gingival crevice fluid levels of MMP-9 and TIMP-1 were determined by sandwich enzyme-linked immunosorbent assays.
The mean amounts of MMP-9 and TIMP-1 in the gingivitis and periodontitis sites sites were significantly higher than in the healthy sites (P < 0.0001). The progressing site was defined as a site that had 2 mm or more attachment loss during the 6-month study period. Gingival crevice fluid levels of MMP-9 were significantly correlated with probing depth, attachment loss, TIMP-1, age, smoking pack years, and viral load values at baseline and 6-month visits (0.0001 < P < 0.001). TIMP-1 levels were only correlated with CD4, viral load, attachment loss, and MMP-9 (0.001 < P < 0.01). Repeated measures analysis of 11 active sites vs. 269 inactive sites indicated that MMP-9 and TIMP-1 levels were significantly higher in active sites than in inactive sites (P < 0.0001). These data indicate that sites with high ginigval crevice fluid levels of MMP-9 and TIMP-1 in HIV-positive patients are at significantly greater risk for progression of periodontitis.
本研究旨在确定龈沟液中的基质金属蛋白酶-9（MMP-9）和金属蛋白酶组织抑制剂-1（TIMP-1）是否可作为人类免疫缺陷病毒（HIV）阳性患者牙周炎进展的预后因素。活化的炎症细胞产生炎症介质，刺激MMP及其抑制剂的产生。免疫系统受损可能在HIV阳性患者牙周炎的发病机制中起作用。
在35例患者的基线访视和6个月访视时，通过纸条从每个患者的两个健康部位（包括牙龈退缩部位，牙龈指数=0；探诊深度≤3mm；附着丧失≤2mm）、三个牙龈炎部位（牙龈指数>0；探诊深度≤3mm；附着丧失=0）和三个牙周炎部位（牙龈指数>0；探诊深度≥5mm；附着丧失≥3mm）采集临床测量数据，包括牙龈指数、菌斑指数、出血指数、探诊深度、附着丧失和龈沟液样本。采用夹心酶联免疫吸附测定法测定龈沟液中MMP-9和TIMP-1的水平。
牙龈炎和牙周炎部位的MMP-9和TIMP-1平均含量显著高于健康部位（P<0.0001）。进展部位定义为在6个月研究期间附着丧失达2mm或更多的部位。在基线和6个月访视时，龈沟液中MMP-9水平与探诊深度、附着丧失、TIMP-1、年龄、吸烟包年数和病毒载量值显著相关（0.0001<P<0.001）。TIMP-1水平仅与CD4、病毒载量、附着丧失和MMP-9相关（0.001<P<0.01）。对11个活动部位与269个非活动部位进行重复测量分析表明，活动部位的MMP-9和TIMP-1水平显著高于非活动部位（P<0.0001）。这些数据表明，HIV阳性患者龈沟液中MMP-9和TIMP-1水平高的部位发生牙周炎进展的风险显著更高。
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