Emingil Gülnur, Atilla Gül, Sorsa Timo, Tervahartiala Taina
Department of Periodontology, School of Dentistry, Ege University, Bornova, Izmir, Turkey.
J Periodontol. 2008 Mar;79(3):469-76. doi: 10.1902/jop.2008.070165.
The aim of the present randomized, double-masked, placebo-controlled, parallel-arm study was to examine the effectiveness of a 3-month regimen of subantimicrobial dose doxycycline (SDD) in combination with scaling and root planing compared to scaling and root planing alone on levels of gingival crevicular fluid (GCF) extracellular matrix metalloproteinase inducer (EMMPRIN) in patients with chronic periodontitis.
GCF samples were collected, and clinical parameters, including probing depth (PD), clinical attachment level, gingival index (GI), and plaque index, were recorded. Thirty chronic periodontitis subjects were randomized to receive SDD or placebo. The SDD group received SDD (20 mg, twice a day) for 3 months plus scaling and root planing, whereas the placebo group took placebo capsules twice a day for 3 months and received scaling and root planing. The subjects were reevaluated at 3 and 6 months. At each visit, all clinical parameters were measured and GCF was sampled. GCF EMMPRIN levels were determined by Western immunoblotting assay. Intragroup comparisons were tested by the Friedman test followed by the Wilcoxon signed-rank test to analyze the significance of changes over time. The Mann-Whitney test was used to determine differences between the SDD and placebo groups.
Significant improvements were observed in all clinical parameters in the SDD group over the 6-month study period (P <0.025). The SDD group showed a significantly greater reduction in mean PD scores at 6 months and in mean GI scores at 3 and 6 months than the placebo group (P <0.05). From baseline to 6 months, the GCF EMMPRIN levels were reduced significantly in the SDD group (P <0.025). The GCF EMMPRIN level in the SDD group was significantly lower than that of the placebo group at 3 and 6 months (P <0.05).
SDD therapy in combination with scaling and root planing reduced GCF EMMPRIN levels and improved clinical periodontal parameters in subjects with chronic periodontitis. The ability of SDD to downregulate, in vivo, the GCF levels of EMMPRIN, a unique upregulator of matrix metalloproteinase expression, is one of its beneficial host-modulatory properties. These results expand the usefulness of SDD therapy as an adjunct to scaling and root planing in the long-term management of periodontal disease.
本随机、双盲、安慰剂对照、平行组研究的目的是，比较3个月亚抗菌剂量强力霉素（SDD）联合龈下刮治和根面平整与单纯龈下刮治和根面平整，对慢性牙周炎患者龈沟液（GCF）细胞外基质金属蛋白酶诱导剂（EMMPRIN）水平的影响。
收集GCF样本，并记录临床参数，包括探诊深度（PD）、临床附着水平、牙龈指数（GI）和菌斑指数。30名慢性牙周炎受试者被随机分为接受SDD组或安慰剂组。SDD组接受SDD（20毫克，每日两次）治疗3个月加龈下刮治和根面平整，而安慰剂组每日服用两次安慰剂胶囊，持续3个月，并接受龈下刮治和根面平整。在3个月和6个月时对受试者进行重新评估。每次就诊时，测量所有临床参数并采集GCF样本。通过Western免疫印迹法测定GCF中EMMPRIN水平。组内比较采用Friedman检验，随后进行Wilcoxon符号秩检验，以分析随时间变化的显著性。采用Mann-Whitney检验确定SDD组和安慰剂组之间的差异。
在6个月的研究期内，SDD组所有临床参数均有显著改善（P<0.025）。SDD组在6个月时的平均PD评分以及在3个月和6个月时的平均GI评分较安慰剂组有显著更大幅度的降低（P<0.05）。从基线到6个月，SDD组GCF中EMMPRIN水平显著降低（P<0.025）。在3个月和6个月时，SDD组GCF中EMMPRIN水平显著低于安慰剂组（P<0.05）。
SDD治疗联合龈下刮治和根面平整可降低慢性牙周炎患者GCF中EMMPRIN水平，并改善临床牙周参数。SDD在体内下调EMMPRIN（基质金属蛋白酶表达的独特上调因子）GCF水平的能力是其有益的宿主调节特性之一。这些结果扩展了SDD治疗作为龈下刮治和根面平整辅助手段在牙周病长期管理中的应用价值。
