Department of Periodontology.
Division of Periodontology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Sapporo, Japan.
J Diabetes Investig. 2012 Aug 20;3(4):402-9. doi: 10.1111/j.2040-1124.2012.00209.x.
Aims/Introduction: Chronic inflammation aggravates glycemic control in patients with type 2 diabetes mellitus. An increase or decrease in the release and activities of various inflammatory mediators, such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein (CRP), are presumed to be responsible for inducing insulin resistance. The purpose of the present study was to examine the effects of non-surgical periodontal treatment incorporating topical antibiotics on glycemic control and serum inflammatory mediators in patients with type 2 diabetes mellitus with periodontitis.
Periodontal inflammation and periodontal tissue destruction were evaluated by bleeding on probing (BOP) and the probing pocket depth (PPD), respectively. A total of 41 patients with type 2 diabetes and periodontitis received periodontal treatment with the topical application of antibiotics four times within a 2-month period. A periodontal examination, including PPD and BOP, and venous blood sampling were carried out at baseline and at 2 and 6 months after periodontal treatment. Glycated hemoglobin (HbA1c), and serum levels of high-sensitivity (hs)-CRP, TNF-α and IL-6 were analyzed.
A generalized linear model showed significant associations between the change in the HbA1c values at 6 months after periodontal treatment, and the change in the BOP, baseline TNF-α levels and the baseline mean PPD.
As BOP is a marker of total gingival inflammation, these results suggest that non-surgical periodontal therapy with topical antibiotics in patients with mild periodontitis might improve glycemic control by resolving periodontal inflammation. Such treatments might be insufficient for the amelioration of insulin resistance in type 2 diabetic patients with severe periodontitis. This trial was registered with the University Hospital Medical Information Network (no. UMIN000006693). (J Diabetes Invest, doi: 10.1111/j.2040-1124.2012.00209.x, 2012).
目的/引言：慢性炎症会加重 2 型糖尿病患者的血糖控制。各种炎症介质（如肿瘤坏死因子-α、白细胞介素-6 和 C 反应蛋白）的释放和活性的增加或减少被认为是诱导胰岛素抵抗的原因。本研究旨在探讨牙周非手术治疗联合局部应用抗生素对伴牙周炎的 2 型糖尿病患者血糖控制和血清炎症介质的影响。
采用探诊出血（BOP）和探诊深度（PPD）评估牙周炎症和牙周组织破坏。41 例 2 型糖尿病伴牙周炎患者接受了为期 2 个月内 4 次局部应用抗生素的牙周治疗。在基线和牙周治疗后 2 个月和 6 个月进行牙周检查，包括 PPD 和 BOP，以及静脉采血。分析糖化血红蛋白（HbA1c）和血清高敏（hs）-CRP、TNF-α和 IL-6 水平。
广义线性模型显示，牙周治疗后 6 个月 HbA1c 值的变化与 BOP、基线 TNF-α水平和基线平均 PPD 的变化之间存在显著相关性。
由于 BOP 是总牙龈炎症的标志物，这些结果表明，在轻度牙周炎患者中，使用局部抗生素的牙周非手术治疗可能通过解决牙周炎症来改善血糖控制。对于 2 型糖尿病伴严重牙周炎的患者，这种治疗可能不足以改善胰岛素抵抗。本试验在大学医院医学信息网络（UMIN000006693）注册。（糖尿病研究杂志，doi：10.1111/j.2040-1124.2012.00209.x，2012 年）。
