Department of Specific Formation, Institute of Health, School of Dentistry, UFF - Federal Fluminense University, Nova Friburgo, RJ, Brazil.
Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, UNESP - Univ Estadual Paulista, São José dos Campos, SP, Brazil.
Mol Neurobiol. 2018 Apr;55(4):2814-2827. doi: 10.1007/s12035-017-0545-z. Epub 2017 Apr 28.
Evidence indicates that major depression is accompanied by increased translocation of gut commensal Gram-negative bacteria (leaky gut) and consequent activation of oxidative and nitrosative (O&NS) pathways. This present study examined the associations among chronic apical periodontitis (CAP), root canal endotoxin levels (lipopolysaccharides, LPS), O&NS pathways, depressive symptoms, and quality of life. Measurements included advanced oxidation protein products (AOPP), nitric oxide metabolites (NOx), lipid peroxides (LOOH), -sulfhydryl (SH) groups, total radical trapping antioxidant parameter (TRAP), and paraoxonase (PON)1 activity in participants with CAP, with and without depression, as well as healthy controls (no depression, no CAP). Root canal LPS levels were positively associated with CAP, clinical depression, severity of depression (as measured with the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory) and O&NS biomarkers, especially NOx and TRAP. CAP-related depression was accompanied by increased levels of NOx, LOOH, AOPP, and TRAP. In CAP participants, there was a strong correlation (r = 0.734, p < 0.001) between root canal LPS and the HDRS score. There were significant and positive associations between CAP or root canal endotoxin with the vegetative and physio-somatic symptoms of the HDRS as well as a significant inverse association between root canal endotoxin and quality of life with strong effects on psychological, environmental, and social domains. It is concluded that increased root canal LPS accompanying CAP may cause depression and a lowered quality of life, which may be partly explained by activated O&NS pathways, especially NOx thereby enhancing hypernitrosylation and thus neuroprogressive processes. Dental health and "leaky teeth" may be intimately linked to the etiology and course of depression, while significantly impacting quality of life.
有证据表明，重度抑郁症伴随着肠道共生革兰氏阴性菌（漏肠）易位的增加和随之而来的氧化和亚硝化（O&NS）途径的激活。本研究探讨了慢性根尖周炎（CAP）、根管内内毒素水平（脂多糖，LPS）、O&NS 途径、抑郁症状和生活质量之间的关联。测量指标包括晚期氧化蛋白产物（AOPP）、一氧化氮代谢物（NOx）、脂质过氧化物（LOOH）、-巯基（SH）基团、总自由基捕获抗氧化参数（TRAP）和对氧磷酶 1 （PON）1 活性，这些指标在患有 CAP 和无 CAP 的抑郁症患者以及健康对照组中进行了测量。根管内 LPS 水平与 CAP、临床抑郁症、抑郁症严重程度（用汉密尔顿抑郁量表（HDRS）和贝克抑郁量表测量）和 O&NS 生物标志物，特别是 NOx 和 TRAP 呈正相关。CAP 相关的抑郁症伴有 NOx、LOOH、AOPP 和 TRAP 水平的升高。在 CAP 患者中，根管内 LPS 与 HDRS 评分之间存在很强的相关性（r=0.734，p<0.001）。CAP 或根管内内毒素与 HDRS 的植物神经和生理躯体症状之间存在显著正相关，而根管内内毒素与生活质量之间存在显著负相关，对心理、环境和社会领域有强烈影响。研究结论为，CAP 伴随的根管内 LPS 增加可能导致抑郁症和生活质量下降，这可能部分归因于 O&NS 途径的激活，特别是 NOx，从而增强了过亚硝化作用，进而促进了神经进展过程。牙齿健康和“漏牙”可能与抑郁症的病因和病程密切相关，同时对生活质量有重大影响。
