Socransky Sigmund S, Haffajee Anne D
J Periodontol. 1992 Apr;63 Suppl 4S:322-331. doi: 10.1902/jop.1992.63.4s.322.
The interpretation of diagnostic tests for the detection of subgingival bacterial species is dependent on knowledge of the microbial etiology of destructive periodontal diseases. Specific etiologic agents of these diseases have been sought for over 100 years; however, the complexity of the microbiota, an incomplete understanding of the biology of periodontal diseases, and technical problems have handicapped this search. Nonetheless, a number of possible pathogens have been suggested on the basis of their association with disease, animal pathogenicity, and virulence factors. The immunological response of the host to a species and the relation of successful therapy to the elimination of the species have also been used to support or refute suspected periodontal pathogens. Current data suggest that pathogens are necessary but not sufficient for disease activity to occur. Factors which influence activity include susceptibility of the individual host and the presence of interacting bacterial species which facilitate or impede disease progression. Recent studies have attempted to distinguish virulent and avirulent clonai types of suspected pathogenic species and seek transmission of genetic elements needed for pathogenic species to cause disease. Finally, the local environment of the periodontal pocket may be important in the regulation of expression of virulence factors by pathogenic species. Thus, in order that disease result from a pathogen, 1) it must be a virulent clonal type; 2) it must possess the chromosomal and extra-chromosomal genetic factors to initiate disease; 3) the host must be susceptible to this pathogen; 4) the pathogen must be in numbers sufficient to exceed the threshold for that host; 5) it must be located at the right place; 6) other bacterial species must foster, or at least not inhibit, the process; and 7) the local environment must be one which is conducive to the expression of the species' virulence properties. J Periodontol 1992; 63:322-331.
用于检测龈下细菌种类的诊断测试的解读取决于对破坏性牙周疾病微生物病因的了解。人们寻找这些疾病的特定病因已超过100年；然而，微生物群的复杂性、对牙周疾病生物学的不完全理解以及技术问题阻碍了这一探索。尽管如此，基于它们与疾病的关联、动物致病性和毒力因子，已提出了一些可能的病原体。宿主对某一细菌种类的免疫反应以及成功治疗与该细菌种类消除之间的关系也被用于支持或反驳疑似牙周病原体。目前的数据表明，病原体是疾病活动发生的必要但非充分条件。影响疾病活动的因素包括个体宿主的易感性以及促进或阻碍疾病进展的相互作用细菌种类的存在。最近的研究试图区分疑似致病种类的有毒和无毒克隆类型，并寻找致病种类引起疾病所需的遗传元件的传播。最后，牙周袋的局部环境可能在调节致病种类毒力因子的表达方面很重要。因此，为了使疾病由病原体引起，1）它必须是有毒的克隆类型；2）它必须拥有启动疾病的染色体和染色体外遗传因子；3）宿主必须对这种病原体易感；4）病原体数量必须足以超过该宿主的阈值；5）它必须位于正确的位置；6）其他细菌种类必须促进，或至少不抑制，这一过程；7）局部环境必须有利于该细菌种类毒力特性的表达。《牙周病学杂志》1992年；63:322 - 331。
