Christersson L A
Department of Periodontology, Faculty of Odontology, University of Göteborg, Sweden.
Swed Dent J Suppl. 1993;90:1-46.
The present studies examined Actinobacillus actinomycetemcomitans and its role in localized juvenile periodontitis (LJP). The distribution of the bacteria was studied in healthy normals, patients with adult periodontitis, diabetics, and those with LJP. Over 95% of the LJP patients harbored A. actinomycetemcomitans, whereas only 17% of healthy subjects, 21% of adult periodontitis patients, and 5% of diabetics were positive. All members of a LJP family harboring the organism yielded isolates of the same biotype and serotype. The transmission of the bacteria was studied after transfer of the bacteria, with periodontal probes from infected to healthy gingival sites, within the oral cavity of LJP patients. Newly colonized gingival sites, 50% of those involved, became free of A. actinomycetemcomitans after only 3 weeks. A purposely forceful inoculation contributed to a more predictable colonization (89%), but only prolonged the colonization with one week. Treatment of LJP lesions with scaling and root planing resulted in minimal clinical and microbiological changes during a 16 week follow-up period. However, gingival curettage and modified Widman flap surgery suppressed A. actinomycetemcomitans in 75% and 89% of the sites, and resulted in resolution of periodontal pocket depth and gain in attachment level. Gingival tissue specimens, from 35 LJP sites, 3 control sites, and one monkey biopsy, were studied to verify the hypothesis of gingival infiltration of A. actinomycetemcomitans. Bacteria were identified immunohistologically with rabbit antisera serospecific to the three A. actinomycetemcomitans serotypes. Positive staining was observed in the tissue from all but one LJP patient. Twenty-eight (80%) lesions were positive for A. actinomycetemcomitans antigens in the gingival connective tissue, often with antigens located both between and within cells. The specimen from a culture positive control demonstrated no signs of invasion, similar to the monkey specimen. Transmission electron microscopic examination verified gram-negative bacteria that appeared as single microbes or small clusters in the connective tissue. The viability of the invading bacteria was studied by selective culture of minced tissue specimens and a series of washing solutions, after a rigorous surface disinfection. The washings successfully removed the bacteria in most cases, and after mincing 73% of the biopsies showed to be culture positive. The culture recovery of A. actinomycetemcomitans from minced tissues correlated exceedingly well with the presence of specific antigens in the gingival tissues from corresponding gingival biopsies. To further demonstrate the importance of A. actinomycetemcomitans in LJP, six culture positive LJP patients were treated by systemic tetracycline alone.(ABSTRACT TRUNCATED AT 400 WORDS)
目前的研究检测了伴放线放线杆菌及其在局限性青少年牙周炎（LJP）中的作用。研究了该细菌在健康正常人、成人牙周炎患者、糖尿病患者以及LJP患者中的分布情况。超过95%的LJP患者携带伴放线放线杆菌，而健康受试者中只有17%、成人牙周炎患者中只有21%、糖尿病患者中只有5%呈阳性。一个LJP家族中所有携带该微生物的成员所分离出的菌株具有相同的生物型和血清型。在LJP患者口腔内，用牙周探针将细菌从感染的牙龈部位转移至健康牙龈部位后，研究了细菌的传播情况。新定植的牙龈部位，其中50%在仅3周后就不再有伴放线放线杆菌。特意进行的强力接种有助于更可预测的定植（89%），但仅将定植时间延长了一周。在16周的随访期内，用龈上洁治术和根面平整术治疗LJP病变，临床和微生物学变化极小。然而，牙龈刮治术和改良Widman翻瓣手术使75%和89%的部位的伴放线放线杆菌受到抑制，并使牙周袋深度消退，附着水平增加。研究了来自35个LJP部位、3个对照部位的牙龈组织标本以及一份猴子活检标本，以验证伴放线放线杆菌牙龈浸润的假说。用对伴放线放线杆菌三种血清型具有血清特异性的兔抗血清进行免疫组织化学鉴定细菌。除一名LJP患者外，所有患者组织中均观察到阳性染色。28个（80%）病变在牙龈结缔组织中伴放线放线杆菌抗原呈阳性，抗原常位于细胞之间和细胞内。来自培养阳性对照的标本未显示侵袭迹象，与猴子标本相似。透射电子显微镜检查证实革兰氏阴性菌在结缔组织中呈单个微生物或小簇状出现。在严格的表面消毒后，通过对切碎的组织标本和一系列洗涤液进行选择性培养，研究了侵袭细菌的活力。在大多数情况下，洗涤液成功去除了细菌，切碎后73%的活检标本显示培养阳性。从切碎组织中培养恢复的伴放线放线杆菌与相应牙龈活检的牙龈组织中特异性抗原的存在高度相关。为了进一步证明伴放线放线杆菌在LJP中的重要性，对6名培养阳性的LJP患者仅进行全身四环素治疗。（摘要截选至400字）
