Eley B M, Cox S W
Periodontal Department, King's College School of Medicine and Dentistry, London, UK.
J Periodontol. 1996 Jul;67(7):703-16. doi: 10.1902/jop.1996.67.7.703.
The aim of this study is to determine whether either gingival crevicular fluid (GCF) bacterial gingivain/gingipain or dipeptidyl peptidase (DPP) levels, total activity (TA) and concentration (EC), predict progressive attachment loss (AL) in 75 patients with moderate periodontitis. GCF was collected from 16 molar and premolar mesiobuccal sites and then clinical attachment level (CAL) and probing depth (PD) were measured with an electronic constant pressure probe. Lastly, gingival, gingival bleeding, and plaque indices were scored. Prior to the baseline visit, patients were given basic periodontal treatment after which the above procedures were repeated. In addition, carefully localized radiographs were taken of the test teeth and repeated annually. Patients were then seen every 3 months for 2 years and the clinical measurements repeated at each visit. In 48 patients, 124 AL sites, 91 rapid AL (RAL), and 33 gradual AL (GAL) were detected. Gingivain/gingipain and bacterial DPP levels (TA and EC) at RAL sites were significantly higher (P < or = 0.0001) than at paired control sites at the attachment loss time (ALT) and prediction time (PT). Mean levels over the study period of both proteases (TA and EC) at GAL sites were significantly higher (P < or = 0.0001) than those at paired control sites. The GCF levels of gingivain/gingipain were always higher than those of DPP. Critical values (CV) of 5 microU/30 seconds (TA) and 30 microU/microL (EC) for both proteases showed high sensitivity and specificity values for TA and EC, which were the same at both ALT and PT. The positive predictive values were higher for gingivain/ gingipain. Mean site levels, over the course of the study, of both proteases (TA and EC) were significantly higher (P < or = 0.0001) at AL, RAL, and GAL sites than non-attachment loss (NAL) sites in AL patients and mean patient levels were significantly higher (P < or = 0.0001) in AL, RAL, and GAL patients than NAL patients. These results indicate that both of these bacterial proteases in GCF may be predictors of periodontal attachment loss.
本研究的目的是确定龈沟液（GCF）中的牙龈蛋白酶/牙龈溶素或二肽基肽酶（DPP）水平、总活性（TA）和浓度（EC）是否能预测75例中度牙周炎患者的附着丧失进展情况。从16个磨牙和前磨牙的近中颊侧位点采集龈沟液，然后用电子恒压探针测量临床附着水平（CAL）和探诊深度（PD）。最后，对牙龈、牙龈出血和菌斑指数进行评分。在基线检查前，患者接受基础牙周治疗，之后重复上述操作。此外，对受试牙齿进行仔细定位的X光片拍摄，并每年重复一次。然后患者每3个月复诊一次，持续2年，每次复诊时重复进行临床测量。在48例患者中，检测到124个附着丧失位点，其中91个为快速附着丧失（RAL），33个为渐进性附着丧失（GAL）。RAL位点在附着丧失时间（ALT）和预测时间（PT）时的牙龈蛋白酶/牙龈溶素和细菌DPP水平（TA和EC）显著高于配对对照位点（P≤0.0001）。GAL位点在研究期间两种蛋白酶（TA和EC）的平均水平显著高于配对对照位点（P≤0.0001）。牙龈蛋白酶/牙龈溶素的龈沟液水平始终高于DPP。两种蛋白酶的临界值（CV）分别为5微单位/30秒（TA）和30微单位/微升（EC），对TA和EC显示出高灵敏度和特异性值，在ALT和PT时相同。牙龈蛋白酶/牙龈溶素的阳性预测值更高。在研究过程中，两种蛋白酶（TA和EC）在附着丧失（AL）、RAL和GAL位点的平均位点水平显著高于AL患者中的非附着丧失（NAL）位点，且在AL、RAL和GAL患者中的平均患者水平显著高于NAL患者（P≤0.0001）。这些结果表明，龈沟液中的这两种细菌蛋白酶可能都是牙周附着丧失的预测指标。
