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成人牙周炎中伴放线放线杆菌、腐蚀埃肯菌和二氧化碳嗜纤维菌属的微生物生态学

Microbial ecology of Actinobacillus actinomycetemcomitans, Eikenella corrodens and Capnocytophaga spp. in adult periodontitis.

作者信息

Müller H P, Heinecke A, Borneff M, Knopf A, Kiencke C, Pohl S

机构信息

Department of Operative Dentistry and Periodontology, University of Heidelberg, Germany.

出版信息

J Periodontal Res. 1997 Aug;32(6):530-42. doi: 10.1111/j.1600-0765.1997.tb00569.x.

Abstract

Information on intraoral distribution of putative periodontal pathogens might be essential for controlling different forms of periodontal disease. Colonization may be either promoted or impeded by other bacteria competing in the subgingival ecosystem. In recent investigations microbial associations between dental organisms have been determined in a multitude of subgingival plaque samples within multiple patients and described by odds ratios, in most circumstances without taking into account the correlated structure of the observations within a single individual. The present investigation had 3 major objectives: (i) to describe the intraoral distribution of some facultatively anaerobic, Gram-negative rods, i.e. Actinobacillus actinomycetemcomitans, Eikenella corrodens-like organisms and Capnocytophaga spp., in a multitude of subgingival and extracrevicular samples of 10 adult subjects with A. actinomycetemcomitans-associated periodontitis; (ii) to analyse possible inconsistencies of microbial associations between these periodontal organisms; and (iii) to determine factors increasing the likelihood of isolating these bacteria in a given subgingival site by employing Generalized Estimation Equation (GEE) methods. Clinical examinations were carried out at 6 sites of every tooth present. In each subject, 13 extracrevicular (2 cheek mucosa, 3 tongue, 4 gingival, 2 tonsillar samples, 1 palatinal, 1 saliva sample) and between 22 and 44 subgingival samples from deepest sites of every tooth present (n = 296) were selectively cultivated for A. actinomycetemcomitans, E. corrodens and Capnocytophaga spp. In extracrevicular material, A. actinomycetemcomitans, Capnocytophaga spp. and E. corrodens were isolated in 9, 10 and 6 patients, and from 65, 82 and 15% samples, respectively. The organisms were recovered from 51, 62 and 27% subgingival plaque samples, respectively. Heterogeneity tests did not reveal significant inconsistencies of microbial associations between bacteria in subgingival plaque. Mantel-Haenszel's odds ratios ranged between 2.0 for A. actinomycetemcomitans and Capnocytophaga spp. and 18.7 for Capnocytophaga spp. and E. corrodens. An exchangeable working dependence structure was employed in the GEE approach. The odds of isolating A. actinomycetemcomitans was increased by factor 3.7 in 4-6 mm deep pockets, and 9.5 in > or = 7 mm deep pockets. The odds of presence of E. corrodens was increased by factor 10.8 in the case of presence of Capnocytophaga spp. and 2.1 in the case of presence of A. actinomycetemcomitans. Capnocytophaga spp. were associated with bleeding on probing and molar sites. Presence of E. corrodens was associated with clinical attachment loss but not periodontal probing depth. Results of the present study indicated an association of A. actinomycetemcomitans with periodontal pathology. Whereas this organism and Capnocytophagae were widely distributed in extracrevicular ecosystems of the mouth, E. corrodens only occasionally appeared in saliva or on mucous membranes of the oral cavity. In general, GEE methods seem to allow to determine factors associated with the presence of periodontal organisms in a multivariate approach and considering the correlated structure of the data.

摘要

关于牙周可疑病原体在口腔内分布的信息,对于控制不同形式的牙周疾病可能至关重要。在龈下生态系统中,其他细菌的竞争可能促进或阻碍定植。在最近的研究中,已在多名患者的大量龈下菌斑样本中确定了口腔微生物之间的关联,并通过比值比进行描述,在大多数情况下未考虑单个个体内观察结果的相关结构。本研究有3个主要目标:(i)描述10名患有伴放线放线杆菌相关性牙周炎的成年受试者的大量龈下和龈外样本中一些兼性厌氧革兰氏阴性杆菌,即伴放线放线杆菌、腐蚀艾肯菌样菌和二氧化碳嗜纤维菌属的口腔内分布;(ii)分析这些牙周微生物之间微生物关联可能存在的不一致性;(iii)通过使用广义估计方程(GEE)方法确定在给定龈下部位分离出这些细菌可能性增加的因素。对每颗现存牙齿的6个部位进行临床检查。在每个受试者中,从每颗现存牙齿最深部位选择性培养13份龈外样本(2份颊黏膜、3份舌、4份牙龈、2份扁桃体样本、1份腭部、1份唾液样本)以及22至44份龈下样本(n = 296),以检测伴放线放线杆菌、腐蚀艾肯菌和二氧化碳嗜纤维菌属。在龈外样本中,伴放线放线杆菌、二氧化碳嗜纤维菌属和腐蚀艾肯菌分别在9名、10名和6名患者中分离到,分别占样本的65%、82%和15%。这些微生物分别从51%、62%和27%的龈下菌斑样本中检出。异质性检验未发现龈下菌斑中细菌之间微生物关联存在显著不一致性。曼特尔 - 亨塞尔比值比在伴放线放线杆菌与二氧化碳嗜纤维菌属之间为2.0,在二氧化碳嗜纤维菌属与腐蚀艾肯菌之间为18.7。在GEE方法中采用了可交换工作依赖结构。在4 - 6毫米深的牙周袋中,分离出伴放线放线杆菌的几率增加3.7倍,在≥7毫米深的牙周袋中增加9.5倍。在存在二氧化碳嗜纤维菌属的情况下,腐蚀艾肯菌存在的几率增加10.8倍,在存在伴放线放线杆菌的情况下增加2.1倍。二氧化碳嗜纤维菌属与探诊出血和磨牙部位相关。腐蚀艾肯菌的存在与临床附着丧失相关,但与牙周探诊深度无关。本研究结果表明伴放线放线杆菌与牙周病变有关。虽然这种微生物和二氧化碳嗜纤维菌在口腔的龈外生态系统中广泛分布,但腐蚀艾肯菌仅偶尔出现在唾液或口腔黏膜上。总体而言,GEE方法似乎能够以多变量方法并考虑数据的相关结构来确定与牙周微生物存在相关的因素。

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