Eggert F M, Flowerdew G, McLeod M H, McIntyre E W, Wasylyk J, Koschzeck L
Department of Oral Health Sciences, Faculty of Medicine and Oral Health Sciences, University of Alberta, Edmonton.
J Periodontol. 1998 Dec;69(12):1373-81. doi: 10.1902/jop.1998.69.12.1373.
Specific detection of marker organisms Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans with an immunoassay provided 2 types of useful information directly into private clinical practice: 1) persistence of P. gingivalis in patients undergoing regular treatment allowed rapid identification of pockets requiring further treatment without waiting for measurable progression of lesions and 2) presence of A. actinomycetemcomitans in adults at any stage of diagnosis or treatment identified patients who may prove to have difficult-to-manage periodontitis. We made these findings in 253 patients (234 in specialist periodontal practices [F-ME 55; MHM 179] and 19 in general dental practice [EWM]). The search for useful diagnostic markers overlaps only partly with the search for periodontal pathogens. The P. gingivalis marker and the A. actinomycetemcomitans marker identify 2 different patterns of infection that appear to reflect 2 different underlying problems. Demonstration of pocket-dependent infection with P. gingivalis in treated patients provides an outcome marker for sites not converting to marker-negative sites at detection levels of the immunoassay. This information facilitates selection of sites and patients requiring adjustment of treatment regimens. Detection of A. actinomycetemcomitans in adult patients is significantly associated with periodontitis characterized as refractory. Positive identification of A. actinomycetemcomitans with the immunoassay supports clinical decision-making by drawing attention to adult patients who require closer monitoring and intensive persistent treatment. Successful application of immunoassay detection of microbiological markers is based on continuous patient monitoring to support clinical decisions; it does not replace careful clinical judgment.
采用免疫分析法对标志性微生物牙龈卟啉单胞菌、中间普氏菌和伴放线放线杆菌进行特异性检测，可为私人临床实践直接提供两类有用信息：1）在接受常规治疗的患者中，牙龈卟啉单胞菌的持续存在使得无需等待病变出现可测量的进展，就能快速识别需要进一步治疗的牙周袋；2）在诊断或治疗的任何阶段，成年患者中伴放线放线杆菌的存在可识别出可能患有难治性牙周炎的患者。我们在253例患者中得出了这些结果（234例来自专科牙周诊所[女性55例；男性179例]，19例来自普通牙科诊所[EWM]）。寻找有用的诊断标志物与寻找牙周病原体的工作仅部分重叠。牙龈卟啉单胞菌标志物和伴放线放线杆菌标志物识别出两种不同的感染模式，这似乎反映了两种不同的潜在问题。在接受治疗的患者中，牙龈卟啉单胞菌引起的牙周袋依赖性感染的证实，为在免疫分析法检测水平上未转变为标志物阴性位点的部位提供了一个结果标志物。这些信息有助于选择需要调整治疗方案的部位和患者。在成年患者中检测到伴放线放线杆菌与难治性牙周炎显著相关。通过免疫分析法对伴放线放线杆菌进行阳性鉴定，可提醒需要密切监测和强化持续治疗的成年患者，从而支持临床决策。微生物标志物免疫分析法检测的成功应用基于对患者的持续监测以支持临床决策；它不能取代仔细的临床判断。
