侵袭性牙周炎伴错牙合畸形患者牙周-正畸联合治疗前后血清SAA、leptin的变化及与牙周指标和辅助性T细胞亚群的相关性分析

摘要 目的：探讨侵袭性牙周炎伴错牙合畸形患者牙周-正畸联合治疗前后血清淀粉样蛋白A（SAA）、瘦素（leptin）的变化及与牙周指标和辅助性T细胞（Th）亚群的相关性。方法：选择2020年6月-2022年8月解放军总医院京中医疗区黄寺门诊部口腔科收治的80例侵袭性牙周炎伴错牙合畸形患者（牙周炎组）和65例于口腔门诊检查的健康志愿者（对照组）。所有患者均接受牙周-正畸联合治疗，治疗前后分别检测血清SAA、leptin水平以及外周血中Th1、Th2、Th17细胞占比，并评估牙周指标变化。Pearson相关性分析血清SAA、leptin水平与牙周指标以及外周血中Th1、Th2、Th17细胞占比的相关性。结果：牙周炎组治疗前血清SAA、leptin水平，外周血Th1、Th17细胞占比，出血指数（SBI）、菌斑指数（PLI）、附着丧失（AL）、牙周探诊深度（PD）高于对照组（P＜0.05），外周血Th2细胞占比低于对照组（P＜0.05）。牙周炎组治疗后血清SAA、leptin水平，外周血Th1、Th17细胞占比，PLI、SBI、AL、PD较治疗前降低（P＜0.05），外周血Th2细胞占比较治疗前增高（P＜0.05）。牙周炎组血清SAA、leptin与PLI、SBI、AL、PD，外周血Th1、Th17细胞占比呈正相关，与外周血Th2细胞占比呈负相关（P＜0.05）。结论：侵袭性牙周炎伴错牙合畸形患者血清SAA、leptin水平增高，经牙周-正畸联合治疗后下降，高水平SAA、leptin与牙周组织破坏程度以及Th亚群紊乱有关，检测血清SAA、leptin水平可评估侵袭性牙周炎牙周组织破坏程度以及细胞免疫状态。

Changes of Serum SAA and Leptin in Patients with Aggressive Periodontitis Complicated with Malocclusion Deformity before and after Combined Periodontal-orthodontic Treatment and Their Correlation Analysis with Periodontal Indicators and Helper T Cell Subsets

ABSTRACT Objective: To investigate the changes of serum amyloid A (SAA) and leptin before and after combined periodontal-orthodontic treatment in patients with aggressive periodontitis complicated with malocclusion deformity, and their correlation with periodontal indicators and helper T cell (Th) subsets. Methods: From June 2020 to August 2022, 80 patients with aggressive periodontitis complicated with malocclusion deformity (periodontitis group) who were admitted to the department of stomatology in Huangsi Outpatient Department of Central Beijing Medical Area of the General Hospital of the People''s Liberation Army and 65 healthy volunteers (control group) who were examined in the oral clinic were selected. All patients received combined periodontal-orthodontic treatment. Serum SAA and leptin levels, as well as the proportion of Th1, Th2, and Th17 cells in peripheral blood were measured before and after treatment, and changes in periodontal indicators were evaluated. Pearson correlation analysis was used to analyze the correlation between serum SAA and leptin levels and periodontal indicators, as well as the proportion of Th1, Th2, and Th17 cells in peripheral blood. Results: Before treatment, the serum SAA and leptin levels, the proportion of Th1 and Th17 cells, the sulcus bleeding index (SBI), plaque index (PLI), attachment loss (AL) and periodontal probing depth (PD) in peripheral blood of the periodontitis group were higher than those of the control group (P<0.05), and the proportion of Th2 cells in peripheral blood was lower than that of the control group (P<0.05). After treatment, the serum SAA and leptin levels, the proportion of Th1, Th17 cells in peripheral blood, PLI, SBI, AL and PD of the periodontitis group were decreased compared with those before treatment (P<0.05), while the proportion of Th2 cells in peripheral blood was increased compared with that before treatment (P<0.05). In the periodontitis group, serum SAA and leptin were positively correlated with PLI, SBI, AL, PD, the proportion of Th1 and Th17 cells in peripheral blood, and negatively correlated with the proportion of Th2 cells in peripheral blood (P<0.05). Conclusion: The serum SAA and leptin levels in patients with aggressive periodontitis complicated with malocclusion deformity increased, but decreased after combined periodontal-orthodontic treatment, high SAA and leptin levels are related to the degree of periodontal tissue destruction and Th subgroup disorder. Detecting the serum SAA and leptin levels can evaluate the degree of periodontal tissue destruction and cellular immune status in aggressive periodontitis.