龈沟液Melatonin、PTX3与老年牙隐裂伴慢性牙髓炎患者炎症因子和治疗效果的关系研究

摘要 目的：探究龈沟液褪黑素（Melatonin）、正五聚体蛋白3（PTX3）与老年牙隐裂伴慢性牙髓炎（CP）患者炎症因子和治疗效果的关系。方法：选择2021年6月-2022年6月我院收治的165例老年牙隐裂伴CP患者纳入研究组，选取同期在我院实施正畸牙拔除的健康受试者100例纳入对照组。比较两组龈沟液Melatonin、PTX3及炎症因子[肿瘤坏死因子-α （TNF-α）、白细胞介素（IL-6）、C反应蛋白（CRP）]水平。Pearson检验分析老年牙隐裂伴CP患者龈沟液Melatonin、PTX3水平与炎症因子的相关性。165例老年牙隐裂伴CP患者接受根管治疗+全冠修复后随访1年，根据治疗效果分为有效组和无效组，比较两组临床资料。多因素Logistic回归模型分析老年牙隐裂伴CP患者治疗无效的影响因素；受试者工作特征（ROC）曲线分析龈沟液Melatonin、PTX3对老年牙隐裂伴CP患者治疗无效的预测价值。结果：与对照组比较，研究组龈沟液中Melatonin水平降低（P＜0.05），PTX3、TNF-α、CRP、IL-6水平升高（P＜0.05）。Pearson检验显示，老年牙隐裂伴CP患者龈沟液PTX3与TNF-α、CRP、IL-6呈正相关（P＜0.05），龈沟液Melatonin与TNF-α、CRP、IL-6呈负相关（P＜0.05）。165例老年牙隐裂伴CP患者，根管治疗+全冠修复治疗结束后随访1年，失访3例，最终共162例患者完成随访。162例患者中成功122例、好转26例、失败14例，无效率为8.64%（14/162）。与有效组比较，无效组裂纹达髓底占比、探诊深度＞5 mm占比、PTX3水平显著升高（P＜0.05），Melatonin水平显著降低（P＜0.05）。多因素Logistic回归模型结果显示，裂纹深度达髓底、探诊深度＞5 mm、PTX3水平升高是老年牙隐裂伴CP患者治疗无效的危险因素（P＜0.05），Melatonin水平升高为其保护因素（P＜0.05）。ROC曲线显示，龈沟液Melatonin联合PTX3检测预测老年牙隐裂伴CP患者治疗无效的曲线下面积（AUC）、灵敏度、特异度为0.803、0.857、0.777。结论：龈沟液Melatonin水平降低、PTX3水平升高与老年牙隐裂伴CP患者炎症反应有关，且Melatonin水平越低、PTX3水平越高者治疗效果越差，Melatonin联合PTX3检测对于根管治疗+全冠修复治疗效果有较高的预测价值。

Study on the Relationship between Melatonin and PTX3 in Gingival Crevicular Fluid and Inflammatory Factors and Therapeutic Effects in Elderly Patients with Cracked Teeth and Chronic Pulpitis

ABSTRACT Objective: To explore the relationship between melatonin (Melatonin) and pentameric protein 3 (PTX3) in gingival crevicular fluid and inflammatory factors and therapeutic effects in elderly patients with cracked teeth and chronic pulpitis (CP). Methods: 165 elderly patients with cracked teeth and CP who were admitted to our hospital from June 2021 to June 2022 were selected as study group, and 100 healthy subjects who underwent orthodontic tooth extraction in our hospital during the same period were selected as control group. The levels of Melatonin, PTX3 and inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin (IL-6), C-reactive protein (CRP)] in gingival crevicular fluid were compared between two groups. The correlation between Melatonin, PTX3 levels and inflammatory factors in gingival crevicular fluid of elderly patients with cracked teeth and CP were analyzed by Pearson test. 165 elderly patients with cracked teeth and CP were followed up for 1 year after root canal therapy+full crown restoration. Patients were divided into effective group and ineffective group according to the treatment effect, the clinical data of two groups were compared. The influencing factors of ineffective treatment in elderly patients with cracked teeth and CP were analyzed by multivariate logistic regression model. The predictive value of Melatonin and PTX3 in gingival crevicular fluid for ineffective treatment in elderly patients with cracked teeth and CP were analyzed by receiver operating characteristic (ROC) curve. Results: Compared with control group, the level of Melatonin in gingival crevicular fluid in study group decreased (P<0.05), and the levels of PTX3, TNF-α, CRP and IL-6 increased (P<0.05). Pearson test showed that, PTX3 in gingival crevicular fluid was positively correlated with TNF-α, CRP and IL-6 in elderly patients with cracked teeth and CP (P<0.05), and Melatonin in gingival crevicular fluid was negatively correlated with TNF-α, CRP and IL-6 (P<0.05). A total of 165 elderly patients with cracked teeth and CP were followed up for 1 year after root canal therapy+full crown restoration, 3 patients were lost to follow-up, and a total of 162 patients completed follow-up. Of the 162 patients, 122 were successful, 26 were improved, and 14 were failed, the inefficiency rate was 8.64% (14/162). Compared with effective group, the proportion of cracks reaching the pulp floor, the proportion of probing depth>5 mm, and the level of PTX3 in ineffective group were significantly increased (P<0.05), and the level of Melatonin was significantly decreased (P<0.05). The results of multivariate Logistic regression model showed that, the crack depth reaching the pulp floor, the probing depth>5 mm, and the increase of PTX3 level were the risk factors for the ineffective treatment of elderly patients with cracked teeth and CP (P<0.05), and the increase of Melatonin level was the protective factor (P<0.05). The ROC curve showed that, the area under the curve(AUC), sensitivity and specificity of Melatonin combined with PTX3 in gingival crevicular fluid for predicting ineffective treatment in elderly patients with cracked teeth and CP were 0.803, 0.857 and 0.777 respectively. Conclusion: The decrease of Melatonin level and the increase of PTX3 level in gingival crevicular fluid are relate to the inflammatory response of elderly patients with cracked teeth and CP, and the lower the Melatonin level and the higher the PTX3 level, the worse the treatment effect, Melatonin combine with PTX3 detection has a high predictive value for the effect of root canal therapy+full crown restoration.