Periodontal therapy improved lipoprotein-associated phospholipase A2 and lipid levels in serum of chronic periodontitis subjects with hyperlipidemia

目的 观察牙周基础治疗对牙周炎伴高血脂患者血清脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,LP-PLA2)和血脂水平的影响,探讨通过牙周基础治疗降低高血脂患者心血管疾病风险的可能性.方法 选择40例慢性牙周炎伴高血脂患者[男性20例,女性20例,平均年龄(56.1±10.3)岁],对所有患者进行牙周基础治疗前和治疗后3个月的牙周临床指标、血清LP-PLA2水平、血脂水平及白细胞计数测定,治疗前后数据比较采用Wilcoxon符号秩检验或配对t检验,样本率的比较采用x2检验.结果 牙周基础治疗3个月后,牙周探诊深度[M(Q25,Q75)]从3.93(3.63,4.48) mm下降为2.47 (2.06,2.92) mm,临床附着丧失[M(Q25,Q75)]从5.14(4.51,5.46) mm下降为4.03(3.38,4.33) mm,菌斑指数[M(Q25,Q75)]从1.28(0.94,1.61)下降为0.77(0.65,1,13),探诊出血阳性位点百分比[M(Q25,Q75)]从99.82％(86.25％,100.00％)下降为33.49％(29.45％,43.30％),与治疗前相比差异均有统计学意义(P ＜0.001)；血清LP-PLA2水平[(30.06 ±9.96) mg/L]、血脂总胆固醇[M(Q25,Q75)][5.57(5.26,6.25) mmol/L]、三酰甘油[M(Q25,Q75)][1.79(1.55,2.01) mmol/L]水平及白细胞计数[M(Q25,Q75)][5.90(5.40,6.55)×103个/L]均较治疗前[分别为(23.80±14.76) mg/L、5.36(5.16,5.86) mmol/L、1.57 (1.34,1.79) mmol/L及5.45(5.13,5.80)×103个/L]显著降低(P＜0.01)；高密度脂蛋白水平[M(Q25,Q75)][1.23(1.13,1.53) mmol/L]较治疗前[1.12(0.97,1.49) mmol/L]显著升高(P=0.001).血清LP-PLA2水平的减低值(△LP-PLA2)与探诊深度的降低值(△PD)呈显著正相关(r=0.367,P=0.020).结论 牙周基础治疗对牙周炎伴高血脂患者血清LP-PLA2水平和白细胞计数有显著降低作用,同时还可改善高血脂人群的血脂水平；提示牙周基础治疗可能是降低高血脂伴牙周炎人群心血管风险的途径之一.Objective To observe the effect of non-surgical periodontal therapy on levels of lipoprotein-associated phospholipase A2 (LP-PLA2) and lipid profile markers in chronic periodontitis (CP)subjects with hyperlipidemia.Methods Forty CP subjects with hyperlipidemia (mean age 56.1 ± 10.3 years old,male 20,female 20) were enrolled.In addition to periodontal clinical parameters,serum concentrations of LP-PLA2,serum lipid profiles including total cholesterol (TC),triglyceride (TG),high-density lipoprotein(HDL),low-density lipoprotein (LDL),and white blood cell (WBC) counts were determined at baseline and 3 months after non-surgical periodontal therapy.Results After non-surgical periodontal therapy,all clinical parameters improved significantly [probing depth (PD):from 3.93 (3.63,4.48) mm to 2.47 (2.06,2.92) mm; clinical attachment loss:from 5.14(4.51,5.46) mm to 4.03 (3.38,4.33) mm; plaque index from 1.28 (0.94,1.61) to 0.77 (0.65,1,13) ; bleeding on probing percentage from 99.82％ (86.25％,100.00％) to 33.49％ (29.45％,43.30％) ; P ＜ 0.001.Levels of LP-PLA2,TC,TG and WBC counts were reduced significantly [LP-PLA2:from (30.06 ± 9.96) mg/L to (23.80 ± 14.76) mg/L,P =0.019; TC:from 5.57(5.26,6.25) mmol/L to 5.36(5.16,5.86) mmol/L,P =0.001 ; TG:from 1.79 (1.55,2.01) mmol/L to 1.57 (1.34,1.79) mmol/L,P ＜ 0.001 ; WBC counts:from 5.90(5.40,6.55) × 103 cell/L to 5.45(5.13,5.80) × 103 cell/L,P ＜0.001] ; HDL level increased significantly [from 1.12 (0.97,1.49) mmol/L to 1.23 (1.13,1.53) mmol/L,P =0.001] ; the reduction of LP-PLA2 (△LP-PLA2) was correlated with the reduction of PD (△PD) (r =0.367,P =0.020).Conclusions The results indicate that non-surgical treatment reduces systemic LP-PLA2 and WBC levels and improves lipid profiles.These results suggest that non-surgical periodontal therapy may reduce the risk of cardiovascular disease in some subjects with hyperlipidemia.国家自然科学基金; "十一五"国家科技支撑计划中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)0z16-104