牙周病人牙齦溝液乳酸去氫酶活性的評估

An Evaluation of the Lactate Dehydrogenase Activity in Gingival Crevicular Fluid of Patient with Periodontitis

劉明德(Min-Der Liou) ； 蔡吉政(Chi-Cheng Tsai)

《The Kaohsiung Journal of Medical Sciences》 4卷1期 (1988/01) Pp. 41-52

https://doi.org/10.6452/KJMS.198801.0041

摘要

本研究主要目的乃探討牙周病患者與正常人牙齦溝液 (gingival crevicular fluid，GCF)乳酸去氫酶 (lactate dehydrogenase，LDH)的活性，同時也探討牙周患者治療前與治療後，乳酸去氫酶的活性變化。本實驗共收集20位受檢者的資料，其中控制組5位，皆具健康之牙齦組織，且其臨床上並無可見之發炎現象存在 (GI＝0，PLI＜1，PD≦3 ㎜)，共收集30支牙齦溝液檢體。另外15位則為實驗組，其皆為臨床上X光檢查具有明顯齒槽骨破壞的牙周病患者，本組共取110支牙齦溝液檢體，而在經過一個月的非手術性牙周病治療後，又做同一位置的取樣。依其囊袋測深度 (probing depth，PD)的不同將實驗組又分為三群(group 1：PD＝1～3㎜，group 2：PD＝4～6㎜，group 3：PD＞6㎜)。此外又將所有檢體，依牙齦指數 (gingival index，GI)和菌斑指數 (plaque index，PLI)來加以分群。牙齦溝液的收集則利用濾紙條來做30秒的牙齦溝內收集，再由Periotron 6000來測其量。乳酸去氫酶的活性分析，則利用分光光度計 (spectrophotometer)來測定。本研究結果顯示實驗組患者牙齦溝液乳酸去氫酶的總單位活性 (total unit activity) (0.017±0.002～0.042±0.002 IU/30-S)皆較控制組 (0.009±0.001 IU/30-S)來的高 (p＜0.01)，同時當實驗組患者在接受過非手術性的牙周治療後，其牙齦溝液乳酸去氫酶的總單位活性也皆有明顯減少的現象 (p＜0.01)。但是對於乳酸去氫酶的單位體積活性 (volume activity)而言，則除了 group 3 (PD＞6㎜)外，控制組與實組之間並無統計學上的差異，而於實驗組治療前及治療後之比較時，雖然顯示治療後單位體積活性有增加的趨勢，但它們之間皆不具統計學上的差別 (p＞0.05)。本研究同時發現乳酸去氫酶的總單位活性與臨床參數 (clinical parameters)之間，除了菌斑指外具較高的相關關係。因此乳酸去氫酶的活性變化，可對疾病的進展提供一敏感且客觀的診斷輔助。另外本研究發現牙齦溝液乳酸去氫酶的單位體積活性遠高於血清中的濃度，約在180～575倍的範圍。然而血清乳酸去氫酶單位體積活性在控制組與實驗組之間以及實驗治療前後之間並無明顯差別。

並列摘要

The aim of this study was to investigate the lactate dehydrogenase (LDH) activity in gingival crevicular fluid (GCF) from the periodontally healthy individuals and patients with periodontitis before and after therapy. Twenty subjects were evaluated in this study. Five subjects (control group) had essentially normal gingiva and free of any clinically detectable gingival inflammation (GI＝0, PLI＜1, PD≦(3 mm). Gingival crevicular fluid was collected from 30 sites in this control subjects. An additional fifteen subjects (experimental group) were classified as having periodontitis defined by loss of alveolar bone on radiographic examination. One hundred and ten sites from patients with periodontitis were examined before and one month after nonsurgical periodontal therapy. Two hundred and twenty sites from the experimental group were further divided into three probing depth groups (group 1: PD＝1－3 mm, group 2: PD＝4－6 mm, group 3: PD＞6 mm). A total of 250 sites were also divided into four groups either by gingival index or by plaque index. Gingival crevicular fluid was harvested with a 30-second collection by filter paper strip from the gingival sulcus and periodontal pockets. A calibration graph was constructed for the Periotron 6000 to determine the actual volume of GCF on each filter strip. LDH activity was assayed by using spectrophotometer at 340 nm. Our results showed that the total unit activity (IU/30-s) of LDH in GCF was higher in periodontitis (0.017±0.002 IU/30-s－0.042±0.002 IU/30-s) than in control (0.009±0.001 IU/30-s) (p＜0.01). There was also a significant decrease in total unit activity of LDH in GCF from the patients with periodontitis after nonsurgical therapy. Nevertheless, when calculated on the basis of concentration (volume activity, IU/1), aside from that of group 3 (PD＞6 mm), there was no significant difference between control group and experimental group (p＞0.05). There was a tendency for the enzyme to be higher concentration after periodontal therapy, but it did not show any significant difference among the experimental groups. With the exception of plaque index, we found a higher correlation in total unit activity of LDH with the clinical parameters. Analysis of the relationship between clinical parameters and enzyme activity/30-s sample suggests a modest, but not absolute correlation between increasing severity of pathology (probing depth, GI and GCF value) and an increased amount of enzyme in the GCF samples. Investigating the change of the activity of lactate dehydrogenase in GCF could be served as an objective and sensitive diagnostic aid for disease process. In addition, we showed that the LDH activity (IU/1) in GCF was about 180 to 575 times greater than that in serum of control and experimental groups. There was no significant difference of LDH in serum volume activity between control group and experimental groups and between the initial and post-therapy data from experimental group.

並列關鍵字

gingival crevicular fluid ； lactate dehydrogenase