牙周病治療對於血清中發炎指數及自體免疫指數改變的影響

The Influence of Periodontal Therapy on Serum Inflammatory Markers and Autoimmune Antibody Titers

楊甯雅(Ning-Ya Yang)

指導教授 ： 陳漪紋

國立臺灣大學/牙醫專業學院/臨床牙醫學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.03172

摘要

牙周病與類風溼性關節炎皆為慢性發炎疾病，並共享類似的免疫發炎模式，造成了骨頭及周圍組織的破壞，使功能受損。類風溼性關節炎的成因相當多，包括基因、環境、賀爾蒙及細菌的感染。P. gingivalis 是慢性牙周炎主要致病菌之一，也是目前已知唯一會表現peptidyl-arginine deiminase(PPAD) 的原核生物，可將人類的蛋白質瓜胺酸化，就有可能使得一些易感性的宿主對瓜胺酸化蛋白質的免疫容忍度降低，產生抗環瓜胺酸肽抗體(anti-cyclic citrullinated peptide antibody; ACPA)，造成後續一連串的自體免疫反應發生，就有可能影響類風濕性關節炎的病程及疾病活性。
本研究的目的主要是想了解，在經過非手術性牙周病治療的牙周病病人(其中有5位為抽菸患者)，其血清中自體免疫抗體(ACPA、RF)、發炎因子(TNF-α、CRP、IL-1β、IL-6、MMP-3)及牙周病菌抗體(A. actinomycetemcomitans, P. intermedia, T. denticola, T. forsythia和F. nucleatum)的變化。分析治療前與治療後牙周狀況與血清中發炎因子、抗體的改變量，及治療前牙周狀況與血清中發炎因子與抗體間的相關性。
實驗方法則是分別收集31位牙周病患者在牙周治療前與後的血清，以酵素免疫分析法(ELISA)檢測血清中的自體免疫抗體、發炎因子及牙周病細菌抗體的量。
在本研究中，牙周病治療可有效降低F. nucleatum抗體量、ACPA和TNF-α，尤其在中重度牙周病患者的治療效果尤佳。拔除掉嚴重牙周病患齒的數量，也分別和ACPA及IL-1β的下降量呈正相關。說明了改善牙周病感染的狀況，會影響全身性的發炎狀況和自體免疫抗體產生的情形。抽菸病人對於牙周病治療的效果良好，但在改善ACPA及TNF-α的效果就相當有限。
總括，類風濕性關節炎的病人，甚至是類風溼性關節炎高危險群的病人，都應該要重視並接受牙周病的檢查和治療，並且維持口腔的清潔與衛生，以降低類風溼性關節炎的嚴重度。

關鍵字

牙周病 ； 類風溼性關節炎 ； 抗環瓜胺酸肽抗體 ； 腫瘤壞死因子 ； P. gingivalis ； F. nucleatum

並列摘要

Introduction: Chronic periodontitis and rheumatoid arthritis are the most common chronic inflammatory disease. They share a common immunoinflammatory profile, and demonstrate remarkably similar patterns of soft and hard tissue destruction. The pathogenesis of rheumatoid arthritis is complex, and there is a combination of genetic, environmental, hormonal, and infectious co-factors. It has been reported that serum anti-cyclic citrullinated peptide antibody(ACPA) titers and rheumatoid factor antibodies(RF) are significantly higher in the RA patients. P. gingivalis, a major periodontopathic bacteria, expresses peptidylarginine deimiase(PPAD) that mediates post-translational conversion of arginine to citrulline. We hypothesize that P. gingivalis infection might induce autoimmunity and is associated with elevated anti-CCP antibody titers in susceptible individuals. The aim of this study was to evaluate the effect of non-surgical periodontal treatment on serum inflammatory marker levels and autoimmune antibody titers.
Materials and Methods: 31 Taiwanese adults with chronic periodontitis were recruited from the dental clinic of National Taiwan University Hospital. Clinical periodontal examinations including probing depth (PD), clinical attachment level (CAL) and tooth number were performed. All subjects received full-mouth scaling and root planing within one month. Serum samples were collected before and 6-8 weeks after periodontal treatment. ACPA, RF, TNF-α, CRP, IL-1β, IL-6, MMP-3 and periodontopathic bacteria antibodies, including A. actinomycetemcomitans, P. intermedia, T. denticola, T. forsythia and F. nucleatum, were measured by ELISA method. Wilcoxon signed-rank test and Spearman’s rank correlation coefficient were used for statistics.
Results: After non-surgical periodontal treatment, patients showed significant reduction in percentage of PD, serum anti-F. nucleatum antibody titers, ACPA titers, and TNF-α levels, especially in moderate to severe periodontitis group. Besides, the number of extracted teeth was positively correlated with decreasing of ACPA and IL-1β serum levels separately. In smokers, the periodontal therapy improved the periodontal health, but had a limitation effect on inflammatory markers and autoimmune antibodies.
Conclusions: Periodontitis may affect systemic inflammation and autoimmune conditions. The periodontal therapy might improve the ACPA titers in rheumatoid arthritis patients. Therefore, the rheumatoid arthritis susceptible patients should pay more attention to oral hygiene and periodontal health in order to control disease activity.

並列關鍵字

chronic periodontitis ； rheumatoid arthritis ； ACPA ； TNF-α ； P. gingivalis ； F. Nucleatum

參考文獻

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