探討伴放線桿菌血清型態與牙周疾病之關係

The Relationship Between Actinobacillus actinomycetemcomitans Serotypes and Periodontal Condition

楊惠雯(Hui-Wen Yang)

指導教授 ： 周明勇

中山醫學大學/醫學院/醫學研究所/博士(2006年)

https://doi.org/10.6834/CSMU.2006.00043

摘要

到目前為止，並沒有任何一個研究是利用新的牙周病分類準則來探討伴放線桿菌五種血清型態與牙周疾病分類之關係。本研究的第一部份是要利用舊的牙周病分類與新的牙周病分類，來探討從北美地區不同型態之牙周病病患的口腔中所取得之牙齦下牙菌斑可培養出的伴放線桿菌，其五種血清型態的分佈頻率；並研究血清型態與年齡或臨床診斷間有無相關性存在。第二部份是探討在台灣地區年輕族群（35歲以下）中患有侵犯性牙周病、慢性牙周病之患者與牙周健康者，其伴放線桿菌血清型態在牙齦下牙菌斑樣本出現之盛行率及比例。在第一部份本研究總共收集來自115位可培養出伴放線桿菌的345菌種，病患之平均年齡為38.0±18.3歲，其中女性佔59%。根據新的牙周病分類準則，33位屬於侵犯性牙周病患者、82位屬於慢性牙周病患者；若根據舊的牙周病分類準則，則6位屬於青春前期牙周病、12位屬於局部性年輕型牙周病、15位屬於年輕後期型牙周病、28位屬於頑強型牙周病、54位屬於成年型牙周病。在第二部份本研究總共收集221個牙齦下牙菌斑樣本，其中171個來自牙周病患（70位為侵犯性牙周病、101位為慢性牙周病），病患平均年齡為25.0±8.2歲；50個來自牙周健康者，平均年齡為18.4±9.5歲。以間接免疫螢光分析法，利用對伴放線桿菌菌種ATCC 29523（血清型態a）、ATCC 43728（血清型態b）、ATCC 33384（血清型態c）、IDH 781（血清型態d）和IDH 1705（血清型態e）有血清型態專一性的多株抗血清來決定伴放線桿菌之血清型態。在第一部份以Chi square檢定檢視血清型態b在不同診斷與年齡分組間之關係。結果發現大部分之病患為單一血清型態，其中22位為血清型態a、44位為血清型態b、30位為血清型態c、1位為血清型態d、3位為血清型態e。11位病患同時具有兩種不同的血清型態，2位病患同時具有三種不同的血清型態，另有2位病患之血清型態無法被鑑定。雖然血清型態b與年齡之相關性不大，但血清型態b仍是18歲以下之小孩子以及年齡介於19歲至35歲之間的年輕成年人病患最主要之血清型態。血清型態d和血清型態e不會出現在年齡小於35歲的病患，但在62位年齡大於35歲之成年人病患，則分別可發現1個血清型態d和3個血清型態e。血清型態b為侵犯性牙周病患最主要之血清型態(60.61%)且血清型態b在侵犯性牙周病患出現之頻率明顯高於慢性牙周病患(P<0.01)。血清型態d和血清型態e則不會出現在任一位侵犯性牙周病之病患。血清型態a (20.73%)、血清型態b (29.27%)與血清型態c (28.05%)在慢性牙周病患之分佈頻率差不多。血清型態b為青春前期牙周病患(50.00%)、局部性年輕型牙周病患(66.67%)與年輕後期型牙周病患(60.00%)最主要之血清型態。在第二部份以單因子變異數分析(ANOVA)計算伴放線桿菌在各種診斷分組之盛行率及比例。結果發現伴放線桿菌之盛行率在侵犯性牙周病患為84.3%、在慢性牙周病患為60.4%、在牙周健康者為64.0%。伴放線桿菌之比例在牙周健康者（0.55±0.08%）明顯低於侵犯性牙周病患（1.05±0.15%）（P<0.05）；而在慢性牙周病患，其伴放線桿菌之比例也明顯低於侵犯性牙周病患(P<0.05)。血清型態b之比例在侵犯性牙周病患（0.66±0.14%）與慢性牙周病患（0.43±0.11%）均明顯高於牙周健康者（0.02±0.01%）(P<0.05)。血清型態c之比例在牙周健康者（0.46±0.08%）顯著高於慢性牙周病患（0.15±0.04%）(P<0.01)。至於血清型態a在三種不同牙周狀況下之比例則沒有任何之顯著差異存在。
綜合兩部分之研究結果可以發現，在北美地區伴放線桿菌血清型態b為侵犯性牙周病患最主要之血清型態，在慢性牙周病患則血清型態b與血清型態c之分佈頻率差不多。在台灣地區年輕族群中，血清型態b為侵犯性牙周病患與慢性牙周病患最主要之血清型態，而血清型態c則較常出現於牙周健康者。

關鍵字

伴放線桿菌 ； 間接免疫螢光 ； 血清型態 ； 侵犯性牙周病 ； 慢性牙周病

並列摘要

To our knowledge, the association of the five serotypes of Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans) to the new diagnostic classification scheme described by the American Academy of Periodontology in 1999 has not yet been described. The purpose of this part I study was to characterize the frequencies of the five serotypes of A. actinomycetemcomitans in A. actinomycetemcomitans isolates from various forms of periodontitis using both old and new diagnostic classifications and to determine the relationships between serotype and age and clinical diagnosis. The purpose of this part II study was to investigate prevalence and proportions of A. actinomycetemcomitans serotypes in subgingival plaque samples from a young Taiwanese population with aggressive periodontitis, chronic periodontitis and no periodontal disease. A total of 345 A. actinomycetemcomitans isolates from 115 A. actinomycetemcomitans culture positive subjects (mean age 38.0 ± 18.3 years, 59% female) were collected from part I study. Based on the new classifications, 33 subjects had aggressive periodontitis and 82 chronic periodontitis. According to old classifications, there were six pre-pubertal periodontitis (PPP), 12 localized juvenile periodontitis (LJP), 15 post-localized juvenile periodontitis (PLJP), 28 refractory periodontitis (Ref-P), and 54 adult periodontitis (AP) cases. A total of 221 subgingival plaque samples from 171 diseased subjects (70 had aggressive periodontitis, and 101 had chronic periodontitis) (mean age 25.0 ± 8.2 yr) and 50 periodontally healthy subjects (mean age 18.4 ± 9.5 yr) were screened for A. actinomycetemcomitans from part II study. Serotypes of A. actinomycetemcomitans were determined by an indirect immunofluorescence assay using serotype-specific polyclonal antisera to A. actinomycetemcomitans strains ATCC 29523, ATCC 43728, ATCC 33384, IDH 781 and IDH 1705 (serotype a, b, c, d, and e, respectively). Proportions of serotype b were examined between different diagnostic and age groups with a Chi square test. Most subjects (n = 100, 86.96%) were infected with a single serotype (22 serotype a, 44 serotype b, 30 serotype c, 1 serotype d and 3 serotype e). There were 11 subjects (9.57%) with two serotypes and two subjects (1.74%) with 3 serotypes. Two individuals had isolates lacking any detectable serotype antigen. Serotype b was the predominant serotype in children under 18 years of age and young adults between 19 to 35 years, although serotype b status was not significantly associated with age. Serotypes d and e were not found in patients under 35 years old. In 62 adult patients, one subject had serotype d and three had serotype e. Serotype b was the most common serotype in aggressive periodontitis (60.61%). The proportion of cases with serotype b was significantly higher in aggressive periodontitis compared to chronic periodontitis (P<0.05). Other serotypes were not significantly associated with new diagnostic categories. Serotypes d and e were not detected in aggressive periodontitis. The results of this part II study show that proportions of serotype b of A. actinomycetemcomitans are significantly greater in culture-positive patients with aggressive periodontitis than those with chronic periodontitis. Prevalence (% of positive samples) of A. actinomycetemcomitans was 84.3% in aggressive periodontitis, 60.4% in chronic periodontitis, and 64.0% in periodontally healthy subjects. Proportions of A. actinomycetemcomitans (mean percentage per total bacteria) in periodontally healthy subjects were significantly lower than in aggressive periodontitis subjects. The proportion of serotype b in subjects with aggressive periodontitis and subjects with chronic periodontitis were significantly greater than that in periodontally healthy subjects. The proportion of serotype c in periodontally healthy subjects was much higher than that in chronic periodontitis subjects. The results of this study suggest that prevalence and proportions of A. actinomycetemcomitans are significantly greater in patients with aggressive periodontitis than in those with chronic periodontitis. Serotype b is the predominant serotype of A. actinomycetemcomitans in patients with diseased periodontal conditions. Serotype c is a more common serotype detected in periodontally healthy subjects.

並列關鍵字

Actinobacillus actinomycetemcomitans ； indirect immunofluorescence ； serotype ； aggressive periodontitis ； chronic periodontitis

參考文獻

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