與血清免疫球蛋白G有關的基因變異作為罹患牙周炎之危險因子的探討

The immunoglobulin G related genetic variations as risk factors in periodontitis

鍾先揚(Hsien-Yang Chung)

指導教授 ： 蔡吉政

高雄醫學大學/口腔醫學院/牙醫學研究所/博士(2003年)

摘要

本實驗的第一部份，首先檢測罹患不同類型之牙周炎的台灣病患，其血清免疫球蛋白G的濃度。其中包括50位慢性牙周炎的病患，30位廣泛性侵犯性牙周炎的病患，以及74位牙周健康的對照個體。四種免疫球蛋白G的濃度分別以enzyme-linked immunosorbent assay 測得。而其Gm (23) allotype 是正或負，則以radial immunodiffusion test決定。結果顯示以慢性牙周炎和年齡相類似的對照組相比較，免疫球蛋白G2高於對照組，其他3種免疫球蛋白G的濃度，則無差別。在廣泛性侵犯性牙周炎和小於等於25歲的對照組比較中，免疫球蛋白G1 和G2 的濃度在病患組，高於對照組，均具有統計學上的意義。另外Gm (23) allotype 是正或負，對各類型的牙周炎病患之免疫球蛋白G2 的濃度，並無統計學上的影響。故而本實驗發現，慢性牙周炎病患，在面對牙周致病菌的挑戰時，只有免疫球蛋白G2 的濃度會升高；但是在廣泛性侵犯性牙周炎的病患，其血清免疫球蛋白G1、 G2 的濃度，比年齡類似的對照組高。Gm (23) allotype對已成熟的廣泛性侵犯性或慢性的牙周炎病患的免疫球蛋白G2的濃度沒有影響。
在實驗的第二部份， 同一批台灣實驗群體的Gm (23) allotypes 及hFc?R IIa (CD32)/ hFc?R IIIb (CD16)之遺傳性型多形性，分別加以檢測，比較其在各不同類型之牙周炎病患中的分佈，並發掘相關之臨床意義。各個檢體的去氧核醣核酸先加以分離。其hFc?R IIa (CD32)/ hFc?R IIIb (CD16)之多形性，以PCR-based allele-specific oligonucleotide hybridization 決定。在所有的樣本中，為Gm (23+) allotype 者略高於85%；而在慢性牙周炎和對照組的比較，病患中有較多的Gm (23-) allotype者。在hFc?R IIa (CD32)/ hFc?R IIIb (CD16)之多形性分佈，3個組別之間並無統計學上的不同。但當以卡方檢定，Fc?R IIa中之R131對偶質的分佈，在廣泛性侵犯性牙周炎病患，高於慢性牙周炎的病患(P=0.01)。故而，Gm (23-) allotype可能作為罹患慢性牙周炎的危險因子。與慢性牙周炎比較起來，廣泛性侵犯性牙周炎雖然有較高的R131對偶質的分佈，但其臨床意義，尚無法確立。

關鍵字

牙周炎 ； 多形性

並列摘要

In the first part of this study, the serum immunoglobulin G (IgG) concentrations were examined in Taiwanese patients with different forms of periodontitis.
The serum levels of 4 IgG subclasses were determined by enzyme-linked immunosorbent assay and Gm (23) allotypes were verified by radial immunodiffusion test in 50 patients with chronic periodontitis (CP), 30 patients with generalized aggressive periodontitis (G-AgP), and 74 healthy controls.
The IgG2 levels were elevated with no differences in the concentrations of other 3 IgG subclasses in patients with CP compared with age-matched controls. However, in subjects equal to or younger than 35 years, levels of IgG1 and IgG2 were significantly elevated in patients with G-AgP compared with controls. Gm (23) allotypes were not correlated with the serum levels of IgG2 in either patient group.
It was concluded that microbial challenge might only provoke significant changes in systemic IgG2 response in patients with CP. However, in patients with G-AgP, IgG1 and IgG2 levels were increased when compared with age-matched controls. Gm (23) allotypes had no influence on IgG2 levels in well-established generalized CP or G-AgP.
In the second part of this study, the diversity of the distribution of Gm (23) allotypes and FcγR genotypes was investigated in the same Taiwanese group to examine their clinical significance.
Genomic DNA was harvested from each subject. The FcγR IIa (CD32) and IIIb (CD16) genotypes were determined by PCR-based allele-specific oligonucleotide hybridization.
The overall carrier rate of Gm (23+) allotype was higher than 85%, and Gm (23-) allotype was statistically overrepresented in patients with CP compared to the controls. There were no differences in the distributions of the 3 genotypes of FcγR IIa and IIIb among the 3 tested groups. The frequency of the R131 allele of the FcγR IIa polymorphisms was higher in G-AgP than CP (P=0.01) when R/ H allelic frequencies were examined by the chi square test.
It was concluded that Gm (23-) allotype might be a potential risk factor for CP. Although the R131 allele of FcγR IIa occurred more frequently in G-AgP than CP, its clinical significance could not be justified in this study.

並列關鍵字

periodontitis ； Gm(23) ； FcrR ； polymorphism

參考文獻

參考文獻

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