慢性牙周病患者經不同非手術性治療模式治療後之成效比較，以及成效與唾液中基質金屬蛋白酶之改變量的相關性

Comparisons in Treatment Outcomes of Chronic Periodontitis between Two Nonsurgical Periodontal Treatment Protocols and Their Correlations with Saliva Levels of Matrix Metalloproteinases

李敏綱(Min-Kang Lee)

指導教授 ： 林英助

高雄醫學大學/口腔醫學院/牙醫學系碩士班/碩士(2019年)

摘要

研究目的: 比較兩種非手術性牙周炎治療計畫，牙周炎病患在治療前後的臨床牙周健康指標與基質金屬蛋白酶 (matrix metalloproteinases (MMP-8 and MMP-9) 的量有無不同，以及臨床牙周健康指標與基質金屬蛋白酶濃度在治療前後變化的相關性。
材料與方法: 慢性牙周炎病患依就診的時間序列，隨機分配到兩種不同模式的全口牙結石刮除合併牙根整平術接受治療 ，分別為分次性組 (n = 10) 及一次性組 (n = 9)，最後共有19位病患納入研究。資料收集包含治療前及治療後一個月的非刺激性全口唾液 、全口牙周囊袋探測深度 (probing pocket depth；PPD)、臨床附連水平 (clinical attachment level；CAL)、探測出血百分比 (percentage of bleeding on probing；BoP%)、牙菌斑百分比 (percentage of plaque；PI%) 等，並在治療後一周也收集唾液及測定牙菌斑百分比，之後以酵素聯結免疫吸附試驗測定唾液中的基質金屬蛋白酶濃度。所有資料經整理建檔後以無母數統計方法進行分析，比較其相關性。
結果: 研究發現，分次性組與一次性組在各項牙周臨床指標與基質金屬蛋白酶（MMP-8和MMP-9）濃度的治療前、治療後一周及一個月皆無顯著差異。但在治療後一個月相對治療前的改變量，分次性組在PPD下降量 (17.10 ± 8.80% vs. 9.10 ± 4.97% ，p = 0.03) 及PPD≥7mm的牙齒百分比下降量 (61.99 ± 25.41 % vs. 20.94 ± 33.40 %，p < 0.01) 比一次性組顯著下降較多。臨床指標中的PI%、BoP%、PPD、PPD≥5mm的百分比及CAL等指標在治療後一個月比起治療前，兩組皆有顯著下降。而在MMP濃度中，分次性和一次性治療兩組的唾液MMP-9 (p < 0.01) 和MMP-8 (p < 0.01) 的唾液濃度在治療後一個月與治療前相比皆有顯著下降。，此外只在分次性組觀察到治療後一周與治療前相比有顯著下降 (p = 0.04)。相關性分析發現，經過治療後一個月，患者唾液中的 MMP-8和 MMP-9濃度改變量於分次性組 (ρ = 0.70，p = 0.03) 和一次性組 (ρ = 0.67，p = 0.05) 皆有顯著正相關。而在治療後一個月，發現MMP-9濃度的下降量在分次性組中BOP% (ρ = 0.70，p = 0.02) 的下降量有顯著正相關，在一次性組中則與PPD≥7mm% (ρ = 0.68，p = 0.04)、PPD (ρ = 0.86，p < 0.01) 和CAL (ρ = 0.83，p = 0.01) 的下降量有顯著正相關，而MMP-8的濃度下降量則與臨床指標改變量在兩組中皆無相關。合併兩組擴大樣本數來看，MMP-9濃度下降量和PPD≥5mm% (ρ = 0.51，p = 0.03) 和CAL (ρ = 0.55，p = 0.02) 下降量有顯著正相關，然而在MMP-8濃度下降量與臨床數值改變量依然沒有觀察到任何顯著的相關性。
結論: 臨床牙周健康指標和MMP濃度在分次性和一次性全口牙結石刮除合併牙根整平術治療後皆有顯著性的改善，但在不同階段的比較，兩組間皆沒有顯著差異。在牙周囊袋探測深度與囊袋深度≥7mm之牙齒百分比的下降量比較，顯示分次性治療較能更有效降低較深的囊袋深度，不論是不同分組或合併兩組，MMP-9濃度下降量比起MMP-8濃度下降量與臨床指標的改變量相關性較明顯，但受限於樣本數和追蹤時間只有一個月，未來仍需要更多的研究來驗證。

關鍵字

分次性及一次性全口牙結石刮除合併牙根整平術 ； 非刺激性全唾液 ； 基質金屬蛋白酶8和9

並列摘要

Objectives: Our aims are to investigate the differences and correlations in periodontal clinical index and the levels of matrix metalloproteinase 8 and 9 (MMP-8 and MMP-9) between two different therapeutic strategies of periodontal non-surgical treatment in patient with chronic periodontitis (CP).
Material and methods: A total of 19 CP patients were enrolled and randomly assigned into two groups (quadrant-wise scaling and root planning group (Q-SRP) and one-stage SRP group (FM-SRP), respectively) according to the order of their clinical visit. Non-stimulated whole saliva, data of probing pocket depth (PPD), clinical attachment level (CAL), percentage of bleeding on probing (BoP%) and percentage of plaque (PI%) were collected before and after the treatment at one week and at one month. Saliva samples were analyzed using enzyme-linked immunosorbent assay (ELISA) to obtain the concentrates of MMP-8 and MMP-9. Data were analyzed using nonparametric statistical analysis (SPSS V22.0).
Results: Clinical dental parameters and levels of MMP-8 (p < 0.01) and MMP-9 (p < 0.01) were significant improved after SRP treatment but no such differences were found between Q-SRP and FM-SRP groups at baseline and post treatment 1 week and 1 month. After treatment at one month, Q-SRP group had significantly higher reduction both in PPD and in the percentage of tooth sites with PPD≥7mm than FM-SRP group had (17.10 ± 8.80 % vs. 9.10 ± 4.97 %, p = 0.03; 61.99 ± 25.41 % vs. 20.94 ± 33.40 %, p < 0.01). The PI%, BoP%, PPD, tooth sites with PPD≥5mm% and CAL were significantly decreased at post treatment 1 month in both groups. In addition, the level of MMP-8 was also significantly decreased at post
treatment 1 week in Q-SRP group (p = 0.04). The changes of MMP-8 and MMP-9 levels between baseline and 1 month after the treatment were significantly positive correlated with each other in both groups (Q-SRP: ρ = 0.70, p = 0.03 ; FM-SRP: ρ = 0.67, p = 0.05). In Q-SRP group, a significantly positive correlation between changes of MMP-9 levels and BoP% was found (ρ = 0.70, p = 0.02). In FM-SRP group, significantly positive correlations between tooth sites with PPD≥7mm% (ρ = 0.68, p = 0.04), PPD (ρ = 0.86, p < 0.01), and CAL (ρ = 0.83, p = 0.01) and changes of MMP-9 levels were found. After combining two groups, there was a significantly positive correlations between changes of MMP-9 levels and tooth sites with PPD≥5mm% (ρ = 0.51, p = 0.03) and decrease in CAL (ρ = 0.55, p = 0.02). However, no such significantly correlation was found between changes of MMP-8 levels and clinical parameters in each groups.
Conclusion: These study results indicated that significant improvement in clinical parameters and saliva levels of MMP-8 and MMP-9 after the treatment were found in both groups, and no significant difference was found between these two groups. The improvement in PPD was significant higher in Q-SRP group, especially in tooth sites with PPD≥ 7mm%. Compared to MMP-8, the change of salivary MMP-9 level was a better indicator to correlate with the changes of clinical parameters in both groups post treatment at 1 month. However, it needs more studies to verify the relationships.

並列關鍵字

quadrant-wise scaling and root planning (Q-SRP) ； one-stage full mouth scaling and root planning (FM-SRP) ； non-stimulated whole saliva ； matrix metalloproteinase 8 and 9 (MMP-8 and MMP-9)

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