懷孕婦女牙周狀況與牙齦溝液PGE2、IL-1β、TNF-α和血液中PGE2、TNF-α以及脂溶性抗氧化維生素含量之相關性

The relationships among periodontal conditions, the levels of PGE2、IL-1β、TNF-α in gingival crevicular fluid and the levels of PGE2、TNF-α、fat-soluble antioxidant vitamins in peripheral blood of pregnant women

蘇筌瑋(Chuan-Wei Su)

指導教授 ： 蔡吉政 ； 洪信嘉

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2005年)

摘要

引言：研究證實孕婦的牙周病是造成體重不足早產兒的一大危險因子，也有許多假設推論牙周病造成體重不足早產兒發生的機轉，另一方面，營養素的攝取可能透過影響發炎反應的相關機轉(PGE2, IL-1?狺垌NF-?悛熔ㄔ?)，進而影響到牙周疾病及新生兒體重不足早產兒發生兩者之相關性，本研究主要的目的在於討論脂溶性抗氧化劑vitamin A、E是否能夠對於孕婦在懷孕期間以及牙周疾病方面相關調控的促炎性細胞激素造成影響。研究方法：本研究收集68位參加本研究的孕婦前後孕期(第一、第三孕期或第二、第三孕期)之牙齦溝液及血漿檢體，以ELISA檢測牙齦溝液及血漿中之PGE2、IL-1β和TNF-α，並另外將第三期的血檢體額外以HPLC檢測脂溶性抗氧化維生素的含量，並分析彼此之間的關係。結果：臨床牙周指數(平均GI、PD、CAL、BOP%)與收集30秒牙齦溝液中PGE2、IL-1β的總量呈顯著的正相關(P<0.05)；血液中TNF-α的濃度和臨床牙周指數中的平均PD(r=0.24,p=0.01)、平均CAL(r=0.26,p=0.01)以及牙齦溝液中PGE2的總量(r=0.22,p=0.03)呈顯著正相關；維生素方面：我們發現牙齦溝液中PGE2的總量與血液中retinol(r=-0.34,p=0.02)與total vitamin E(r=-0.34,p=0.02)【其中α-tocopherol(r=-0.32,p=0.03)，δ-tocopherol(r=-0.32,p=0.03)】成顯著負相關，而血液中TNF-α的濃度也與retinol(r=-0.54,p=0.0001)成顯著負相關。本研究發現血液中TNF-α的濃度和牙齦溝液中的PGE2可能與脂溶性抗氧化維生素是有關的，它們之間是否有因果關係，還需要進一步的研究來探討。

關鍵字

體重不足早產兒 ； 牙周病 ； 牙齦溝液 ； 細胞激素 ； 血漿 ； 血液 ； TNF-α ； IL-1β ； PGE2 ； 脂溶性抗氧化維生素

並列摘要

Increase of inflammatory mediators related to periodontal disease is a potential pathway to explain the association between periodontal disease and several systemic diseases, especially preterm low-birth weight (PLBW). Several antioxidative vitamins are considered as protective supplement for pregnancy women through their ability to inhibit the production of these mediators. Hence, in this study, we evaluate the associations among periodontal status and PGE2, IL-1β, TNF-α levels in GCF and Blood first. Then, further compare the relationship of this result with levels of retinol, lycopene, α-, β-carotene and α-, γ-, δ-tocopherol in blood.
We recruited sixty-eight pregnant women, who received a full-mouth clinical periodontal examination at early and late trimesters (1st and 3rd trimester or 2nd and 3rd trimesters). GCF samples were collected at the same time as oral examinations and blood samples were collected within one month after oral examinations. the PGE2, IL-1β, TNF-α in GCF and plasma were assayed using commercial ELISA kits and 48 3rd trimesters plasm sample were additionally sent to HPLC assay for antioxidant vitamins.
We found that the periodontal clinical parameters (mean GI, PD, CAL, BOP%) were associated with the total amount of PGE2, IL-1β and mean CAL with TNF-α (p<0.05). The plasma levels of TNF-α concentration was significant associated with mean PD (r=0.24, p=0.01), mean CAL ( r=0.26, p=0.01)and the total amount of PGE2 (r=0.22, p=0.03). There was no significant relation between clinical parameters, total amount of PGE2, IL-1β and TNF-α in 30-second GCF samples and the concentration of plasma- PGE2 (p > 0.05). For vitamins, we found total amount of PGE2 was negatively associated with plasma levels of retinol (r=-0.34, p=0.02) and total vitamin E (r=-0.34, p=0.02)【α-tocopherol (r=-0.32, p=0.03) and δ-tocopherol (r=-0.32, p=0.03)】. TNF-α concentration in plasma was significantly related to retinol (r=-0.54, p=0.0001).
Conclusion: the results of this study showing that the periodontal status was associated with local level of PGE2, IL-1β, TNF-α and local level of PGE2 were also related to systemic level of TNF-α in blood suggest that chronic inflammatory status might play an important role linking oral health and systemic disease. Retinol and vitamin E might inhibit the production of inflammatory mediators resulting for periodontal status. Further longitudinal studies conducted with large sample size are needed to clarify the causal association.

並列關鍵字

tocopherol ； retinol ； vitamin E ； PLBW ； periodontitis ； GCF ； TNF-α ； IL-1β ； PGE2

參考文獻

1. Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, McKaig R, Beck J: Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 67(10 Suppl):1103, 1996.

2. Madianos PN, Lieff S, Murtha AP, Boggess KA, Auten RL, Jr., Beck JD, Offenbacher S: Maternal periodontitis and prematurity. Part II: Maternal infection and fetal exposure. Ann Periodontol 6(1):175, 2001.

3. Lopez NJ, Smith PC, Gutierrez J: Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized controlled trial. J Periodontol 73(8):911, 2002.

4. Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC: Periodontal infection and preterm birth: results of a prospective study. J Am Dent Assoc 132(7):875, 2001.

5. Romero R, Baumann P, Gomez R, Salafia C, Rittenhouse L, Barberio D, Behnke E, Cotton DB, Mitchell MD: The relationship between spontaneous rupture of membranes, labor, and microbial invasion of the amniotic cavity and amniotic fluid concentrations of prostaglandins and thromboxane B2 in term pregnancy. Am J Obstet Gynecol 168(6 Pt 1):1654, 1993.