牙髓牙周病变患者感染根管的主要致病菌及其影响因素分析

Pathogen profile and contributing factors of root canal infections in patients with pulp and periodontal diseases

摘要:

目的 探讨牙髓牙周病变患者感染根管的主要致病菌及其影响因素分析。方法 选取2020年2月—2021年8月成都大学附属医院收治的88例牙周牙髓病变患者，根据是否根管感染分组为感染组（38例）和未感染组（50例）。分析感染患者病原菌的分布构成，采用单因素和多因素一般Logistic回归分析影响感染的危险因素。比较两组患者血清和龈沟液白细胞介素-1β（IL-1β）、干扰素-γ（IFN-γ）水平，并采用受试者工作特征曲线分析IL-1β、IFN-γ水平对根管感染的诊断效能。结果 88例患者中感染38例（43.18%），共检出46株病原菌，其中革兰阳性菌28株（60.87%），包括葡萄球菌属（21.74%）、微单胞菌（17.39%）、粪肠球菌（13.04%）、放线菌（4.35%）及其他革兰阳性菌（4.35%）；革兰阴性菌18株（39.13%），包括中间普氏菌（15.22%）、福塞类杆菌（10.87%）、牙龈卟啉单胞菌（4.35%）、产黑普雷沃菌（4.35%）及其他革兰阴性菌（4.35%）。两组患者性别构成、年龄、体重指数、收缩压、舒张压比较，差异均无统计学意义（P >0.05）。感染组刷牙时间< 3 min、刷牙次数1次、喜食甜食、龋牙占比高于未感染组，血清和龈沟液中IL-1β和IFN-γ水平高于未感染组（P <0.05）。多因素一般Logistic回归分析结果显示：刷牙时间< 3 min［O^R=1.950（95% CI：1.116，3.410）］、刷牙次数1次［O^R=2.192（95% CI：1.100，4.371）］、喜食甜食［O^R=1.754（95% CI：1.081，2.847）］、龋牙［O^R=2.252（95% CI：1.166，4.352）］、血清IL-1β ≥ 7.69 ng/mL［O^R=1.842（95% CI：1.195，2.841）］、龈沟液IL-1β ≥ 22.59 ng/mL［O^R=1.519（95% CI：1.032，2.235）］、血清IFN-γ ≥ 11.73 ng/mL［O^R=1.701（95% CI：1.147，2.522）］、龈沟液IFN-γ ≥ 8.33 ng/mL［O^R=1.495（95% CI：1.032，2.165）］均是根管感染的危险因素（P <0.05）。龈沟液IL-β为22.59 ng/mL时曲线下面积最高，为0.850（95% CI：0.763，0.937），血清IL-β为7.69 ng/mL时敏感性最高，为86.8%（95% CI：0.826，0.908），龈沟液IL-β为22.59 ng/mL时特异性最高，为92.0%（95% CI：0.895，0.937）。结论 牙髓牙周病变患者根管感染病原菌主要为革兰阳性菌，刷牙时间、刷牙次数、喜食甜食、龋牙、血清IL-1β ≥ 7.69 ng/mL、龈沟液IL-1β ≥ 22.59 ng/mL、血清IFN-γ ≥ 11.73 ng/mL、龈沟液IFN-γ ≥ 8.33 ng/mL均是根管感染的影响因素，其中感染患者的血清和龈沟液IL-1β、IFN-γ均处于高表达状态，对于根管感染具有良好的诊断效能。

Abstract:

Objective To investigate the composition of major pathogens in infected root canals in patients with pulp and periodontal diseases and the values of serum and gingival crevicular fluid levels of interleukin (IL)-1β and interferon (IFN)-γ in the diagnosis of root canal infections.Methods Eighty-eight patients with pulp and periodontal diseases admitted to our hospital from February 2020 to August 2021 were selected and divided into infected group (38 cases) and non-infected group (50 cases) according to whether the root canal was infected. The composition of pathogens in patients with root canal infections was analyzed, and the risk factors for root canal infections were determined by univariable and multivariable Logistic regression analyses. The serum and gingival crevicular fluid levels of IL-1β and IFN-γ were compared between the two groups of patients, and the receiver operating characteristic (ROC) curve was used to analyze the efficacy of levels of IL-1β and IFN-γ in the diagnosis of root canal infections.Results Among the 88 patients, 38 (43.18%) were infected. A total of 46 pathogens were detected, of which 28 strains (60.87%) were Gram-positive bacteria, including Staphylococcus (21.74%), Micromonas (17.39%), Enterococcus faecalis (13.04%), Actinomyces (4.35%) and other Gram-positive bacteria (4.35%), and 18 strains (39.13%) were Gram-negative bacteria, including Prevotella intermedia (15.22%), Bacteroides forsythus (10.87%), Porphyromonas gingivalis (4.35%), Prevotella nigricans (4.35%) and other Gram-negative bacteria (4.35%). There was no difference in the sex composition, age, body mass index, systolic blood pressure or diastolic blood pressure between the infected group and the non-infected group (P > 0.05). The proportions of patients with duration of tooth brushing < 3 min, tooth brushing once a day, a sweet tooth, and dental caries and serum and gingival crevicular fluid levels of IL-1β and IFN-γ in the infected group were higher than those in the non-infected group (P < 0.05). The multivariable Logistic regression analysis (inclusion of variables with P-value < 0.05) showed that duration of tooth brushing < 3 min [O^R =1.950 (95% CI: 1.116, 3.410) ], tooth brushing once a day [O^R = 2.192 (95% CI: 1.100, 4.371) ], sweet tooth [O^R = 1.754 (95% CI: 1.081, 2.847) ], dental caries [O^R = 2.252 (95% CI: 1.166, 4.352) ], serum IL-1β ≥ 7.69 ng/mL [O^R = 1.842 (95% CI: 1.195, 2.841)], gingival crevicular fluid IL-1β ≥ 22.59 ng/mL [O^R = 1.519 (95% CI: 1.032, 2.235) ], serum IFN-γ ≥ 11.73 ng/mL [O^R=1.701 (95% CI: 1.147, 2.522) ], and gingival crevicular fluid IFN-γ ≥ 8.33 ng/mL [O^R = 1.495 (95% CI: 1.032, 2.165) ] were all risk factors for root canal infection (P < 0.05). The area under the ROC curve, sensitivity and specificity were the highest when the cut-off values of gingival crevicular fluid IL-1β, serum IL-1β, and gingival crevicular fluid IL-1β were set as 22.59 ng/mL, 7.69 ng/mL and 22.59 ng/mL, with them being 0.850 (95% CI: 0.763, 0.937), 86.8% (95% CI: 0.826, 0.908), and 92.0% (95% CI: 0.895, 0.937), respectively.Conclusions Gram-positive bacteria are dominant pathogens of root canal infection in patients with pulp and periodontal diseases. The duration and frequency of tooth brushing, sweet tooth, dental caries, serum IL-1β ≥ 7.69 ng/mL, gingival crevicular fluid IL-1β ≥ 22.59 ng/mL, serum IFN-γ ≥ 11.73 ng/mL, and gingival crevicular fluid IFN-γ ≥ 8.33 ng/mL are all factors affecting the infection. The serum and gingival crevicular fluid levels of IL-1β and IFN-γ are high in the infected patients, and exhibit great diagnostic efficacy for root canal infections.