南方医科大学学报

南方医科大学学报 ›› 2024, Vol. 44 ›› Issue (1): 36-44.doi: 10.12122/j.issn.1673-4254.2024.01.05

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多囊卵巢综合征与牙周炎呈正相关：一项前瞻性研究

胡当立，张 锋，李蕙君，许小艺，文 萍，郑 峥，姚吉龙   

  1. 南方医科大学第一临床医学院，深圳市妇幼保健院，广东 广州 516006；深圳市妇幼保健院妇科，口腔防治中心，科教科，广东 深圳 518028
  • 发布日期:2024-01-19

Polycystic ovary syndrome is positively correlated with periodontitis: a prospective study

HU Dangli, ZHANG Feng, LI Huijun, XU Xiaoyi, WEN Ping, ZHENG Zheng, YAO Jilong   

  1. Shenzhen Maternity and Child Healthcare Hospital, First School of Clinical Medicine, Southern Medical University, Guangzhou 516006, China; Department of Gynecology, Department of Stomatology, Department of Science and Education, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen 518028, China
  • Published:2024-01-19

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摘要： 目的 探讨细胞因子水平、性激素水平和代谢相关指标与多囊卵巢综合征（PCOS）和牙周炎之间相互作用和疾病进展的关系。方法 招募了2021年10月~2022年12月在我院就诊的健康受试者20例和PCOS患者40例。分别在首次入组时、入组后3月和6月进行全口牙周检查、问卷信息采集以及血清和唾液样本收集。通过全口牙周检查获得全口菌斑积分(FMPS)、探诊时牙龈出血率（BOP）、牙周袋深度（PD）、临床附着水平（CAL）、PD≥4 mm、PD≥6 mm的位点率以及CAL数值在1~2 mm和3~4 mm占全口牙中的位点率等牙周参数。通过信息采集获得血清黄体生成素/卵泡刺激素 (LH/FSH)、血清总睾酮（T）、血清催乳素（PRL）、孕酮（P）和雌二醇（E2）等数值。检测血清和唾液样本中的白介素6（IL-6）、IL-17A、肿瘤坏死因子α（TNF-α）、基质金属蛋白酶8（MMP-8)这4种细胞因子的水平。根据牙周检查情况把受试者分为非牙周炎非PCOS受试者（A）组（n=15）、非牙周炎PCOS受试者（B）组（n=28）、牙周炎非PCOS受试者（C）组（n=5）和患有牙周炎的PCOS受试者（D）组（n=12）。通过组间差异性分析、广义估计方程、Spearman相关性分析探讨这些指标与牙周炎和PCOS的关系。结果 LH/FSH的比值在B组和D组均高于A组（P<0.05），D组明显高于C组（P<0.05）。B组的血清MMP-8水平高于A组（P<0.05）。而C组和D组的唾液MMP-8水平都明显高于A组（P<0.05），D组也明显高于B组（P<0.05）。PD、BOP、PD≥4 mm位点率和CAL在1~2 mm的位点率在C组和D组均明显高于A组（P<0.05）和B组（P<0.05）。入组6个月后的唾液MMP-8、LH、LH/FSH、血清和唾液的IL-6、PD、PD≥4 mm和CAL=1~2 mm的位点率与首次入组时水平相比均呈上升趋势（OR值>1，P<0.05）。在随访期间，非PCOS组（A+C）和PCOS组（B+D）相比，血清IL-6水平有统计学差异；血清IL-6、唾液MMP-8、PD、BOP、PD≥4 mm的位点率和CAL在1~2 mm的位点率在非牙周炎组（A+B）与有牙周炎组（C+D）组间有统计学差异。所有受试者的综合Spearman相关性分析提示：LH和LH/FSH与PD呈正相关（P<0.05）；血清总睾酮和LH/FSH与血清MMP-8水平也呈正相关（P<0.05）；PD、BOP、FMPS、PD≥4 mm位点率和CAL在1~2 mm位点率与唾液MMP-8均呈正相关（P<0.01）。结论 PCOS和牙周炎存在相关性，且这两种疾病的进展可改变血清和唾液中的促炎细胞因子和血清性激素水平。

关键词: 多囊卵巢综合征；牙周炎；性激素；细胞因子

Abstract: Objective To explore the correlation between polycystic ovary syndrome (PCOS) and periodontitis in light of cytokines levels, sex hormone levels and metabolism-related indicators and their changes during progression of the two diseases. Methods Twenty healthy subjects and 40 patients diagnosed with PCOS underwent full-mouth periodontal examinations to obtain full-mouth plaque score (FMPS), gingival bleeding index of probing (BOP), probing depth (PD), and clinical attachment level (CAL). The participants were divided into Group A without periodontitis or PCOS (n=15), Group B with PCOS but without periodontitis (n=28), Group C with periodontitis but without PCOS (n=5), and Group D with both diseases (n=12). Serum levels of luteinizing hormone/follicle stimulating hormone (LH/FSH), testosterone, prolactin, progesterone and estradiol, and the levels of interleukin 6 (IL-6), IL-17A, tumor necrosis factor α and matrix metalloproteinase 8 (MMP-8) in both serum and saliva samples were measured at the time of enrolment and at 3 and 6 months after enrolment and compared among the 4 groups. Results Serum MMP-8 level was significantly higher in Group B than in Group A (P<0.05). Salivary MMP-8 level was significantly higher in Group D than in Group B (P<0.05). Salivary MMP-8, LH, and LH/FSH levels and serum and salivary IL-6 and progesterone levels all tended to increase in the 6 months after enrollment (OR>1, P<0.05). During the follow-up period, serum IL-6 levels differed significantly between the non-PCOS groups (A and C) and PCOS groups (B and D)(P<0.05); serum IL-6 and salivary MMP-8 levels differed significantly between the non-periodontitis groups (A and B) and periodontitis groups (C and D)(P<0.05). Spearman correlation analysis indicated positive correlations of LH and LH/FSH with PD (P<0.05); testosterone and LH/FSH were positively correlated with serum MMP-8 levels (P<0.05), and PD, BOP and FMPS were positively correlated with salivary MMP- 8 levels (P<0.01). Conclusion There is a correlation between PCOS and periodontitis, and their progression is accompanied by changes in serum and salivary levels of pro-inflammatory cytokines and serum sex hormones.

Key words: polycystic ovarian syndrome; periodontitis; sex hormone; cytokine