Abstract:

Objective　To explore the correlation of Th1/Th2 and tumor necrosis factor alpha (TNF-α) levels with the severity of chronic periodontitis (CP) in patients with type 2 diabetes mellitus (T2DM). Methods　This retrospective analysis included 90 patients with T2DM and CP (a T2DM+CP group), 60 patients with CP (a CP group), and 60 healthy examinees (a control group) from Yulin Traditional Chinese Medicine Hospital between January and December 2023. There were 48 males and 42 females in the T2DM+CP group; they were (52.35±5.78) years old; their disease course was (3.44±0.91) years. There were 33 males and 27 females in the CP group; they were (52.63±5.69) years old; their disease course was (3.56±1.07) years. There were 31 males and 29 females in the control group; they were (52.58±5.64) years old. The patients with T2DM and CP were categorized into a mild group (33 cases), a moderate group (30 cases), and a severe group (27 cases) based on the periodontal assessment standards. Their general data were collected. The periodontal indicators [probing depth (PD), attachment loss (AL), gingival index (GI), and plaque index (PLI)], inflammatory markers [interferon gamma (INF-γ), interleukin 4 (IL-4), and tumor necrosis factor alpha (TNF-α)], and Th1/Th2 cell ratios were compared. The Spearman's correlation analysis was employed to assess the correlation of Th1/Th2 and TNF-α with the severity of periodontitis in the T2DM+CP group. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic values of Th1/Th2 and TNF-α for CP + T2DM. t, F, and χ² tests were applied. Results　There were no statistical differences in gender, age, body mass index, and CP course between the three groups (all P>0.05). The levels of INF-γ in the CP+T2DM group and the CP group were lower than that in the control group [(29.25±8.46) μg/L and (51.45±16.25) μg/L vs. (90.13±29.85) μg/L]; the PD, AL, GI, PLI, levels of IL-4 and TNF-α, and Th1/Th2 ratios in the CP+T2DM group and the CP group were higher than those in the control group [(6.38±1.23) mm and (4.82±0.64) mm vs. (1.93±0.52) mm, (5.79±0.82) mm and (3.02±1.06) mm vs. (0.42±0.11) mm, (1.63±0.25) and (1.13±0.18) vs. (0.52±0.14), (1.25±0.14) and (1.04±0.12) vs. (0.73±0.05), (25.84±3.72) μg/L and (20.04±5.18) μg/L vs. (14.38±2.16) μg/L, (67.88±22.22)μg/L and (56.47±15.03) μg/L vs. (25.17±8.42) μg/L, and (2.28±0.68) and (1.33±0.41) vs. (0.41±0.13)]; there were statistical differences (F=185.595, 423.411, 860.564, 533.540, 367.510, 160.486, 112.925, and 253.712; all P<0.05). The Th1/Th2 ratio and TNF-α level in the mild group, the moderate group, and the severe group were (1.47±0.21), (2.61±0.34), and (2.89±0.26) and (46.82±5.93) μg/L, (63.73±7.32) μg/L, and (98.24±6.89) μg/L, with statistical differences (F=233.226 and 436.772; both P<0.05). The Spearman's correlation analysis showed that Th1/Th2 and TNF-α were positively correlated wtih the severity of periodontitis (r=0.852 and 0.914; both P<0.05). The areas under the curves (AUC) of Th1/Th2 and TNF-α were 0.866 and 0.631; the sensitivities were 63.3% (57/90) and 57.8% (52/90); the specificities were 98.3% (59/60) and 63.3% (38/60). The AUC of the combination was 0.881; the sensitivity was 73.3% (66/90); the specificity was 88.3% (53/60). Conclusions　In patients with T2DM+CP, Th1/Th2 ratio and TNF-α are significantly positively correlated with the severity of periodontitis. Their combination provides good diagnostic efficacy for the disease.

Key words:

Type 2 diabetes mellitus, Chronic periodontitis, Th1/Th2, Tumor necrosis factor alpha, Disease severity, Correlation

摘要：

目的　探讨2型糖尿病（T2DM）合并慢性牙周炎（CP）患者辅助性T细胞1型/辅助性T细胞2型（Th1/Th2）及肿瘤坏死因子α（TNF-α）水平与牙周炎严重程度的相关性。方法　回顾性分析，选取2023年1月至12月在榆林市中医医院诊治的90例T2DM+CP患者及60例单纯CP患者，另选取同期60例健康体检者作为对照组。T2DM+CP组男48例、女42例，年龄（52.35±5.78）岁，CP病程（3.44±0.91）年；CP组男33例、女27例，年龄（52.63±5.69）岁，CP病程（3.56±1.07）年；对照组男31例、女29例，年龄（52.58±5.64）岁。将90例T2DM+CP患者根据牙周评估标准分为轻度（33例）、中度（30例）、重度（27例）。收集患者一般资料，并比较患者牙周指标［探诊深度（PD）、附着丧失（AL）、牙龈指数（GI）、菌斑指数（PLI）］、炎症因子［干扰素γ（INF-γ）、白细胞介素-4（IL-4）、肿瘤坏死因子-α（TNF-α）］水平和Th1/Th2细胞比例。采用Spearman相关性分析Th1/Th2、TNF-α水平与T2DM+CP患者严重程度之间的相关性。采用受试者操作特征曲线（ROC）评估Th1/Th2、TNF-α水平对T2DM+CP的诊断价值。统计学方法采用t检验、F检验、χ²检验。结果　3组性别、年龄、体质量指数、CP病程比较，差异均无统计学意义（均P>0.05）；T2DM+CP组、CP组INF-γ水平低于对照组［（29.25±8.46）μg/L、（51.45±16.25）μg/L比（90.13±29.85）μg/L］，PD、AL、GI、PLI、IL-4、TNF-α、Th1/Th2比值均高于对照组［（6.38±1.23）mm、（4.82±0.64）mm比（1.93±0.52）mm、（5.79±0.82）mm、（3.02±1.06）mm比（0.42±0.11）mm、（1.63±0.25）分、（1.13±0.18）分比（0.52±0.14）分、（1.25±0.14）分、（1.04±0.12）分比（0.73±0.05）分、（25.84±3.72）μg/L、（20.04±5.18）μg/L比（14.38±2.16）μg/L、（67.88±22.22）μg/L、（56.47±15.03）μg/L比（25.17±8.42）μg/L、（2.28±0.68）、（1.33±0.41）比（0.41±0.13）］，差异均有统计学意义（F=185.595、423.411、860.564、533.540、367.510、160.486、112.925、253.712，均P<0.05）。T2DM+CP患者Th1/Th2、TNF-α水平比较，轻度<中度<重度［Th1/Th2：（1.47±0.21）比（2.61±0.34）比（2.89±0.26）；TNF-α：（46.82±5.93）μg/L比（63.73±7.32）μg/L比（98.24±6.89）μg/L］，差异均有统计学意义（F=233.226、436.772，均P<0.05）。Spearman相关性分析显示，Th1/Th2、TNF-α水平与牙周炎严重程度均呈正相关（r=0.852、0.914，均P<0.05）。Th1/Th2、TNF-α水平单独诊断的AUC为0.866、0.631，灵敏度为63.3%（57/90）、57.8%（52/90），特异度为98.3%（59/60）、63.3%（38/60），而联合诊断的AUC为0.881，灵敏度为73.3%（66/90），特异度为88.3%（53/60）。结论　T2DM+CP患者中，Th1/Th2细胞比例及TNF-α水平与牙周炎严重程度呈正相关，且两者联合评估对疾病的诊断具有良好的效能。

关键词:

2型糖尿病, 慢性牙周炎, Th1/Th2, 肿瘤坏死因子α, 疾病严重程度, 相关性