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【摘要】 目的 探讨牙周非手术治疗对糖尿病患者牙周炎症控制及血糖水平的影响。方法 从83例胰岛素非依赖性糖尿病牙周炎患者中选出代谢控制不良的31例，行牙周非手术治疗，测量并比较术前、术后4、8周的探诊出血、探诊深度及糖化血红蛋白水平。结果 所有患者治疗后探诊出血、探诊深度明显减少。重度牙周炎患者糖化血红蛋白从(9.86±2.10)%降低为（8.77±1.62）%，差异有显著性（P＜ 0.01)；中轻度牙周炎患者糖化血红蛋白的变化差异无显著性（P＞0.05)。结论 糖尿病患者牙周炎症控制能在一定程度上改善代谢水平，但改善的效果可能与治疗前血糖水平和牙周状况有关。
The effect of non-surgical periodontal therapy on blood sugar level of non-insulin dependent diabetes mellitus diabetics with periodontitis
FU Yun，LING Junqi，DENG Yongzhong，et al.
(Department of Oral Medicine, School of Stomatology, Sun Yat-sen University of Medical Science, Guangzhou 510060, China)
【Abstract】 Objective To investigate the effect of periodontal therapy on blood sugar level of non-insulin dependent diabetes mellitus(NIDDM) diabetics with periodontitis.Methods Patients with unfavorable control of diabetes were selected from out patients of the first affiliated hospital of Sun Yat-sen University of Medical Science. The percentage of bleeding on probing、probing depth and glycosylated hemoglobin level were studied at baseline, four weeks and eight weeks after non-surgical treatment.Results The percentage of bleeding on probing and probing depth were significantly reduced in all the patients after treatment . The mean glycosylated hemoglobin level were significantly decreased in patients with advanced periodontitis while patients with moderate periodontitis showed no changes following therapy.Conclusions The control of periodontal inflammation can improve metabolism to some extent in patients with diabetes mellitus, but the effect may relate to blood sugar level and periodontal conditions at baseline
【Key words】 Diabetes mellitus； Hemoglobin A，glycosylated； Periodontitis
牙周病现已被认为是糖尿病的第六大并发症［1］。大量研究表明，牙周病与糖尿病存在双向关系，未控制或控制不良的糖尿病可增加牙周炎易感性；糖尿病患者的牙周炎发病率随病程延长而增高；牙周炎治疗有利于糖尿病的控制［2］。我们对代谢失控的胰岛素非依赖性糖尿病(non-insulin dependent diabetes mellitus, NIDDM)患者，在牙周非手术治疗前后的牙周状况和血糖水平的变化进行了研究，并分析了牙周炎症控制对NIDDM患者血糖水平的影响。
材料与方法
1．病例选择：从中山医科大学附属第一医院门诊患者中筛选代谢控制不良的NIDDM牙周炎患者，患者均满足以下条件：① 根据1985年WHO标准被诊断为NIDDM至少1年以上；② 无严重糖尿病并发症；③ 糖化血红蛋白(glycosylated hemoglobin, HbAIc) ＞ 8%；④ 良好的依从性；⑤ 至少口内有15颗天然牙；⑥ 一直口服降糖药治疗，近期降糖药用量无变化；⑦ 诊断标准：重度牙周炎：X线平均牙槽骨丧失(mean alveolar bone loss, ABL) ＞50%或4个以上位点探诊深度(probing depth, PD) ≥6 mm；中轻度牙周炎：25%≤ABL ＜50%或4个以上位点 3 mm≤PD ＜6 mm。
2．临床检查：根据Ainamo 和Bay［3］标准估计探诊出血( bleeding on probing, BOP) 牙面的百分比；用WHO探针测量PD, 用力约20 g 。采用平行定位投照，灰度矫正技术拍X线全景片，根据Salonen等
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