首页|化脓性牙髓炎龈沟液中炎症介质水平与术后疼痛的关系

化脓性牙髓炎龈沟液中炎症介质水平与术后疼痛的关系

扫码查看
目的 探讨化脓性牙髓炎患者龈沟液中炎症介质水平与术后疼痛的关系.方法 收集2020年3月至2023年3月邯郸市第三医院口腔科收治的98例化脓性牙髓炎患者的临床资料.患者均行根管治疗,术后7 d采用Mohd Sulong法评估患者疼痛情况,根据疼痛情况分为轻度疼痛组(0级、Ⅰ级)和重度疼痛组(Ⅱ级、Ⅲ级).检测患者术前和术后48 h龈沟液中肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-17(IL-17)及高敏C反应蛋白(hs-CRP)水平;Logistic回归分析根管治疗术后患者疼痛的影响因素;采用受试者工作特征(ROC)曲 线分析炎症介质水平对根管治疗术后患者疼痛的预测价值.结果 98例患者术后疼痛分级:0级23例,Ⅰ级34例,Ⅱ级26例,Ⅲ级15例;重度疼痛组患者牙髓无活力、根管填充欠填、有牙周病变占比均高于轻度疼痛组(P<0.05);轻度疼痛组术后48 h的血清TNF-α、IL-6、IL-17、hs-CRP水平均低于重度疼痛组(P<0.05);不同疼痛程度患者术后48 h血清TNF-α、IL-6、IL-17、hs-CRP水平低于术前(P<0.05).Logistic回归模型分析结果显示,根管填充欠填、术后48 h IL-17和hs-CRP高水平是影响根管治疗术后疼痛的独立危险因素(P<0.05);ROC分析表明,术后48 h IL-17、hs-CRP单独及二者联合检测预测根管治疗术后疼痛的AUC(95%CI)分别为0.714(0.614~0.801)、0.642(0.539~0.736)、0.811(0.719~0.883),IL-17、hs-CRP联合检测的预测效能高于单独检测(Z=2.021、1.986,P<0.05).结论 化脓性牙髓炎患者龈沟液中TNF-α、IL-6、IL-17和hs-CRP水平经治疗后降低,术后48 h的IL-17、hs-CRP检测水平与根管治疗术后疼痛关系密切,二者联合检测对于根管治疗术后重度疼痛具有较高的预测价值.
Relationship between changes of inflammatory mediators in gingival crevicular fluid and postoperative pain in suppurative pulpitis
Objective To explore the changes of inflammatory mediators in gingival crevicular fluid in pa-tients with suppurative pulpitis,and to analyze the relationship between inflammatory mediators and post-operative pain.Methods The clinical data of 98 patients with suppurative pulpitis admitted to the hospital from March 2020 to March 2023 were collected.All patients underwent root canal therapy,and the post-operative pain was evaluated by Mohd Sulong method 7 days after surgery,and the patients were divided into mild pain group(grade 0 and Ⅰ)and severe pain group(grade Ⅱ and Ⅲ).Levels of inflammatory mediators(tumor necrosis factor(TNF-α),interleukin-6(IL-6),interleukin-17(IL-17)and high-sensitive C-reactive protein(hs-CRP))in gingival creval fluid were measured and compared before and 48 hours af-ter surgery.Logistic regression model was used to analyze the influencing factors of pain after root canal treatment.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of in-flammatory mediators in pain after root canal treatment.Results The postoperative pain classification of 98 patients was grade 0 in 23 cases,grade Ⅰ in 34 cases,grade Ⅱ in 26 cases and grade Ⅲ in 15 cases.The percentages of pulp inactivity,root canal underfilling and periodontal disease in severe pain group were higher than those in mild pain group(P<0.05).The levels of serum TNF-α,IL-6,IL-17 and hs-CRP in patients with different pain degrees 48 h after surgery were lower than those before surgery(P<0.05).The levels of TNF-α,IL-6,IL-17 and hs-CRP in mild pain group 48h after surgery were lower than those in severe pain group(P<0.05).Logistic regression model analysis showed that underfilling of root canal and high levels of IL-17 and hs-CRP 48 h after surgery were independent risk factors for postoperative pain(P<0.05).ROC analysis showed that the AUC(95%CI)of IL-17 and hs-CRP alone and combined de-tection for postoperative pain after root canal treatment at 48 h after surgery were 0.714(0.614~0.801),0.642(0.539~0.736)and 0.811(0.719~0.883)respectively.The predictive efficacy of IL-17 and hs-CRP combined was higher than that of single detection(Z=2.021,1.986,P<0.05).Conclusion The levels of TNF-α,IL-6,IL-17 and hs-CRP in gingival creval fluid of the patients with suppurative pulpitis were decreased after the treatment.The detection of IL-17 and hs-CRP 48 h after surgery is closely related to postoperative pain,and the combined detection of IL-17 and HS-CRP has high predictive value for post-operative severe pain after root canal therapy.

suppurative pulpitisgingival crevicular fluidinflammatory mediatorsroot canal therapypostoperative pain

牛龙龙、申秀梅、石敬瑜、赵增波

展开 >

邯郸市第三医院口腔科, 河北 邯郸 056001

河北医科大学口腔医院口腔综合科, 石家庄 050017

化脓性牙髓炎 龈沟液 炎症介质 根管治疗 术后疼痛

河北省医学科学研究项目(2022)

20221469

2024

新疆医科大学学报
新疆医科大学

新疆医科大学学报

CSTPCD
影响因子:0.76
ISSN:1009-5551
年,卷(期):2024.47(3)
  • 18