摘要
慢性牙周炎是一种以牙周支持组织慢性炎症为特征的疾病，其发病机制涉及微生物群落失调、宿主免疫应答以及遗传和环境因素的相互作用。牙周致病菌（如牙龈卟啉单胞菌）通过生物被膜形成及毒素释放介导组织破坏，同时促炎因子（如TNF-α、IL-1β）加剧炎症级联反应并促进牙槽骨吸收。遗传易感性（如IL-1基因多态性）与吸烟、营养状况不良等环境危险因素协同增加患病风险。在诊断技术层面，微生物组学分析、生物标志物检测（如基质金属蛋白酶）及影像学检查显著提升了疾病评估的精准度。临床治疗策略涵盖非手术疗法（抗菌药物应用、口腔卫生宣教）与手术干预（牙周翻瓣术、组织工程再生技术），未来研究方向聚焦于靶向抗炎药物、干细胞疗法及基于人群的公共卫生预防措施。
关键词： 慢性牙周炎；牙周病原菌；炎症因子；组织工程再生
Abstract
Chronic periodontitis is a disease characterized by chronic inflammation of periodontal tissues. Its pathogenesis involves the interaction of microbial community imbalance, host immune response and genetic and environmental factors. Periodontal pathogens (such as Porphyromonas gingivalis) destroy periodontal tissues through biofilm formation and toxin release, while inflammatory factors (such as TNF-α, IL-1β) aggravate inflammatory response and bone resorption. Genetic susceptibility (such as IL-1 gene polymorphism) and environmental factors such as smoking and malnutrition further increase the risk of disease. In terms of diagnostic technology, microbiome, biomarkers (such as MMPs) and imaging examinations have improved the accuracy of disease assessment. Treatment strategies include non-surgical methods (antimicrobial treatment, oral hygiene guidance) and surgical intervention (periodontal flap surgery, tissue engineering regeneration technology). Future directions focus on anti-inflammatory drugs, stem cell therapy and public health prevention measures.
Key words： Chronic periodontitis; Periodontal pathogens; Inflammatory factors; Tissue engineering regeneration
参考文献 References
[1] Abdulkareem A A, Al-Taweel F B, Al-Sharqi A J B, et al. Current concepts in the pathogenesis of periodontitis: from symbiosis to dysbiosis[J]. Journal of Oral Microbiology, 2023, 15(1): 2197779.
[2] Di Stefano M, Polizzi A, Santonocito S, et al. Impact of oral microbiome in periodontal health and periodontitis: a critical review on prevention and treatment[J]. International journal of molecular sciences, 2022, 23(9): 5142.
[3] Kavarthapu A, Gurumoorthy K. Linking chronic periodontitis and oral cancer: A review[J]. Oral oncology, 2021, 121: 105375.
[4] Liu X, Li H. A systematic review and meta-analysis on multiple cytokine gene polymorphisms in the pathogenesis of periodontitis[J]. Frontiers in immunology, 2022, 12: 713198.
[5] Wang B, Bai S, Wang J, et al. TPCA‐1 negatively regulates inflammation mediated by NF‐κB pathway in mouse chronic periodontitis model[J]. Molecular Oral Microbiology, 2021, 36(3): 192-201.
[6] Neurath N, Kesting M. Cytokines in gingivitis and periodontitis: from pathogenesis to therapeutic targets[J]. Frontiers in immunology, 2024, 15: 1435054.
[7] Larsson L, Kavanagh N M, Nguyen T V N, et al. Influence of epigenetics on periodontitis and peri‐implantitis pathogenesis[J]. Periodontology 2000, 2022, 90(1): 125-137.
[8] Saliem S S, Bede S Y, Cooper P R, et al. Pathogenesis of periodontitis–A potential role for epithelial-mesenchymal transition[J]. Japanese Dental Science Review, 2022, 58: 268-278.
[9] Avula H, Chakravarthy Y. Models of periodontal disease pathogenesis: A journey through time[J]. Journal of Indian Society of Periodontology, 2022, 26(3): 204-212.
[10] Teles F, Collman R G, Mominkhan D, et al. Viruses, periodontitis, and comorbidities[J]. Periodontology 2000, 2022, 89(1): 190-206.
[11] 陈斌,李丽丽,张倩,等.侵袭性牙周炎,慢性牙周炎与牙周健康者龈下菌群的差异研究[J].中华口腔医学杂志, 2020, 55(7):9.
[12] 李雪菁,苏俭生.NLRP3炎性小体调控慢性牙周炎的研究进展[J].口腔颌面外科杂志, 2024, 34(1):63-66.
[13] 张晓璇,王兴,任秀云.细胞外囊泡在慢性牙周炎疾病进程及诊疗中作用的研究进展[J].中华口腔医学杂志, 2021, 56(4):5.
[14] 曾小丽,李生娇,单铮男,等.基于基因芯片整合分析筛选慢性牙周炎相关基因和转录因子[J].华西口腔医学杂志, 2021.
[15] 彭曼斯,韩淋畴,张华贵,等.IL-33和IL-35对慢性牙周炎患者疗效评价的研究[J].现代医学, 2020, 48(3):4.
[16] 宋海瑞综述,孙刚综述,党玉兰审校.中枢神经系统疾病与牙周炎的相关性及其发病机制研究[J].武警医学, 2023, 34(12):1086-1089.
[17] 王祥璞.LncRNA-TNFRSF13C在侵袭性牙周炎中的作用及调控机制的初步研究[D].天津医科大学,2020.
[18] Zhao C , Chen Z , Li M .[Research progress of polymicrobial synergy and dysbiosis in periodontitis].[J].Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese journal of stomatology, 2021, 56(3):301-305.