| Objective:1.Comparison of serum from patients with IgA nephropathy(IgAN)with different periodontal conditions β2-Microglobulin(β2-MG),serum creatinine(Scr),and serum uric acid(SUA)levels.Analyze the periodontal status and serum of IgAN patients relationship between β2-MG,Scr,and SUA,To explore the influence of periodontal status on IgAN related indexes.2.To explore the effect of basic periodontal treatment on serum of grade Ⅲ-ⅤIgAN patients with moderate to severe periodontitis β2-MG,Scr,and SUA levels.The purpose is to provide clinical evidence for the study of the correlation between periodontitis and IgAN,and provide new ideas for the prevention and treatment of periodontitis and IgAN.Methods:Part one:During the period from January 2021 to December 2022,among the hospitalized patients who were first diagnosed as primary IgAN by renal biopsy and voluntarily underwent periodontal examination at the Department of Nephrology,the Fifth Clinical Hospital of Shanxi Medical University,120 patients were randomly selected as research subjects,with the approval of the Hospital Ethics Society,in strict accordance with the inclusion and exclusion criteria.They signed an informed consent form for periodontal examination and were given a questionnaire survey and periodontal examination,including the depth of periodontal exploration(PD),Clinical attachment loss level(CAL),exploratory bleeding index(BI),and serum testing β2-MG,Scr,SUA levels.According to the criteria of "2018 New International Classification of Periodontal and Implant Periodontal Diseases" and the results of periodontal examinations,the subjects were divided into three groups: periodontal health IgAN group(12 cases),gingivitis IgAN group(21 cases),and periodontitis IgAN group(87 cases);87 patients with IgAN associated with periodontitis were divided into three groups according to the "1999Classification of Periodontitis" criteria: IgAN with mild periodontitis group(27 cases),IgAN with moderate periodontitis group(30 cases),and IgAN with severe periodontitis group(30 cases).Record the basic clinical data,periodontal examination results,and serum test of each group of study subjects comparison of serum levels of β2-MG,Scr,and SUA in IgAN patients with different periodontal conditions β2-MG,Scr,and SUA levels were analyzed statistically.Part two:From November 2021 to December 2022,among IgAN patients diagnosed as Grade III-V(stable after treatment by a nephrologist)by the Department of Nephrology of the Fifth Clinical Hospital of Shanxi Medical University in accordance with the modified HS Lee classification diagnostic criteria for primary IgAN,30 IgAN patients with moderate to severe periodontitis who voluntarily received periodontal basic treatment were randomly selected to be included in the experimental group,following the principle of voluntary periodontal examination and treatment,and strictly following the inclusion and exclusion criteria,Thirty patients who were not willing to receive basic periodontal treatment were randomly selected and included in the control group,and an informed consent form was signed.The two groups of patients were given routine IgAN treatment and oral hygiene instruction(OHI),while the experimental group was given basic periodontal treatment.The treatment content included: total supragingival scaling,subgingival curettage,and scaling and root planning(SRP),Record the serum of two groups of patients before and 6 weeks after treatment compare the serum levels of β2-MG,Scr,SUA,and periodontal index PD,CAL,and BI between the two groups before and after treatment β2-MG,Scr,and SUA levels in patients with periodontitis IgAN treated with basic periodontal therapy impact of levels of β2-MG,Scr,and SUA.Results:1.Periodontal status of IgAN patients:Among the 120 patients with IgAN,12 had healthy periodontitis(10.00%),21 had gingivitis(17.50%),27 had mild periodontitis(22.50%),30 had moderate periodontitis(25.00%),and 30 had severe periodontitis(25.00%).2.Clinical data of the subjects:There were no significant differences in age,gender,fasting blood glucose,systolic blood pressure and diastolic blood pressure among 5 groups of periodontal health IgAN,IgAN with gingivitis,IgAN with mild periodontitis,IgAN with moderate periodontitis and IgAN with severe periodontitis(P>0.05).3.Comparison of serum β2-MG,Scr and SUA levels in IgAN patients with different periodontal conditions:There were significant differences in serum β2-MG,Scr and SUA levels among IgAN patients with periodontal health,gingivitis and periodontitis groups(P<0.05),The levels of serum β2-MG,Scr and SUA in IgAN group with periodontitis were higher than those in gingivitis group and IgAN group.There was no significant difference in serumβ2-MG,Scr and SUA levels between IgAN group with gingivitis and periodontal health IgAN group(P>0.05).There were statistically significant differences in serum β2-MG,Scr and SUA levels in 5 groups of IgAN patients with different periodontal status(P<0.05).The results of pairwise comparison between groups showed that:There was no significant difference in serum β2-MG,Scr and SUA levels between IgAN group with mild periodontitis and IgAN group with periodontal health and gingivitis(P>0.05).Serum β2-MG,Scr and SUA levels in IgAN group with moderate periodontitis were significantly higher than those in IgAN group with periodontal health,IgAN group with gingivitis and IgAN group with mild periodontitis(P<0.05).Serum β2-MG,Scr and SUA levels in the IgAN group with severe periodontitis were significantly higher than those in the IgAN group with periodontal health,IgAN group with gingivitis,IgAN group with mild periodontitis and IgAN group with moderate periodontitis(P<0.05).4.Comparison of CAL,PD and BI levels of periodontal index in IgAN patients with different periodontal conditions:CAL,PD and BI levels of IgAN patients in 5 groups with different periodontal status were statistically significant(P<0.05).The results of pairwise comparison between groups showed that:There was no significant difference in CAL,PD and BI between IgAN group with gingivitis and periodontal health group(P> 0.05).The levels of CAL,PD and BI in IgAN group with mild periodontitis were significantly higher than those in IgAN group with periodontal health and IgAN group with gingivitis(P<0.05).The levels of CAL and PD in IgAN group with moderate periodontitis were significantly higher than those in IgAN group with periodontal health,IgAN group with gingivitis and IgAN group with mild periodontitis(P<0.05).BI level of IgAN group with moderate periodontitis was significantly higher than that of IgAN group with periodontal health and gingivitis(P<0.05).There was no significant difference in BI level between IgAN group with moderate periodontitis and IgAN group with mild periodontitis(P>0.05).The levels of CAL,PD and BI in the IgAN group with severe periodontitis were significantly different from those in the IgAN group with periodontal health,IgAN group with gingivitis,IgAN group with mild periodontitis and IgAN group with moderate periodontitis(P<0.05),and the former group was higher than the latter.5.Pathological grade analysis of IgAN patients with different periodontal conditions:In the IgAN group(12 cases),4 cases(33.33%),5 cases(41.67%)and 3 cases(25.00%)of grade Ⅰ,grade Ⅱ and grade Ⅲ were pathological.In the IgAN group(21 cases),there were 5 cases(23.81%)of grade I,9 cases(41.67%)of grade II,and 7cases(33.33%)of grade Ⅲ.In the IgAN group(27 cases),there were 3 cases(11.11%)of grade I,7 cases(25.93%)of grade Ⅱ,15 cases(55.56%)of grade Ⅲ,and 2 cases(7.41%)of grade Ⅳ.The IgAN group(30 cases)with moderate periodontitis included 12 cases(40.00%)of grade Ⅲ,10 cases(33.33%)of grade Ⅳ and 8 cases(26.67%)of grade Ⅴ.In the IgAN group(30 cases),there were 5 cases(16.67%)of grade Ⅲ,11 cases(36.67%)of grade Ⅳ,and 14 cases(46.67%)of grade Ⅴ.Grade Ⅲ-Ⅴ of IgAN patients in 5 groups with periodontal health,gingivitis,mild periodontitis,moderate periodontitis and severe periodontitis were 3,7,17,30,30(about 2.5%,5.8%,14.2%,25%,25% of the total number of patients),respectively.There were significant differences in periodontal status and pathological grade of IgAN(P<0.05).6.Correlation analysis between periodontal index and serum β2-MG,Scr and SUA levels in IgAN patients:Serum β2-MG(r=0.277,P<0.01),Scr(r=0.263,P<0.01),SUA(r=0.280,P<0.01)were significantly correlated with CAL in IgAN patients.Serum β2-MG(r=0.467,P<0.01),Scr(r=0.464,P<0.01),SUA(r=0.486,P<0.01)were significantly correlated with PD in IgAN patients.Significant correlation: serum β2-MG in IgAN patients(r=0.231,P<0.05);Scr(r=0.188,P<0.05)and SUA(r=0.202,P<0.05)were significantly correlated with BI.7.ROC curve analysis of serum β2-MG,Scr and SUA levels for early prediction of chronic periodontitis in IgAN patients:The AUC of serum β2-MG was 0.800,the Youden index was 0.724,the sensitivity was 0.758,and the specificity was 0.482;The AUC was 0.642,the Youden index was0.368,the sensitivity was 0.879,and the specificity was 0.247;the AUC of serum SUA was 0.695,the Youden index was 0.402,the sensitivity was 0.939,and the specificity was0.341.8.Comparison of serum β2-MG,Scr,SUA levels and periodontal index before and after periodontal basic treatment:There were no significant differences in serum β 2-MG,Scr and SUA levels between the experimental group and the control group before receiving periodontal basic treatment(P>0.05).Serum β2-MG,Scr and SUA levels in experimental group were decreased before and after 6 weeks of periodontal basic treatment,the difference was statistically significant(P<0.01).After 6 weeks,serum β2-MG,Scr and SUA levels in control group were decreased compared with before treatment,and the difference was statistically significant(P<0.01).6 weeks later,the serum β2-MG(P<0.01),Scr(P<0.01),SUA(P<0.05)levels of the experimental group and the control group were significantly different.Before periodontal basic treatment,there were no significant differences in PD,CAL and BI levels between the experimental group and the control group(P>0.05).After 6weeks of basic periodontal treatment,PD,CAL and BI levels of the experimental group were decreased compared with those before treatment,the differences were statistically significant(P<0.01).There was no significant difference in PD,CAL and BI of control group after 6 weeks compared with before treatment(P>0.05).6 weeks later,there were significant differences in PD,CAL and BI levels between the experimental group and the control group(P<0.01).Conclusion:1.There was a certain correlation between the periodontal status of IgAN patients and the levels of serum β2-MG,Scr and SUA,and the more serious the periodontal destruction was,the higher the levels of serum β2-MG,Scr and SUA were.2.The periodontal status of IgAN patients affected the pathological grade.3.Serum β2-MG,Scr and SUA levels have certain reference value for early prediction of the risk of chronic periodontitis in IgAN patients;4.The periodontal status of IgAN patients with moderate and severe periodontitis was improved after basic periodontal treatment,while serum β2-MG,Scr and SUA levels were decreased,suggesting that periodontitis may affect the occurrence,development and prognosis of IgAN.In conclusion,this study provides clinical evidence for the relationship between periodontitis and IgAN,and provides new ideas for the prevention and treatment of periodontitis and IgAN... |
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