A Clinical Study:the Correlation Between Poor Oral Hygiene And Carotid Plaque Formation And Stability Of Patients With Type 2 Diabetes Mellitus

Objective:For type 2 diabetes mellitus patients,the existence of carotid atherosclerotic plaque seriously affects their prognosis,especially the unstable plaque.The poor oral hygiene is related to the occurrence of carotid atherosclerotic plaque closely.On this basis,We conducted a cross-sectional survey study,divided the research subjects into groups according to whether plaques occurred and the acoustic(echoic)characteristics of plaques,with questionnaire surveys,oral examinations,carotid ultrasound examinations,studies on detection indexes and panoramic radio-graphs.Our research objective is to explore the correlation between poor oral hygiene and the occurrence and stability of plaques in the inpatients,as well as possible association indicators,in order to provide a theoretical basis for the management of type 2 diabetes mellitus inpatients and the prevention of complications.Methods:1.From March 2021 to August 2021,we selected inpatients with type 2 diabetes mellitus from the Endocrine Department of the Second Hospital of Shanxi Medical University.2.We collected the questionnaire contents,oral examination indicators,carotid ultrasound features,laboratory indicators and the degree of alveolar bone resorption,divided them into groups.The questionnaire includes general information(basic information,past medical history,etc.)and oral hygiene behavior habits(brushing methods,brushing times,brushing time,use of dental floss or interdental brush,etc.);Oral examination indicators include the number of missing teeth,the number of loose teeth,and the plaque index;Carotid ultrasound features include carotid atherosclerotic plaque formation,location,and echo characteristics;The degree of alveolar bone resorption was judged by panoramic radiography.The patients were divided into T2DM plaque group and T2DM+CAS group according to the formation of carotid atherosclerosis plaque;According to the echo characteristics of carotid atherosclerotic plaques,they were divided into hyperechoic CAS group,isoechoic CAS group,heterogeneous CAS group and hypoechoic CAS group.3.SPSS 26.0 software was used to analyze the collected data statistically,P<0.05 indicated a statistically significant difference.Chi-square test,LSD-t test,Kruskal-Wallis H test,Mann-Whitney U test,and one-way ANOVA were used to compare the general data,laboratory indicators,and oral examination indicators among the groups;Spearman correlation test and multiple linear regression were used to analyze the correlation between laboratory and oral examination indicators;The receiver operating characteristic curve was used to analyze the efficacy of laboratory indicators in predicting the stability of carotid atherosclerotic plaque.Results:1.Correlation analysis of carotid atherosclerotic plaque occurrence in patients with type 2 diabetes mellitus1.1 general data analysis:The average age of patients in the T2DM+CAS group was older,the course of diabetes was longer,and there was a statistical difference(P<0.05).There was no statistical difference in gender,Body Mass Index,smoking,drinking,history of hyperlipidemia history,history of hypertension,and oral health habits(P>0.05).1.2 oral examination indicators analysis:The analysis of oral examination indicators in the T2DM and T2DM+CAS groups showed that the T2DM+CAS group had a higher number of missing teeth and mobility no.3(P<0.05).There was no statistical difference in other oral examination indicators(P>0.05).1.3 laboratory indicators analysis:Statistical analysis was conducted on laboratory indicators between the T2DM group and the T2DM+CAS group.The results showed that at the level of white blood cell count,the T2DM group had a lower level of white blood cell count,while the T2DM+CAS group had a higher level of white blood cell count(P<0.05).There was no statistical difference in other laboratory indicators(P>0.05).2.Correlation analysis of plaque stability grouping in patients with type 2 diabetes mellitus2.1 general data analysis:In terms of age,the hyperechoic CAS group was larger than the other three groups,and the hypoechoic CAS group was the youngest group,with a statistically significant difference(P<0.05).There was no statistical difference in gender,diabetes course,BMI,smoking,drinking,history of hyperlipidemia,history of hypertension,and oral health habits(P>0.05).2.2 oral examination indicators analysis:Among the four groups of T2DM+CAS patients,the isoechoic CAS group had a higher number of mobility no.1 and mobility no.2,while the heterogeneous CAS group had a higher plaque index and a higher proportion of the number of lost teeth(≥ 15)(P<0.05).There was no statistically significant difference in the number of mobility no.3 between the groups(P>0.05).2.3 laboratory indicators analysis:In terms of laboratory indicators,the level of serum albumin globulin ratio were lower in the isoechoic CAS group and heterogeneous CAS group(P<0.05),and there was no statistical difference in other laboratory indicators(P>0.05).2.4 diagnostic value of serum albumin-globulin ratio in stability of carotid atherosclerotic plaque:State variable:plaque stability(stable plaque=1,unstable plaque=2),test variable:the level of serum albumin-globulin ratio.Through ROC curve statistical analysis,the results showed that the area under curve was 0.613,95%CI:(0.518,0.709).The optimal cutoff value was 1.505,sensitivity was 0.585,specificity was 0.647,P=0.026.2.5 Correlation analysis between the level of serum albumin-globulin ratio and oral examination indicators:A Nonparametric test(Spearman correlation analysis)was conducted to observe the correlation between the level of serum albumin-globulin ratio and oral examination indicators.The results showed that the level of serum albumin-globulin ratio were negatively correlated with the number of loose teeth,mobility no.2 and mobility no.3(rs=-0.263/-0.217/-0.204,P=0.002/0.013/0.020).No correlation was found between the level of serum albumin-globulin ratio and mobility no.1,plaque index in T2DM+CAS patients(P>0.05).2.6 linear regression analysis of the level of serum albumin globulin ratio and oral examination indicators:Using the level of serum albumin globulin ratio as the dependent variable(Y),number of lost teeth,number of mobility no.2 and mobility no.3 as the independent variable(X),a multiple linear regression analysis was conducted.The results showed that the number of lost teeth was included in the linear regression equation,and the regression equation was Y=1.590-0.013*X,R2=0.100,P<0.01.The number of lost teeth can explain the degree of 10%change in serum the level of serum albumin globulin ratio,and the number of lost teeth was an independent influencing factor of the level of serum albumin globulin ratio.Conclusions:This study found that poor periodontal status in patients with T2DM is related to the occurrence and stability of carotid atherosclerotic plaque.The patients have poor oral hygiene in the carotid atherosclerotic plaque group and unstable carotid atherosclerotic plaque group.In addition,lower levels of serum albumin globulin ratio are associated with unstable carotid atherosclerotic plaque and poor oral hygiene.Poorer oral hygiene and lower serum AGR levels may be indicative indicators of unstable carotid atherosclerotic plaque,providing new directions for the management of the patients with T2DM and the prevention of complications.