Relationship Between Vitamin D,FGF23 Levels And Type 2 Diabetes Mellitus Complicated With Chronic Periodontitis

BackgroundType 2 Diabetes Mellitus(T2DM)is a clinical syndrome characterized by chronic hyperglycemia caused by a combination of genetic and environmental factors.The global diabetes outbreak is on the rise.China is the largest country in diabetes,with a population of 114 million and a huge reserve army.The incidence of diabetes is getting younger.Diabetes and its complications seriously affect human health,and chronic periodontitis,as the sixth recognized complication of diabetes,has a incidence rate of over 90%in diabetes patients.In China,the main cause of adult tooth loss is Periodontitis,and Chronic Periodontitis(CP)is the most common type,accounting for about 95%of patients with Periodontitis.Gingival Crevicular Fluid(GCF)is an exudate that is collected from the Gingival Crevicular Fluid.Collecting gingival crevicular fluid for testing is a convenient,noninvasive method for assessing the level of local cytokines and mediators of inflammation.Vitamin D is a steroid hormone and an essential fat-soluble vitamin.The relationship between vitamin D3 and periodontitis is currently under study,and its role in the progression of periodontitis is still controversial.Therefore,the role of vitamin D3 in periodontitis needs further study.Fibroblast Growth Factor 23(FGF23)is a newly discovered bone-derived phosphate hormone with biological activity,which is associated with hypophosphatemia,hyperphosphatemia,vitamin D metabolism and heterotopic mineralization.Under physiological conditions,FGF23 is a key regulator of vitamin D metabolism in the body,and maintains the balance of mineral metabolism through the interaction of calcium,phosphorus and vitamin D.1,25-dihydroxyvitamin D rapidly induces FGF23 expression in tibia and other bones through activated vitamin D receptors.However,both diabetes and periodontitis are chronic inflammatory diseases,both of which have an impact on bone destruction Whether FGF23 is related to alveolar bone destruction still needs further discussionObjectiveIn this paper,the participants in the serum and gingival groove liquid vitamin D,FGF23 in researches on the effect of type 2 diabetes and chronic periodontitis,change the effects of vitaminD,FGF23 levels in diabetic chronic periodontitis and OPG/RANKL/RANK channel relations,and further research of vitamin D,FGF23 and inflammatory cytokines in diabetic chronic periodontitis,and their occurrence and development process in type 2 diabetes mellitus and chronic periodontitis in meaning,thus help us from the new targets for understanding and treating diseases,To provide clinical data for the prevention and treatment of diabetes mellitus and chronic periodontitis and improve the quality of life of patients.Method40 patients with Type 2 Diabetes Mellitus complicated with Chronic Periodontitis(DM+CP group),40 patients with Chronic Periodontitis but without Diabetes mellitis(CP group)and 20 Healthy People(HP group)were included.General data of age,blood pressure,BMI,and Diabetes history of each group were collected.Fasting plasma Glucose(Fasting Blood Glucose,FBG),glycosylated hemoglobin(GHbA1c),Blood lipid,uric acid,such as clinical indicators,using enzyme-linked immunosorbent Assay(Enzyme-Linked ImmunoaorbentAssay,ELISA)to detect serum and gingival groove liquid of 25(OH)D3,FGF23,OPG and RANKL,TNF-a,PGE2,IL-1,IL-6,MCP-1 level.SPSS21.0 software was used for data analysis,and Pearson correlation test was used for correlation analysis.For comparison between groups in line with normal distribution,one-way variance was used,and non-parametric test was used.P<0.05 was considered statistically significant.Result1L Comparison of Vitamin D Levels in Different GroupsSerum vitamin D level in DM+CP group was slightly lower than that in CP group and HP group,but the diff'erence was not statistically significant(P>0.05).Vitamin D levels in gingival crevicular fluid were lower in the DM+CP group than in the HP group,and lower in the DM+CP group than in the CP group,with statistically significant differences(P<0.05).The levels of vitamin D in gingival crevicular fluid were further compared in pairs.The DM+CP group was lower than the CP group,and the CP group was lower than the HP group,with statistically significant differences(P<0.05).2.Analysis of the correlation between vitamin D and fibroblast growth factor 23 levels and inflammatory markersThere was no significant correlation between the level of vitamin D in serum and the level of inflammatory factors in serum,while there was a significant negative correlation between the level of vitamin D in gingival crevicular fluid and the level of inflammatory factors TNF-a PGE2 IL-6 IL-1 in gingival crevicular fluid,and the difference was statistically significant(P<0.05).There was no significant correlation between the level of FGF23 in serum and the level of inflammatory factors in serum gingival crevicular fluid(P>0.05).3.Difference analysis of MCP-1 and inflammatory factors in different groupsThere were significant differences in MCP-1,TNF-a,PGE2,IL-6 and IL-1 in serum and gingival crevicular fluid between DM+CP group,CP group and HP group(P<0.05).Further comparing the above indicators,the level of MCP-1 in serum and gingival crevicular fluid in HP group was significantly lower than that in other two groups,DM+CP group was significantly higher than HP group(P<0.001),slightly higher than CP group;for TNF-?,IL-6,IL-1,HP group was significantly below than other two groups,DM+CP group was significantly higher than CP group,the difference was statistically significant(P<0.05).4.Analysis of correlation between glycosylated hemoglobin and other indicatorsThere was a significant positive correlation between hbalc and TNF-a,PGE2,IL-6 and IL-1 in serum and gingival crevicular fluid(except serum PGE2),with statistically significant differences(P<0.05).There was no significant correlation between hbalc and the level of vitamin D in serum,but there was a significant negative correlation between hba1c and the level of vitamin D in gingival crevicular fluid,and the difference was statistically significant(P<0.05).According to different levels of glycosylated hemoglobin participants divided into group A(GHbA1c?6.5%)and group B(6.5%<GHbA1c<9%)and group C(GHbA1c?)9%)three subgroups,inflammatory cytokines in serum and gingival sulcus liquid TNF-?,IL-6,IL-1,and the fluid of the gingival sulcus between vitamin D levels in different groups were significant differences(P<0.05),the higher the glycosylated hemoglobin group,the higher the level of inflammatory factors,local lower vitamin D levels.However,there was no significant correlation between GHbAlc and the level of FGF23 in serum and gingival crevicular fluid(P>0.05).5.Analysis of the correlation between vitamin D and fibroblast growth factor 23 levels and OPG/RANKL/RANK pathwaySerum vitamin D level was not significantly correlated with serum RANKL and OPG/RANKL ratio(P>0.05),but vitamin D level in gingival crevicular fluid was negatively correlated with serum RANKL and OPG/RANKL ratio in gingival crevicular fluid(P<0.001),while serum fibroblast growth factor 23 was not significantly correlated with serum OPG/RANKL ratio,and fibroblast growth factor 23 in gingival crevicular fluid was also negatively correlated with serum OPG/RANKL ratio in gingival crevicular fluid(P<0.001).There was no significant correlation(P>0.05).6.Analysis ofcorrelation between glycosylated hemoglobin level and OPG/RANKL/RANK pathwayThere was a significant positive correlation between hbalc and RANKL levels in serum and gingival crevicular fluid(P<0.05),but no significant correlation between GHbAlc and OPG levels in serum and gingival crevicular fluid(P>0.05).According to the different subgroups of glycosylated hemoglobin,serum and gingival groove liquid level of RANKL in the significant differences in different groups,the difference was statistically significant(P<0.05),and further to RANKL level differences are compared,and two in the subgroups in serum RANKL level B and C group were significantly higher in group A(P<0.05),slightly higher than that of group B,group C but no significant difference;RANKL levels in gingival crevicular fluid were significantly higher in groups B and C than in group A(P<0.05),and there was no significant difference between groups B and C.7.Analysis of the correlation between vitamin D and fibroblast growth factor 23There was no significant difference in serum and gingival crevicular fluid levels of fibroblast growth factor 23 between DM+CP group,CP group and HP group(P>0.05).Serum vitamin D level was not correlated with serum fibroblast growth factor 23 and fibroblast growth factor 23 in gingival crevicular fluid.There was no correlation between serum fibroblast growth factor 23 and fibroblast growth factor 23 in gingival crevicular fluid(P>0.05).Conclusions1.Vitamin D plays a role in the pathogenesis of diabetic chronic pernodontitis.lt is of great significance to improve local vitamin D level through exogenous vitamin D supplementation,or it can be used as a target in clinical treatment of diabetes mellitus complicated with chronic periodontitis.2.The involvement of OPG/RANKL/RANK pathway in the construction of local bone in diabetic patients with chronic periodontitis is affected by blood sugar and local vitamin D levels,but not by the levels of local and systemic fibroblast growth factor 23.Local vitamin D deficiency or deficiency or elevated blood sugar can cause the reduction of alveolar osteogenesis,the enhancement of bone resorption,and then the loss of alveolar bone.3.The level of inflammatory factors in serum gingival crevicular fluid is significantly positively correlated with glycosylated hemoglobin.Diabetes and periodontitis promote each other,and the prevention and treatment of periodontitis should be considered when controlling blood glucose.Similarly,good blood glucose control is an important prerequisite for the development of periodontitis and the treatment effect of periodontitis.4.The combined detection of vitamin D and inflammatory factors in gingival crevicular fluid in patients with diabetes mellitus and chronic periodontitis can understand the occurrence and development of diabetes mellitus and periodontitis.The method is non-invasive,simple and acceptable to patients.It is helpful to take appropriate measures in time to prevent serious complications and improve the quality of life of diabetic patients.5.In diabetes mellitus with chronic periodontitis,no significant correlation was found between local and systemic vitamin D and fibroblast growth factor 23,and no significant correlation was found between fibroblast growth factor 23 and OPG/RANKL/RANK pathway,inflammatory factors.Further large-scale sample and follow-up intervention studies were needed to explore the role of fibroblast growth factor 23 in diabetes mellitus with chronic periodontitis.