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The Preliminary Study on the Mechanism of C-reative Protein in Type 2 Diabetes Mellitus with Chronic Periodontitis

Author: QiWeiJuan
Tutor: ZhangJinCai
School: Southern Medical University,
Course: Clinical Stomatology
Keywords: Chronic periodontitis Type 2 diabetes mellitus Polymorphism C-reactive protein
CLC: R781.42
Type: Master's thesis
Year: 2011
Downloads: 59
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Abstract

Background: Periodontitis is caused by plaque microorganisms infectious diseases, can cause inflammation of the gums, periodontal pocket formation, progressive periodontal attachment loss and alveolar bone destruction. Although the plaque is the initiating factor of periodontitis incidence, but just from the plaque microbiological point of view not sufficient to explain the differences in disease severity. More and more evidence that certain risk factors (such as systemic diseases and genetic factors) is not a direct result of the occurrence of periodontitis, but the impact of its severity. Studies have shown that diabetic patients suffering from periodontitis risk was significantly higher than that in healthy people. Diabetes is a multi-cause metabolic diseases, including type 2 diabetes is the main type, more common in clinical 35-40 years of age, accounting for 90% -95% of all diabetes. Damage of islet function and insulin resistance have long been considered to be the two key factors of type 2 diabetes, but recent studies that type 2 diabetes is the body's natural immune system to start cytokine-mediated inflammatory reaction, inflammation in 2 play the role of the media in the pathogenesis of diabetes. Inflammation has been shown to play an important role in the occurrence of insulin resistance and pancreatic β cell damage; while the role of inflammation in the progression of periodontitis has been fully affirmed. C-reactive protein (CRP) is widely used in clinical markers of inflammation, it has been confirmed with periodontitis and diabetes development. The study showed that: periodontitis can cause elevated serum CRP concentrations, its severity and serum CRP concentrations were positively correlated; CRP is also important predictors of type 2 diabetes. Serum CRP levels is the common reaction of periodontitis and diabetes, it opens up new areas to explore both the internal contact. CRP is traffic messengers \factor IL-Iβ, IL-6, TNF-α, interferon, transforming growth factor-β (TGF-β) induced mainly synthesized by the liver cells, peripheral blood lymphocytes may also produce a small amount. Tissue damage, infection or tumor destruction, serum CRP concentrations can rise sharply within a few hours, condition improved gradually decline, to return to normal. It enhances leukocyte reaction, complement fixed and cell debris removal sites of inflammation, has the characteristics of immune recognition and immune regulation function, is a sensitive indicators of subclinical infections. The study found that the genetic and environmental factors affect CRP levels, genetic factors may explain individuals CRP levels 35% -40% of the difference. More than the populations of large sample studies show significant correlation in the CRP gene polymorphism and serum baseline level. Currently, has found that nearly 40 kinds of CRP single-nucleotide polymorphisms, part SNPs or haplotype correlation with plasma CRP levels has been confirmed. CRP gene polymorphism and systemic disease is more involved in the relationship with cardiovascular disease. The relative lack of study of C-reactive protein gene polymorphism, diabetes and periodontitis. In this study, by detecting the baseline levels of CRP and HbA1c and CRP gene polymorphism distribution, to explore the CRP gene polymorphism and type 2 diabetes with chronic periodontitis, serum CRP and HbA1c baseline level of correlation; through analysis of CRP SNPs with teeth CRP and HbA1c level of the crowd longitudinal changes, explore different genetic background periodontitis patients before and after the weekly basic treatment of periodontal therapy reactivity and sensitivity to differences. The first chapter in type 2 diabetes with chronic periodontitis populations of C-reactive protein gene polymorphism and serum baseline levels of C-reactive protein research purposes: detection of serum CRP in Guangzhou, China, Han type 2 diabetes with chronic periodontitis crowd the level and distribution of CRP gene polymorphism; explore the CRP gene polymorphism and the crowd serum CRP baseline level. Method: This chapter is included in the 135 subjects, from Guangzhou tertiary hospitals outpatient clinics in the period from September 2008 to September 2009. Inclusion criteria: (1) diabetes diagnosed more than 1 year, diabetes in stable condition, medication did not change within two months, no serious complications; ② with chronic periodontitis, full mouth lifetime ≥ 16 teeth, and did not go through the system periodontal treatment 1 year, did not receive scaling. Exclusion criteria: (1) suffering affect periodontal health of other systemic diseases, such as coronary heart disease; ② addition to periodontitis outside, the presence of active inflammation in other parts of the body; ③ survey ago, within four weeks of antibiotics; ④ pregnancy, breast-feeding phase plan to become pregnant during treatment; ⑤ refused to participate in the study. All subjects in the morning between 8-10 points collected fasting venous blood, serum high-sensitivity C-reactive protein (hsCRP) concentration. The genomic DNA extraction kit peripheral blood DNA of all subjects. By direct sequencing and polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) method for the determination of C-reactive protein CRP-757 T gt; C, -717 A gt; G, -409 G gt; A, -286 C gt; A gt; T, 1059 G gt; C and 1444 C gt; the T locus genotypes, detected CRP in type 2 diabetes with chronic periodontitis crowd genotype. Using KruskalWallis test and the Mann-Whitney test analysis CRP locus genotype differences between CRP concentration. If there are differences, according to the median of the hsCRP, the subjects were divided into two groups by x2 test analysis of the differences between the two groups of allele frequencies. Results: 1.CRP SNPs Hardy-Weinberg equilibrium test CRP -757 T gt; C, -717 A gt; G, -286 C gt; A gt; T, 1059 G gt; C and 1444 C gt; genes of T you point type frequency distribution in the study population in Hardy-Weinberg balance (P gt; the 0.05) 2.CRP genotype and allele in type 2 diabetes with chronic periodontitis population distribution of CRP locus genotype: -757 T gt; C TT genotype; -717 A, gt; G AA genotype; -286 C gt; A gt; T CC genotype; 1059 G gt; the C GG genotype; 1444 C gt; T CC genotype. The -409 G gt; A sites only detected GG genotype; 1059 G gt; CC genotype C was not found. 3.CRP gene locus linkage disequilibrium analysis in this study of type 2 diabetes associated with chronic periodontitis crowd -286 C gt; A gt; T and -757 T gt; C there is a strong linkage disequilibrium (r2 = 0.648). 4.CRP gene locus haplotype analysis in this study found that five effective haplotype (CAAGC, TACCC, TACGC, TATGT TGCGC) which TACGC (51.0%) is the main haplotype. 5.CRP gene polymorphism associated with baseline levels of serum CRP CRP-757 T gt; C, -717 A gt; G, -286 C gt; A gt; between T different genotypes of the three polymorphisms significant differences in serum CRP concentrations; remaining two gene polymorphism 1059 G gt; C and 1444 C gt; statistical significance (P gt differences the T different genes between serum CRP concentrations; 0.05) high concentrations of hsCRP ( gt; 50%), -757 T gt; CC allele -717 A gt; G A allele and -286 C gt; A gt; the T A allele carrier rate significantly higher than the low concentration The hsCRP Group. The second chapter in type 2 diabetes with chronic periodontitis crowd in C-reactive protein gene polymorphism and HbA1c baseline levels related research purposes: To investigate the type 2 diabetes mellitus in Guangzhou, China, Han C-reactive protein gene in the population with chronic periodontitis state with HbA1c baseline level of correlation. Methods: The study, CRP genotypes detected with the first chapter. All subjects detect HbA1c levels. Kruskal Wallis test and the Mann-Whitney test to analyze the differences in the level of HbA1c baseline CRP locus genotypes. Results: In this study, CRP-757 T gt; C, -717 A gt; G, -286 C gt; A gt; T, 1059 G gt; C and 1444C gt; the T different genotypes HbA1C baseline differences in levels of no statistically significant (P gt; 0.05). Chapter changes in serum CRP levels in type 2 diabetes associated with C-reactive protein gene polymorphism and periodontal treatment in chronic periodontitis population study Objective: To investigate China Guangzhou Han population with type 2 diabetes with chronic periodontal hsCRP levels change the inflammation crowd CRP gene polymorphism and periodontal therapy. Method: This chapter included in the 90 patients at baseline to accept non-surgical periodontal treatment, including oral hygiene education (OHI), full mouth scaling and root planing, occlusal adjustment, removal of the teeth that can not be retained; 3 months line and 6 months periodontal treatment, including oral hygiene education and conventional supragingival and subgingival scaling scaling. 6-month follow up visit with serum hsCRP level again. CRP genotype analysis of the same chapter. Kruskal Wallis test and the Mann-Whitney test analysis of the differences in different CRP locus genotype and periodontal treatment before and after hsCRP levels change. Results: In this study, CRP-757 T gt; C, -717 A gt; G, -286 C gt; A gt; T, 1059 G gt; C and 1444C gt; hsCRP level changes in T different genotypes was no difference statistically significant (P gt; 0.05). Chapter in type 2 diabetes with chronic periodontitis crowd after the C-reactive protein gene polymorphism and periodontal treatment HbA1c level correlation study Objective: To investigate China Guangzhou Han population with type 2 diabetes with chronic periodontal inflammation crowd CRP gene polymorphism and periodontal therapy HbA1c level change. Methods: CRP genotype detection and periodontal non-surgical treatment with the first chapter. HbA1c serum levels detected again in six month referral. Kruskal Wallis test and the Mann-Whitney test analysis of the difference of the the the CRP locus different genotypes periodontal treatment before and after changes in HbA1c levels. Results: In this study, CRP 1444 C gt; difference was statistically significant changes in HbA1c levels between the different genotypes of the T locus TT TC genotype HbA1c levels change. -757 T gt; C, -717 A gt; G, -286 C gt; A gt; T and 1059 G gt; HbA1c levels between the different genotypes C sites showed no statistical significance (P gt; 0.05) . Full Summary: 1, of Chinese Han type 2 diabetes with chronic periodontitis population CRP-757 T gt; C, -717 A gt; G, -286 C gt; A gt; T polymorphism and serum CRP baseline level ; -757 T gt; CC allele, -717 A gt; G A allele -286 C gt; A gt; T A allele was associated with high levels of CRP. 2,2 diabetes with chronic periodontitis patients CRP 1444 C gt; the T locus polymorphism and periodontal therapy after HbA1c levels related to changes in TC TT genotype was more sensitive periodontal treatment response. 3, still can not believe that type 2 diabetes mellitus patients with chronic periodontitis CRP 1059 G gt; C, 1444 C gt; T polymorphism baseline levels of serum CRP. 4, still can not believe that type 2 diabetes mellitus patients with chronic periodontitis CRP-757 T gt; C, -717 A gt; G, -286 C gt; gt; A T, 1059 G gt; C and 1444 C gt; T polymorphism associated with HbA1c baseline levels. 5, still can not believe that type 2 diabetes mellitus patients with chronic periodontitis CRP-757 T gt; C, -717 A gt; G, -286 C gt; gt; A T, 1059 G gt; C and 1444 C gt; T polymorphism with periodontal therapy related changes in CRP levels. 6, still can not believe that before and after periodontal treatment of type 2 diabetes with chronic periodontitis patients with periodontal CRP-757 T gt; C, -717 A gt; G, -286 C gt; A gt; T and 1059 G gt; The C polymorphism HbA1c level changes related. 7, the Chinese population in CRP-286 C gt; A gt; T and 1444 C gt; T locus and the Japanese have the same genetic background; healthy people in Europe and America have different genetic backgrounds.

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