HOST ENZYMES IN GINGIVAL CREVICULAR FLUID AS DIAGNOSTIC INDICATORS OF PERIODONTITIS
HOST ENZYMES IN GINGIVAL CREVICULAR FLUID AS DIAGNOSTIC INDICATORS OF PERIODONTITIS
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DOI：
10.1111/j.1600-051x.1994.tb00414.x
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发表时间：
1994-08-01
影响因子：
6.7
通讯作者：
MCCULLOCH, CAG
中科院分区：
文献类型：
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作者：
MCCULLOCH, CAG
宿主对牙周感染的反应包括产生由基质细胞、上皮细胞或炎性细胞释放的几个酶家族。对龈沟液中这些酶的研究可能会导致对发病机制的深入了解，并可能为开发新的诊断测试提供合理的基础。然而，与牙科和医学中的其他诊断干预类似，宿主酶作为诊断指标的验证取决于酶的身份、再现性、诊断准确性和临床实用性的明确证明。感兴趣的酶应该在广泛的疾病严重程度范围内和在不同的临床环境中容易地测量。理想情况下，这种酶也应该是提出的致病机制的重要组成部分。在这种情况下，结缔组织基质降解酶弹性蛋白酶，胶原酶和明胶酶是有希望的，因为它们在牙周附着丧失和疾病进展中起着明显的中心作用。灵敏和特异性测定也可用于定量这些酶。与细胞死亡相关的酶（天冬氨酸转氨酶、乳酸脱氢酶）和几种中性粒细胞溶酶体酶（β-葡萄糖醛酸酶、芳基硫酸酯酶、组织蛋白酶）的其他研究表明，酶水平与附着丧失和炎症之间存在正相关性。虽然大量的横断面研究表明，龈沟液中的水解酶的水平平行牙周病变的严重程度，有更少的数据在纵向研究的可重复性，诊断准确性和临床实用性。由于适当的研究设计是确定宿主酶作为诊断测试功效的重要先决条件，因此未来的临床研究应包括：（1）最有可能从早期诊断中受益的个人，即，快速进展和复发性牙周炎病例;（2）纵向、队列研究设计，以表明附着丧失与酶活性的大幅增加在时间上相关;（3）使用一系列测试来克服活动性疾病患病率低时预测值低的内在问题。在最后的分析中，宿主酶作为诊断指标的效用需要在随机对照试验中进行检查，其中提出的问题是：测试的结果是否使患者更好？
Host responses to periodontal infections include the production of several families of enzymes that are released by stromal, epithelial or inflammatory cells. Study of these enzymes in gingival crevicular fluid may lead to insights into pathogenesis and may provide a rational basis for the development of novel diagnostic tests. However, analogous to other diagnostic interventions in dentistry and medicine, validation of host enzymes as diagnostic indicators is dependent on clear-cut demonstrations of the identity of the enzyme, reproducibility, diagnostic accuracy and clinical utility. The enzyme of interest should be readily measured over a broad range of disease severity and in varied clinical settings. Ideally, the enzyme should also be an essential component of proposed pathogenic mechanisms. In this context, the connective tissue matrix degrading enzymes elastase, collagenase and gelatinase are promising because of their apparently central role in periodontal attachment loss and disease progression. Sensitive and specific assays are also available to quantify these enzymes. Other work on enzymes associated with cell death (aspartate aminotransferase, lactate dehydrogenase) and several neutrophil lysosomal enzymes (beta glucuronidase, arylsulphatase, cathepsins) has demonstrated positive associations between enzyme levels and attachment loss and inflammation. While numerous cross-sectional studies have indicated that the levels of hydrolytic enzymes in gingival crevicular fluid parallel the severity of periodontal lesions, there are much less data on reproducibility, diagnostic accuracy and clinical utility in longitudinal studies. As appropriate study design is an essential prerequisite for establishing the efficacy of host enzymes as diagnostic tests, future clinical investigations should include: (1) individuals who would most likely benefit by early diagnosis, i.e., rapidly progressive and recurrent periodontitis cases; (2) longitudinal, cohort study designs to show that attachment loss is temporally linked with large increases in enzyme activity; (3) the use of a battery of tests to overcome intrinsic problems of low predictive values when prevalence of active disease is low. In the final analysis, the utility of host enzymes as diagnostic indicators will need to be examined in randomized controlled trials in which the question is asked: are patients better off as a result of testing?