Comprehensive investigations into the etiology of Buerger disease

Buerger病的病因尚不清楚，尽管在过去的100年里已经提出了许多病因。去年，我们报道了Buerger病的闭塞动脉在14名受试者中有13名的动脉标本中显示了口腔细菌DNA。之后，我们证实吸烟会加重牙周炎，烟草材料会恶化动脉痉挛状况和血管内皮细胞表面。牙周细菌，特别是牙龈卟啉单胞菌(Pg)，对血小板有强烈的激活作用。由于上述事实，Buerger病的病原学主要集中在牙周细菌，主要是PG和齿密螺旋体(TD)。静脉输注PG的实验研究显示，外周动脉血栓形成，细菌DNA阳性。口腔细菌容易到达静脉角，因此在牙周手术完成后几分钟就会出现菌血症。我们调查了细菌是如何运输到血管和心脏的。OU…更多的体外研究表明，PG本身激活了血浆中的血小板，细菌进入了血小板，这些细菌也在聚集血小板。与粒细胞相比，血小板在60分钟内没有表现出吞噬作用，粒细胞中的细菌大多被杀死。用电子显微镜对这些事实进行了研究。我们推测，在Buerger病中，相当大的血小板块对小动脉起到了栓子作用。动脉血栓的形成，我们可以看到微小的脓肿或粒细胞浸润，这是主要的病理点。另一个是保存完好的动脉结构。免疫荧光显微镜检测到TD细菌本身位于内弹力层附近和血栓中。Buerger病患者血清中针对特定牙周病原体的抗体显著升高，戒烟和适当的口腔卫生可降低Buerger病的发病率。现在我们正在检查人类白细胞抗原的配型，估计这表明牙周炎和Buerger病之间有很强的关系。较少

The cause of Buerger disease is not yet known, although many etiological factors have been suggested over the last 100 years. Last year we reported that the occluded artery of Buerger disease showed oral bacteria DNA in the arterial specimens of 13 out of 14 subjects. After that, we confirmed that smoking aggravates periodontitis, and that tobacco materials worsen arterial spastic conditions and endothelial surfaces. Periodontal bacteria, especially Porphyroinonas gingivalis (Pg), strongly activates the platelets. Because of the above- mentioned facts, the etiology of Buerger disease focused on periodontal bacteria, mainly Pg and Treponema denticola (Td). Experimental studies using an intravenous infusion of Pg showed peripheral arterial thrombus formation and positive bacterial DNA.Oral bacteria easily reaches the venous angle, so bacteremia appears several minutes after periodontal procedures are completed. We investigated how the bacteria are transported to the vessels and heart. Ou … More r in-vitro study showed the Pg itself activates the platelets in plasma and bacteria are taken in the platelets, which are also aggregating platelets. Platelets did not demonstrate phagocytotic action within 60 minutes compared with granulocyte, in which bacteria are mostly killed. These facts were investigated with an electro-microscope. We speculated that a pretty good sized platelet lump makes an embolic action on the small arteries in Buerger disease.Arterial thrombus formation, in which we could see micro abscesses or granulocyte infiltration, is the major pathological point. Another is well preserved arterial structures. Immuno-fluorescent microscopy detected Td bacteria itself near the internal elastic lamina and in the thrombus. Serum IgG antibodies against specific periodontal pathogens are elevated significantly in Buerger disease.Smoking cessation and proper dental hygiene are known to decrease the incidence of Buerger disease. Now we are checking the HLA typing, which is estimated to show a strong relationship between periodontitis and Buerger disease. Less