Comprehensive investigations into the etiology of Buerger disease

Buerger病的病因尚不清楚，尽管在过去的100年中提出了许多病因学因素。去年，我们报道了阻塞动脉的Buerger病显示口腔细菌DNA的动脉标本中的13个14名受试者。在那之后，我们证实了吸烟会加重牙周炎，烟草材料会使动脉痉挛和内皮表面恶化。牙周炎细菌，特别是牙龈卟啉单胞菌（Pg），强烈激活血小板。由于上述事实，Buerger病的病因集中在牙周细菌，主要是Pg和齿垢密螺旋体（Td）。静脉注射Pg的实验研究显示外周动脉血栓形成和细菌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出现菌血症。我们研究了细菌是如何运输到血管和心脏的。欧 ...更多信息 一项体外研究表明，Pg本身激活血浆中的血小板，血小板中的细菌也聚集血小板。血小板在60分钟内没有表现出吞噬作用，与粒细胞相比，其中细菌大多被杀死。这些事实是用电子显微镜研究的。我们推测Buerger病中相当大的血小板团块对小动脉有栓塞作用，动脉血栓形成，可见微血管扩张或粒细胞浸润，是主要病理点。另一个是保存完好的动脉结构。免疫荧光显微镜检测Td细菌本身附近的内弹性膜和血栓。Buerger病患者血清中抗牙周病原体的IgG抗体显著升高，戒烟和适当的口腔卫生可以降低Buerger病的发病率。现在我们正在检查HLA分型，估计显示牙周炎和Buerger病之间有很强的关系。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