【作者】 李志强；

【导师】 安黎哲；

【作者基本信息】 兰州大学 ， 生物学， 2009， 博士

【摘要】 通过对甘肃省特有的东乡族、保安族、裕固族三个民族进行了龋病、牙周病、两个年龄组口腔知识问卷调查,对中国三个民族不同人群的口腔健康状况及影响因素有了较为全面的了解,为监测龋病和牙周疾病的患病趋势提供了理论依据;根据中国三个民族不同人群口腔卫生保健的知识、态度和行为及其口腔保健服务利用情况,对口腔卫生需求进行了评估;为监测和评价中国口腔卫生保健工作规划(2004—2010年)提供民族口腔疾病方面的信息支持。为了解甘肃省三个特有民族东乡族、保安族、裕固族的口腔微生物状况,对三个民族进行口腔微生物的流行病学调查,研究三个民族口腔中变形链球菌及口腔微生物与儿童龋病的相关性。通过东乡、保安族两个民族龋病分子流行病学调查,研究甘肃地区的东乡族、保安族人群VDRTaqI单核苷酸多态性(SNPs)与龋病发病风险的相关性。通过对上述基因多态性的检测与分析,探索这些基因中各基因型的分布频率与龋病发病风险的相关性;期待从基因的分子生物学水平发现东乡族、保安族人群龋病发病的遗传学原因;可将发现的易患性相关基因型作为龋病易患性的检测指标,用于发现和识别龋病易患人群;有针对性地提高对相应人群的预警、采取积极的龋病预防措施。具体结果如下:随机、整群抽样方法调查5、12、35～44、65～74岁4个年龄组共1604人,龋病、牙周病检查方法采用第三次全国口腔健康流行病学调查方法,5岁、12岁口腔健康调查问卷采用第三次全国口腔健康流行病学调查问卷,5岁组共问卷301人,家长问卷299人,12岁组问卷448人。东乡族、保安族、裕固族5、12岁儿童口腔微生物流行病学调查。随机抽取5岁组东乡、裕固族各50名共100名儿童;12岁组三个民族随机抽取东乡族(50名)、保安族(55名)、裕固族(60名)共165名儿童。变形链球菌采用芬兰OriOnDiagnostm公司生产试剂盒检测。选择甘肃临夏东乡族、保安族龋病患者264人,以全身健康无系统性疾病者为正常对照组共219人,进行龋病易感基因的研究。DNA用标准的蛋白酶K及酚-氯仿有机抽提法从EDTA抗凝的外周血中提取。1.1龋病结果1.1.1 5岁组东乡族与保安族龋病患病率有明显差异(x~2=9.5403,P=0.002),但东乡族与裕固族(x~2=2.6799,P=0.1016)、保安族与裕固族(x~2=2.9812,P=0.0842)无差异;东乡、保安族比全国及西部高,差异有统计学意义;裕固族高于全国及西部,但差异无统计学意义。(限于篇幅,性别差异及与全国和西部的比较仅在结果中描述分析,下同)1.1.2 12岁组东乡族与保安族(x~2=2.2997,P=0.1294)、东乡族与裕固族(x~2=2.1817,P=0.1397)无统计学差异,但保安族与裕固族(x~2=8.7463,P=0.0031)有明显差异。1.1.3 35～44岁组冠龋患病率三个民族间有明显差异(x~2=32.083,P=0.000);东乡族低于全国及西部,差异有统计学意义。根龋患病率东乡、保安族有明显差异(x~2=28.499,P=0.0004),保安与裕固族(x~2=21.5451,P=0.0000)有明显差异,东乡与裕固(x~2=0.5710,P=0.4499)无差异。1.1.4 65～74岁组冠龋患病率三个民族间患龋率无差异(x~2=5.926,P=0.052)。根龋患龋率东乡与保安族(x~2=10.7434,P=0.001)有差异,东乡与裕固(x~2=1.9428,P=0.1634)、保安与裕固族(x~2=3.1963,P=0.0738)无差异。1.2牙周病结果1.2.1 12岁组牙龈出血东乡与保安族(x~2=0.4206,P=0.0.516)无明显差异,东乡与裕固族(x~2=94.1576,P=0.000)、保安与裕固族(x~2=80.4166,P=0.000)有明显差异。牙结石三个民族间无差异。1.2.2 35～44岁组牙龈出血东乡与保安族间(x~2=0.7309,P=0.3902)无差异,东乡与裕固族(x~2=18.0775,P=0.000)、保安与裕固族(x~2=25.7951,P=0.000)有明显差异。牙结石三个民族间无差异(x~2=1.032,P=0.597)。牙周袋东乡与保安族(x~2=0.0684,P=0.7936)间无差异,东乡与裕固族(x~2=19.1641,P=0.000)、保安与裕固族(x~2=17.3956,P=0.000)有明显差异。1.2.3 65～74岁组牙龈出血东乡与保安族(x~2=5.1868,P=0.0228)、东乡与裕固族(x~2=20.7198,P=0.000)、保安与裕固族(x~2=8.8395,P=0.0029)有明显差异。牙结石三个民族间无差异(x~2=1.656,P=0.437)。牙周袋东乡与保安族(x~2=7.272,P=0.007)、东乡与裕固族(x~2=12.066,P=0.001)有明显差异,保安与裕固族(x~2=1.303,P=0.253)无差异。2.5岁、12岁儿童唾液中的变形链球菌水平民族间的差异有统计学意义;12岁组菌斑中的变形链球菌水平在不同牙位三个民族间的差异有统计学意义;2个民族5岁儿童龋齿的球菌比例显著高于正常牙,杆菌比例均显著低于正常牙;3个民族12岁儿童龋齿的球菌比例显著高于正常牙,杆菌比例均显著低于正常牙。5岁组随着口腔中变形链球菌水平的提高,乳牙龋齿的患病程度呈上升趋势;不提示12岁组口腔中变形链球菌水平的与龋齿的患病程度呈正相关;在龋齿的牙菌斑中,基本上是球菌比例增高,而杆菌比例有所降低;造成这一变化的原因可能与口腔微生物群的演替过程有关。3.对于VDRTaqI多态性位点,携带有Tt基因型的个体患龋齿的风险增高,等位基因t是龋病的易患性基因;VDRTaqI位点的多态性与龋病患者的性别无关;东乡龋病组和保安龋病组以及汉族龋病组之间VDRTaql多态性位点的分布频率的差别亦无统计学意义。两个民族龋病分子流行病学调查,为甘肃保安、东乡族中龋病相关易感基因的分布和分型提供了基本数据;为进一步纵向研究该族群易感基因与龋病关系的动态变化奠定了基础;为龋病的分子分型、分子诊断和基因治疗提供了一定的理论依据。东乡族、保安族、裕固族三个民族除裕固族个别年龄段口腔疾病患病率略好于全国及西部水平外,其余状况均与全国及西部有差异,提示需要加大对三个民族口腔卫生知识普及及人力财力的投入,以逐步实现国家口腔卫生目标;三个特有民族的口腔健康流行病学调查,部分年龄段的部分指标显示口腔卫生知识及观念与患病率的调查结果无相关性,不能解释原因,故不排除民族因素为其中的重要因素之一;口腔健康指标在儿童期差别不大,提示特殊年龄段的儿童的口腔致病危险因素基本相似,成年后的较大差距与口腔卫生观念的不同、医务人员的匮乏、医疗设施的配置不足及民族差异关系较大;现有国力、经济发展水平与匮乏的口腔医生培养极不相称,需加大口腔医生的培养,大幅度增加口腔医学教育的预算。更多还原

【Abstract】 To find out the status of oral epidemiology of the three special nationalities peculiarly resided in Gansu province--Dongxiang,Bao-an,and Yugu.We conducted an epidemiologic study of dental disease on dental caries and periodontal diseases and conducted an oral knowledge questionnaire to two age groups among these three nationalities.Through our investigation,we wanted to know the oral health state and influencing factors of different groups among these three nationalities in Gansu Province,P.R.China,monitoring the prevalence trendency of dental caries and periodontal diseases,to understand their basic knowledge level on dental,their attitude to and behavior of oral hygiene and their utilizing condition of oral health care,io order to provide some information to support for the evaluation and monitoring the execution of"china oral Health care planning"(2004-2010)in ethnic race regions.Find out the status quo of oral microorganism of the three special nationalities peculiar to Gansu province,carried out three national epidemiological survey of oral micro-organisms and study the relevance of the oral streptococcus mutans and microorganism of the three ethnic groups to children’s dental caries.Through the molecular epidemiology research on dental caries of Dongxiang and Bao-an nationalities,study the relevance of VDRTaq1 polymorphism to prevalenc e risk of dental caries of the groups from Dongxiang and Bao-an nationalities in Gansu province.Through the test and analysis of the above-mentioned gene polymorphism,explore the relevance of the distributing frequency of various genotypes in these genes to the prevalence risk of dental caries.Look forward to finding out the genetic causes of the prevelance of dental caries of Dongxiang,Bao-an groups from the molecular biology level of genes.We can use the relative genotypes with susceptibility that have been founded as the detection indicators of dental caries susceptibility,so as to find out and identify the Vulnerable groups with dental caries.To improve with a clear aim the early warning to the corresponding groups and take positive measures against dental caries.Specific results are as follows:The representative samples were selected by cluster sampling methodology from the all 1604 persons,which were divided into four age groups,5,12,35～44,65～74 years,including 55 male and female in each group.Sampling survey proposal and technology were based on the Third National Wide Oral Health epidemiological survey.And we used the questionnaire of the Third National Wide Oral Health epidemiologieal survey questionnaire of oral health at 5,12 group.There are 301 children investigaed at the age of 5 group,299 parents and 448 children investigated for the age group of 12,for questionnaire.Conduct an investigation of oral microbial epidemiology on 5-year-old children and 12-year-old ones of Dongxiang,Bao-an and Yugu nationalities.Make a random sampling of a total of 100,5-year-old children from Dongxiang and Yugu nationalities respectively,with 50 from each.Make a random sampling of 165,12-year-old children in all from the three nationalities,with 50 from Dongxiang nationality,55 from Bao-an nationality and 60 from Yugu nationality.The streptococcus mutans will be tested by the kit produced by Orion Diagnostm company in Finland.Choose 264 patients with dental caries from Dongxiang and Bao-an nationalities in Linxia,Gansu province and a total of 219 persons without systemic disease as the control group,so as to conduct a study on gene suscepbility of dental caries.The DNA was extracted from EDTA anticoagulant peripheral blood by using standard method of proteinase K and phenol-chloroform organic extraction.1.1 The results of dental caries1.1.1 Age 5 group There was a statistical difference between the results of Dongxiang and Bao-an(x~2=9.5403,P=0.002);but there was no statistical difference between Dongxiang and Yugu(x~2=2.6799,P=0.1016),Bao-an and Yugu(x~2=2.9812,P=0.0842).The caries prevalence of Dongxiang and Bao-an is higher than that of the whole nation and the western part of China and also has statistical difference with them.The results of Yugu are higher than that of the whole nation and the western part of China,but there was no statistical difference.(Restrict at length of writing,we only describe the sex differences and comparison with the whole nation and the western part of China in results,same as below)1.1.2 Age 12 group There was no statistic difference between Dongxiang and Bao-an(x~2=2.2997,P=0.1294),Dongxing and Yugu(x~2=2.1817,P=0.1397) but there was a statistical difference between the results of Bao-an and Yugu (x~2=8.7403,P=0.0031).1.1.3 Age 35～-44 groupPrevalence of crown caries There was statistical difference among the three nationalities(x~2=32.083,P=0.000).Prevalence of root caries There was a statistical difference between Dongxing and Bao-an(x~2=28.499,P=0.004),also between Bao-an and Yugu (x~2=21.5451,P=0.000),but there was no statistical difference between Dongxing and Yugu(x~2=0.5710,P=0.4499).1.1.4 Age 65～74 groupPrevalence of crown caries There was no statistical difference among these three nationalities(x~2=5.926,P=0.052).Prevalence of root caries There was a statistical difference between the results of Dongxiang and Bao-an(x~2=10.7434,P=0.001),but there was no statistical difference between Dongxiang and Yugu(x~2=1.9428,P=0.1634),Bao-an and Yugu (x~2=3.1963,P=0.0738).1.2 The results of periodontal diseases1.2.1 Age 12 groupGingival hemorrhage There was no statistical difference beteen the results of Dongxing and Bao-an(x~2=0.4206,P=0.0516),but there was a statistical difference between Dongxiang and Yugu(x~2=94.1576,P=0.000),Bao-an and Yugu (x~2=80.4166,P=0.000).Calulus There was no statistical difference among the three nationalities.1.2.2 Age 35～44 groupGingival hemorrhage There was no statistical difference between the results of Dongxiang and Bao-an(x~2=0.7309,P=0.3902),but there was a statistical difference between Dongxiang and Yugu(x~2= 18.0775,P=0.000).Bao-an and Yugu(x~2=25.7951,P=0.000).Calculus There was no statistical difference among the three nationalities (x~2=1.032,P=0.597).Periodontal pocket There was no statistical difference between the results of Dongxiang and Bao-an(x~2=0.0684,P=0.7936),but there was a statistical difference between Dongxiang and Yugu(x~2=19.1641,P=0.000),Bao-an and Yugu (x~2=17.3956,P=0.000).1.2.3 Age 65～74 groupGingival hemorrhage There was a statistical difference between the results of Dongxiang and Bao-an(x~2=5.1868,P=0.0228),Dongxiang and Yugu(x~2=20.7198,P=0.000),Bao-an and Yugu(x~2=8.8395,P=0.0029).Calculus There are no statistical difference among the three nationalities(x~2=1.656,P=0.437).Periodontal pocket There was a statistical difference between the results of Dongxiang and Bao-an(x~2=7.272,P=0.007),Dongxiang and Yugu(x~2=12.066,P=0.001), but there was no statistical difference between the results of Bao-an and Yugu(x~2=1.303,P=0.253).2.The differences of the levels of streptococcus mutans in saliva of children at 5 and 12 between the nationalities are of statistical significance.The differences of the levels of streptococcus mutans in dental plaque at different tooth positions of the age 12 group among the three nationalities are of statistical significance.Among the 5-year-old children of the two nationalities,the proportion of cocci in dental caries are significantly higher than those in the normal teeth,while the proportion of bacilli are all significantly lower than those in the normal teeth.Among the 12-year-old children of the hree nationalities,proportion of cocci are significantly higher than those in the normal teeth,while the proportion of bacilli are all significantly lower than those in the normal teeth.With the increase of the level of streptococcus mutans in the oral cavities of age 5 group,the prevalence rate of caries of dedicuous teeth shows an upward trend.It doesn’t indicate that the level of oral streptococcus mutans of age 12 group is positively relevant to the degree of dental caries.In dental plaque of caries,basically the ratio of cocci is increasing,while that of bacilli is decreasing.The reason for this change may be related to the succession process of oral microorganisms.3.As for VRDTaq1 locus polymorphism,the prevelance risk of dental caries for individuals with genotype Tt is increasing and allele t is the suscepbility gene of dental caries.VRDTaq1 locus polymorphism is not relevant to the sex of patients with dental caries.The differences of distributing frequency of VRDTaq1 polymorphism among the groups from Dongxiang,Bao-an and Han have no statistical significance.The molecular epidemiology research on dental caries in two nationalities provides the basic data of the distribution and classification of caries-related suscepbility genes;Lays a foundation for the further longitudinal study of the dynamic changes of the relationship between suscepbility gene and dental caries of the groups;Provides certain theoretical basis for the molecular typing,diagnosis and gene therapy of dental caries.Among the three Nationalities,except some groups of Yugu nationality,there exists statistical difference on prevalence of dental disease when comparing to the whole nation and the western part of china.On these three nationalities,the government of China needs to strengthen education about oral health awareness,to improve the situation of human power and financial resources in order to reach the goal of the national oral health.Through the investigation of oral health epidemiology for the three special nationalities,we find out that part of the indicators of some age groups show that the knowledge of oral hygiene and idea are not relevant to the results of the prevalence rate,for which we cannot explain the reason,therefore it cannot be excluded that the ethnic factor is one of the most important attributes to such results.Oral health indicator has no much difference in childhood,which suggests that the risk factor is almost similar to childhood,but different from adult groups for the reason of difference of dental hygiene conception,deficiency of medical personnel,insufficiency of medical treatment facilities and racial difference.The training work on dentists is quite unparallel to the existing national strength,development and level of ecomomy.Therefore we must intensify the training for doctors and significantly increase the budget imput on stomatology education.更多还原