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目的:通过对糖尿病(diabetes mellitus,DM)患者和正常人牙髓组织状况、微血管超微结构的比较,探讨DM与牙髓病变的关系及DM患者牙髓病变的发病机制。方法:采用分组对照法,DM组(30颗)为Ⅱ型DM患者拔除的外观完好、无牙髓病症状的阻生第三磨牙,对照组(30颗)为正常人拔除的阻生第三磨牙。光镜下观察2组牙髓组织的结构特点,电镜下观察牙髓组织中微血管超微结构及改变,测量微血管基底膜厚度,并通过组织化学电镜技术进行VEGF上负电荷位点的计数。采用SAS6.12软件包对数据进行统计学分析。结果:光镜下可见DM组牙髓毛细血管壁增厚。电镜下见DM组牙髓毛细血管壁增厚,管腔狭窄、变形,毛细血管基底膜显著增厚(P<0.01),毛细血管内皮细胞肿胀、结构紊乱。特殊染色电镜下见DM组牙髓毛细血管基底膜上负电荷位点显著减少(P<0.01)。结论:DM患者无龋坏、创伤缺损、牙髓病症状的牙的牙髓中毛细血管内皮细胞肿胀、结构紊乱,毛细血管基底膜增厚,基底膜上负电荷位点数目减少,可能是导致DM性牙髓病变的病理基础。
OBJECTIVE: To investigate the relationship between DM and endodontic diseases and the pathogenesis of dental pulp lesions in DM patients by comparing the dental pulp tissue status and microvascular ultrastructure in patients with diabetes mellitus (DM) and normal individuals. Methods: Grouping control method was used. DM group (30) type II DM patients with intact appearance without impaction of the pulp symptom were impacted third molars, while control group (30) were third implants with normal removal molar. The structure characteristics of dental pulp in two groups were observed under light microscope. The ultrastructure and changes of microvascular in dental pulp tissue were observed under electron microscope. The thickness of microvascular basement membrane was measured. The negative charge sites on VEGF were counted by histochemical electron microscopy. SAS6.12 software package for statistical analysis of the data. Results: Under the light microscope, there was thickening of capillary wall in DM group. Under electron microscope, the thickness of capillary wall, stenosis and deformation of capillary wall in DM group were significantly increased (P <0.01), capillary endothelial cells were swollen and the structure was disorganized. Under the special staining electron microscope, the negative charge sites on the basement membrane of the capillaries of DM group were significantly decreased (P <0.01). Conclusions: The carotid artery endothelial cells in the dental pulp of DM patients without caries, traumatic defects and endodontic symptoms are swollen, structural disorder, capillary basement membrane thickening, and the number of negative charge sites on the basement membrane may be decreased Pathological Basis of DM Sexual Dysfunction.