女性多囊卵巢综合征患者牙龈炎与白细胞-内皮细胞相互作用

鉴于慢性炎症与牙周疾病及心血管风险增加之间的关系，本研究旨在探讨牙龈炎是否加重多囊卵巢综合征（PCOS）女性的炎症反应及亚临床动脉粥样硬化标志物。作为一项病例对照研究，女性被分为三组：两组PCOS（有和无牙龈炎）及对照组。测定人体测量学和生化指标，以及牙周参数（探诊袋深度[PPD]、临床附着丧失[CAL]、探诊出血[BOP]、菌斑指数、牙结石指数及牙齿缺失），系统性和中性粒细胞炎症标志物（肿瘤坏死因子α[TNFα]、C反应蛋白[CRP]和c-Jun氨基末端激酶[JNK]），系统性氧化应激介质（髓过氧化物酶[MPO]及谷胱甘肽）、可溶性细胞粘附分子和中性粒细胞-内皮细胞相互作用（滚动通量、速度和粘附）。共纳入104名妇女，其中68例有PCOS，24例伴牙龈炎，36例为对照组。PCOS患者表现出性激素、脂质和碳水化合物代谢异常。PCOS伴牙龈炎者系统性炎症标志物、MPO和可溶性血小板选择素（sP-selectin）水平升高，谷胱甘肽水平降低。伴牙龈炎的PCOS患者的BOP、菌斑和结石指数更高。来自PCOS患者的中性粒细胞在流动条件下表现出JNK活性增加和粘附性降低，滚动速度减慢，滚动通量和细胞粘附增强，这些变化在伴牙龈炎者中更为明显。BOP与滚动速度、滚动通量和细胞粘附呈独立相关。伴牙龈炎的PCOS患者的中性粒细胞表现出过度活跃，促进与内皮的相互作用，可能促进动脉粥样硬化的发生。当前，牙周疾病的高发影响口腔健康和生活质量，导致牙齿移动、咀嚼功能障碍，最终引起牙齿丧失。近年来，牙周医学的概念逐渐提出，旨在研究牙周疾病如何影响全身炎症系统以及全身炎症性疾病如何影响口腔健康。本研究中，我们分析了表现出性激素及脂质异常和体重增加（体重指数）的PCOS妇女，发现其牙龈炎患病率较高，且影响白细胞与内皮细胞的相互作用。这些妇女的中性粒细胞表现出过度反应，具有更强的内皮粘附能力、较低的流动速度及增强的滚动，明显高于无牙龈炎的PCOS组或对照组。这一研究开辟了分析牙龈炎患者中性粒细胞过度活跃机制的新方向，强调其在动脉粥样硬化中的潜在作用。

Given the link between chronic inflammation and periodontal pathologies and increased cardiovascular risk, this study aims to investigate if gingivitis exacerbates the inflammatory response and subclinical atherosclerotic markers in women with polycystic ovary syndrome (PCOS).For this case-control study, women were assigned to three groups: two PCOS groups (with and without gingivitis) and a control group. Anthropometric and biochemical variables were determined, along with periodontal parameters (probing pocket depth [PPD], clinical attachment level [CAL], bleeding on probing [BOP], plaque index, calculus index, and tooth loss), systemic and neutrophil inflammatory markers (tumor necrosis factor alpha [TNFα], C-reactive protein [CRP], and c-Jun N-terminal kinase [JNK]), systemic oxidative stress mediators (myeloperoxidase [MPO] and glutathione), soluble cellular adhesion molecules, and neutrophil-endothelium cell interactions (rolling flux, velocity, and adhesion).Of 104 women recruited, 68 had PCOS, 24 of whom presented gingivitis, and 36 were controls. PCOS patients presented altered sexual hormone, lipid, and carbohydrate profiles. Levels of systemic inflammatory markers, MPO, and soluble platelet selectin (sP-selectin) were higher, and glutathione levels were lower in PCOS patients. BOP, plaque, and calculus index values were higher in PCOS patients with gingivitis. Neutrophils from PCOS patients showed increased JNK and decreased adhesion under flow conditions, with reduced rolling velocity and increased rolling flux and cellular adhesion, all of which were more pronounced in those with gingivitis. BOP was independently associated with rolling velocity, rolling flux, and cellular adhesion.Neutrophils of PCOS patients with gingivitis exhibit hyperactivity, promoting interaction with the endothelium and potentially contributing to atherosclerotic disease.Currently, there is a high prevalence of diseases that affect tooth-supporting tissues (periodontal diseases) and negatively influence the oral health and quality of life of the adult population. These pathologies lead to movement of the teeth and impairment of chewing function, eventually resulting in the loss of teeth. In recent years, the concept of periodontal medicine has arisen and consists of studying how periodontal diseases can influence our general inflammatory system and how systemic inflammatory pathologies can affect our oral health. In the present study, we evaluate a group of women with polycystic ovary syndrome (PCOS), a condition characterized by alterations of sex hormones and lipid profile and weight gain (body mass index). Our results show a high prevalence of gum inflammation among women with PCOS, which affects the interaction of their leukocytes and endothelial cells. The leukocytes of these women are hyper-responsive, presenting greater endothelial adhesion, lower flow velocity and enhanced rolling compared to those in a PCOS group without gum inflammation or controls. This study has generated a new line of research to analyze how neutrophils from patients with gingivitis exhibit hyperactivity, which promotes their interaction with the endothelium, thus contributing to the development of atherosclerotic disease.