孙毓晗 王德平 李建涛 米光熙 庄天微 孔婷婷

[摘要] 目的 探討T2DM患者ROU严重程度的危险因素。 方法 收集2017年1月至2020年1月于牡丹江医学院附属红旗医院就诊的T2DM合并ROU的患者73例，其中轻型ROU 48例、重型ROU 25例，采用二元Logistic回归及多元逐步回归的方法，对影响ROU严重程度的患者临床基本资料、血糖波动、危险因素、炎症因子、氧化应激和外周血淋巴细胞水平进行分析。 结果 重型ROU患者的年龄、SDBG、PPGE、LAGE、HbA1c、PBG、VB12水平与轻型ROU比较，差异均有统计学意义（P<0.05），但经二元Logistic回归分析后显示，PBG、HbA1c、SDBG及PPGE水平与ROU的严重程度呈独立正相关（P<0.05），且以SDBG（OR=5.221，95%CI：1689～3.812）、PPGE（OR=3.141， 95%CI：1.571～3.121）水平与ROU的严重程度更为密切。另外，重型ROU患者的SOD水平低于轻型ROU（P<0.05），两组患者IL-2、IL-6、CD4+、CD8+、CD4+/CD8+水平比较，差异无统计学意义（P>0.05），采用多元逐步回归分析显示，PBG、HbA1c、SDBG、PPG水平分别与SOD水平呈独立负相关（P<0.05），且以SDBG、PPGE（标准化β=-0.321，-0.212，P<0.05）水平与SOD关系更为密切。 结论 在T2DM患者中，波动的高血糖通过加重氧化应激水平进而加剧ROU的严重程度。

[关键词] 2型糖尿病;复发性口腔溃疡;炎症因子;氧化应激;超氧化物岐化物

[中图分类号] R785.1          [文献标识码] B          [文章编号] 1673-9701（2021）08-0083-04

Analysis of risk factors for the severity of recurrent oral ulcers in type 2 diabetes

SUN Yuhan1   WANG Deping2   LI Jiantao1   MI Guangxi1   ZHUANG Tianwei2   KONG Tingting1

1.Department of Otorhinolaryngology Head and Neck Surgery， Hongqi Hospital Affiliated to Mudanjiang Medical College， Mudanjiang   157100， China; 2.Department of Endocrinology and Metabolism， Hongqi Hospital Affiliated to Mudanjiang Medical College， Mudanjiang   157100， China

[Abstract] Objective To explore the risk factors of the severity of ROU in patients with T2DM. Methods A total of 73 patients with T2DM combined with ROU who were treated at Hongqi Hospital Affiliated to Mudanjiang Medical College from January 2017 to January 2020 were collected， including 48 cases of mild ROU and 25 cases of severe ROU. The basic clinical data， blood glucose fluctuations， risk factors， inflammatory factors， oxidative stress and peripheral blood lymphocyte levels of patients that affect the severity of ROU were analyzed using binary Logistic regression and multiple stepwise regression methods. Results The age， SDBG， PPGE， LAGE，HbA1c，PBG， and VB12 levels of patients with severe ROU were statistically significant different from those of the mild ROU（P<0.05）. But binary logistic regression analysis showed PBG， HbA1c， SDBG and PPGE levels had independent positive correlation with the severity of ROU（P<0.05）， and SDBG （OR=5.221， 95%CI： 1689-3.812）， PPGE（OR=3.141， 95%CI： 1.571-3.121） levels were more closely correlated with the severity of ROU. In addition， the SOD level of patients with severe ROU was lower than that of patients with mild ROU（P<0.05）. There were no statistically significant differences in the levels of IL-2， IL-6， CD4+， CD8+， CD4+/CD8+ between the two groups（P>0.05）. Multiple stepwise regression analysis showed that PBG， HbA1c， SDBG，PPG levels were independently negatively correlated with SOD levels（P<0.05）， and SDBG， PPGE levels were more closely related to SOD（standardized β=-0.321，-0.212， P<0.05）. Conclusion In T2DM patients， fluctuating hyperglycemia can aggravate the severity of ROU by increasing the level of oxidative stress.

[Key words] Type 2 diabetes; Recurrent oral ulcers; Inflammatory factors; Oxidative stress; Superoxide dismutase

复发性口腔溃疡（Recurrent oral ulcers，ROU）又叫做复发性阿弗他溃疡，属于非化脓性疾病，该病临床常见，溃疡好发于舌尖、唇内侧、舌缘及舌腹、软腭弓等部位。因该病病程较长、反复发作、缠绵难愈及疼痛持久，故对患者进食、语言、心情产生了一定影响，患者承受较大痛苦，使得患者生活质量大幅度下降[1]。ROU是口腔黏膜病中最常见的溃疡类疾病，普通人群的患病率约为20%，然而在糖尿病（Diabetes mellitus，DM）患者中，其患病率可高达45%[2]，是DM的常见并发症之一。有研究显示，口腔溃疡的面积、治愈难度、复发率都与DM病程呈正比，这是因为DM患者口腔黏膜中葡萄糖浓度较高，给细菌繁殖提供了良好的环境，故增加了口腔溃疡发生的风险，且治愈难度大及复发率高[3]。本研究对2型糖尿病（Type 2 diabetes mellitus，T2DM）患者ROU严重程度的危险因素进行分析，现报道如下。……