Эндотелиальная дисфункция и пародонтопатогенная микрофлора: аспекты патогенетической коррекции бактериофагом

Abstract

INTRODUCTION: Alteration of the expression of intercellular adhesion molecules on the surface of endotheliocytes is associated with disorders of anticoagulant, antiplatelet, fibrinolytic and barrier functions of the endothelium. It results in derangement of microcirculation in periodontal tissues, and, together with adhesive, invasive toxic properties of the main periodontopathogenic bacteria Аggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Prevotella intermedia, leads to a chronic systemic periodontitis (CSP). AIM: To evaluate pathogenetic aspects of the effect of phagotherapy on the level of secretion of soluble forms of adhesive molecules and on periodontopathogenic microflora. MATERIALS AND METHODS: The study material was the discharge of the dentogingival/periodontal pocket (DG/PP) of patients with intact periodontium and with CSP. The first subgroup with CSP, in addition to therapeutic treatment, received a course of Phagodent bacteriophage applications, the subsecond group received only therapeutic treatment. RESULTS: A high frequency of isolation of periodontal pathogens (92.0%) in patients with CSP was reflected in the detection of P. gingivalis in 81% of cases, T. forsythia in 74% of cases, A. actinomycetemcomitans in 37.0% of cases. On the top of the administered therapy, a statistically significant (6.2 times) decrease in the level of A. actinomycetemcomitans was revealed in subgroup 1 (p = 0.03) and 1.58 times decrease in subgroup 2 (p = 0.045). The content of T. forsythia decreased by 3.9 (p = 0.034) and 2.4 (p = 0.02) times in the respective groups. A significant decrease in the level of T. denticola was detected only in subgroup 1 (p = 0.04). The levels of intercellular adhesion molecules during the therapy decreased in both groups, but most significantly when using a bacteriophage: sICAM-1 decreased 3.2 times in subgroup 1 (p < 0.001) and 2.1 times in subgroup 2 (p < 0.001), sVCAM — 6.4 times (p < 0.001) and 4.6 times (p < 0.001), respectively. The content of sL-selectin and sE-selectin in PP decreased 4.1-times (p < 0.001) and 2.2 times, (p < 0.001), respectively, in individuals receiving bacteriophage and 2.2 times (p < 0.001) and 1.5 times (p < 0.001) in patients with another method of treating CSP. CONCLUSION: The effectiveness of targeted pathogenetic correction using a bacteriophage for the treatment of CSP was confirmed by a decrease in the quantitative content of marker periodontopathogenic microorganisms in the DGP discharge and normalization of the concentration of adhesive molecules, which indicated reduction of the degree of endothelial dysfunction.