基于唾液皮质醇、IL-1β、系统免疫炎症指数及牙周状况对类风湿性关节炎与口腔健康相关性的研究

A Study on the Correlation between Rheumatoid Arthritis and Oral Health Based on Salivary Cortisol, IL-1β, Systemic Immune-Inflammation Index and Periodontal Condition

摘要: 目的：探讨唾液皮质醇(CS)、白介素-1β (IL-1β)、系统免疫炎症指数(SII)及牙周状况在类风湿性关节炎(RA)与口腔健康的相关性。方法：选取2024年11月至2025年2月于安徽医科大学第四附属医院风湿免疫科及口腔科就诊的116例患者作为研究对象(初次确诊为类风湿性关节炎或近6个月内应用过抗风湿药物、糖皮质激素类药物或其他可能干扰机体免疫状态的药物)，依据疾病类型分为慢性牙周炎组(CP组，37例)、类风湿性关节炎组(RA组，34例)、类风湿性关节炎合并慢性牙周炎组(RA + CP组，45例)；另选取同期在该院体检中心进行健康体检的42例健康人群作为健康对照组(HC组)。所有研究对象均完成一般情况调查表及口腔健康影响程度量表(OHIP-14)填写，同时收集实验室检测数据并开展牙周检查；采用酶联免疫吸附试验(ELISA)检测唾液中CS与IL-1β的含量，运用χ²检验、单因素方差分析(ANOVA)、Mann-Whitney U检验、Kruskal-Wallis H检验及Spearman相关分析等统计学方法对数据进行分析。结果：① RA + CP组与CP组的CP分期显著高于HC组，差异具有统计学意义(P < 0.05)；② RA + CP组、RA组、CP组的唾液CS浓度、IL-1β水平、SII值及OHIP-14得分均高于HC组，差异均有统计学意义(P < 0.05)；③ 唾液CS与IL-1β水平均与CP分期呈正相关(P < 0.05)；④ SII与CP分期无显著相关性(P > 0.05)。结论：① 皮质醇(CS)、白细胞介素-1β (IL-1β)及系统免疫炎症指数(SII)可作为评估类风湿关节炎(RA)与慢性牙周炎(CP)患者下丘脑–垂体–肾上腺轴(HPAA)功能失调及全身炎症负荷加重的重要生物标志物；② 唾液样本具有无创、易获取的优势，与基于常规血常规检测、兼具稳定性与低成本特点的SII指标相结合，在RA与CP的大规模人群筛查及疾病进展动态监测中展现出显著的应用价值。

Abstract: Objective: To explore the correlation among salivary cortisol (CS), interleukin-1β (IL-1β), systemic immune-inflammation index (SII), and periodontal status in rheumatoid arthritis (RA) and oral health. Methods: A total of 116 patients (first diagnosed with rheumatoid arthritis, or has used anti-rheumatic drugs, glucocorticoid drugs, or other drugs that may interfere with the body’s immune status within the past 6 months) who visited the Department of Rheumatology and Immunology and the Department of Stomatology at the Fourth Affiliated Hospital of Anhui Medical University from November 2024 to February 2025 were selected as research subjects and divided into chronic periodontitis group (CP group, 37 cases), rheumatoid arthritis group (RA group, 34 cases), and rheumatoid arthritis combined with chronic periodontitis group (RA + CP group, 45 cases) based on disease type. Another 42 healthy individuals undergoing physical examination at the same period in the hospital’s health examination center were selected as the healthy control group (HC group). All study subjects completed a general information survey form and the Oral Health Impact Profile (OHIP-14), while laboratory test data and periodontal examinations were also collected. Salivary CS and IL-1β levels were measured using enzyme-linked immunosorbent assay (ELISA), and statistical analyses were performed using chi-square test, one-way ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, and Spearman correlation analysis. Results: 1) The CP stage in the RA + CP group and CP group was significantly higher than that in the HC group (P < 0.05); 2) Salivary CS concentration, IL-1β level, SII value, and OHIP-14 score in the RA + CP group, RA group, and CP group were all higher than those in the HC group (P < 0.05); 3) Salivary CS and IL-1β levels were positively correlated with the CP stage (P < 0.05); 4) SII was not significantly correlated with the CP stage (P > 0.05). Conclusion: 1) CS, IL-1β, and SII can serve as important biomarkers for assessing hypothalamic-pituitary-adrenal axis dysfunction and increased systemic inflammatory load in RA and CP patients; 2) Saliva samples, which are non-invasive and easy to obtain, combined with the SII index, which is stable and cost-effective, show significant application value in large-scale population screening and dynamic monitoring of disease progression in RA and CP.