Slade G D, Offenbacher S, Beck J D, Heiss G, Pankow J S
Department of Dental Ecology, University of North Carolina at Chapel Hill, 27599-7450, USA.
J Dent Res. 2000 Jan;79(1):49-57. doi: 10.1177/00220345000790010701.
Moderate elevation of serum C-reactive protein (CRP) is a risk factor for cardiovascular disease among apparently healthy individuals, although factors that create this inflammatory response in the absence of systemic illness have not been clarified. This study aimed to: (1) evaluate associations among periodontal disease, established risk factors for elevated CRP, and CRP levels within the US population; and (2) determine whether total tooth loss is associated with reduced CRP. Data were obtained from the third National Health and Nutrition Examination Survey. A random sample of the US population was interviewed in their homes and examined at mobile examination centers. CRP was quantified from peripheral blood samples and analyzed as a continuous variable and as the prevalence of elevated CRP (> or = 10 mg/L). Some 12,949 people aged 18+ years who had periodontal examinations and an additional 1,817 edentulous people aged 18+ years were included in the analysis. Dentate people with extensive periodontal disease (> 10% of sites with periodontal pockets 4+ mm) had an increase of approximately one-third in mean CRP and a doubling in prevalence of elevated CRP compared with periodontally healthy people. Raised CRP levels among people with extensive periodontal disease persisted in multivariate analyses (P < 0.01), with established risk factors for elevated CRP (diabetes, arthritis, emphysema, smoking, and anti-inflammatory medications) and sociodemographic factors controlled for. However, CRP levels were similarly raised in edentulous people. Furthermore, the established risk factors for elevated CRP modified relationships between oral status and CRP levels. Periodontal disease and edentulism were associated with systemic inflammatory response in the US population, most notably among people who had no established risk factors for elevated CRP.
血清C反应蛋白（CRP）适度升高是看似健康个体发生心血管疾病的一个危险因素，尽管在没有全身性疾病的情况下引发这种炎症反应的因素尚未明确。本研究旨在：（1）评估美国人群中牙周疾病、已确定的CRP升高危险因素与CRP水平之间的关联；（2）确定全口牙齿缺失是否与CRP降低有关。数据来自第三次全国健康和营养检查调查。对美国人群的一个随机样本进行了入户访谈，并在流动检查中心进行了检查。从外周血样本中对CRP进行定量，并作为连续变量以及CRP升高（≥10 mg/L）的患病率进行分析。分析纳入了约12,949名接受过牙周检查的18岁及以上人群以及另外1,817名18岁及以上的无牙人群。与牙周健康的人相比，患有广泛牙周疾病（牙周袋深度≥4 mm的部位超过10%）的有牙人群的平均CRP升高约三分之一，CRP升高的患病率增加了一倍。在多变量分析中，患有广泛牙周疾病的人群中CRP水平持续升高（P<0.01），同时控制了已确定的CRP升高危险因素（糖尿病、关节炎、肺气肿、吸烟和抗炎药物）以及社会人口学因素。然而，无牙人群的CRP水平同样升高。此外，已确定的CRP升高危险因素改变了口腔状况与CRP水平之间的关系。牙周疾病和无牙与美国人群的全身炎症反应相关，最明显的是在那些没有已确定的CRP升高危险因素的人群中。
