Paquette David W
Department of Periodontology, Comprehensive Center for Inflammatory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, NC 27599-7450, USA.
J Int Acad Periodontol. 2002 Jul;4(3):101-9.
Observational studies indicate periodontal infections as a risk factor for systemic conditions like cardiovascular disease and preterm low birth weight. This paper reviews and argues the biological plausibility for a periodontal infection-systemic disease link and reviews the available experimental data from animal models and human intervention trials. Five principal lines of evidence can be used to explain the biological plausibility of a link. First, infection in general has been implicated in the pathogenesis of both atherosclerosis and preterm delivery. Periodontal infection secondly causes transient and low-grade bacteraemias and endotoxaemias in patients. Thirdly, periodontal infection promotes systemic inflammatory and immune responses that may play roles in disease. Periodontal pathogens express specific virulence factors that can affect atherogenic or parturition events. Lastly, periodontal pathogens have also been isolated from non-oral tissues like atheromatous plaques. Experimental data derived from rodent and pig models indicate that infection or bacteraemias with the periodontal pathogen, Porphyromonas gingivalis, can increase atheroma size or reduce litter weights as compared to controls. While human intervention data are lacking for patients at risk for cardiovascular disease, early data indicate that periodontal therapy administered to pregnant mothers with periodontitis can reduce the incidence of preterm low birth weight deliveries. Nevertheless, more and larger intervention trials are needed before we can fully accept periodontal infection as a true risk factor in the causal pathways of cardiovascular disease and preterm low birth weight.
观察性研究表明，牙周感染是心血管疾病和早产低体重等全身性疾病的一个风险因素。本文回顾并论证了牙周感染与全身性疾病之间联系的生物学合理性，并回顾了来自动物模型和人体干预试验的现有实验数据。有五条主要证据线可用于解释这种联系的生物学合理性。首先，一般感染与动脉粥样硬化和早产的发病机制都有关联。其次，牙周感染会导致患者出现短暂的轻度菌血症和内毒素血症。第三，牙周感染会促进全身性炎症和免疫反应，这些反应可能在疾病中起作用。牙周病原体表达特定的毒力因子，这些因子可影响动脉粥样硬化或分娩事件。最后，在动脉粥样硬化斑块等非口腔组织中也分离出了牙周病原体。来自啮齿动物和猪模型的实验数据表明，与对照组相比，感染牙周病原体牙龈卟啉单胞菌或出现菌血症会增加动脉粥样硬化斑块大小或降低产仔体重。虽然缺乏针对心血管疾病高危患者的人体干预数据，但早期数据表明，对患有牙周炎的孕妇进行牙周治疗可降低早产低体重分娩的发生率。然而，在我们能够完全接受牙周感染是心血管疾病和早产低体重因果途径中的真正风险因素之前，还需要更多且规模更大的干预试验。
