Ajwani S, Mattila K J, Närhi T O, Tilvis R S, Ainamo A
Institute of Dentistry, University of Helsinki, Finland.
Gerodontology. 2003 Jul;20(1):32-40. doi: 10.1111/j.1741-2358.2003.00032.x.
Epidemiological studies have reported a strong association between C-reactive protein (CRP) and cardiovascular diseases (CVD). Elevated CRP levels have been observed both in dentate individuals with chronic dental infections like periodontal disease and in those edentulous. The mechanisms behind these observations, especially the reasons for the elevation of CRP in the edentulous, are poorly understood. The comparative data on the importance of these inflammatory conditions in the oral cavity as causes of elevated CRP levels and CVD risk factors are also limited.
To determine if edentulism is associated with increased levels of CRP and investigate the possible mechanism for this association; and to study the influence of periodontal disease and edentulism on 10-year mortality.
Of the 364 subjects aged 76, 81, and 86 years in 1990, 196 were dentate and 168 edentulous. By December 1999, 179 had died, almost half (n = 87) of them due to cardiovascular disease.
Significantly more of the edentulous subjects had elevated (> or = 3 mg/L) CRP levels as compared to those with at least 20 teeth (p < 0.01). They also had high salivary microbial counts (p < 0.05), and more mucosal lesions (p < 0.0001) than those with at least 20 teeth. In multivariate analysis, high microbial counts (OR 2.3, CI 1.06-5.05) and mucosal lesions (OR 2.18, CI 1.03-4.61) were significantly associated with elevated CRP levels. The risk for all-cause mortality was non-significantly elevated among the edentulous (RR 1.48, CI 0.95-2.31) and dentate with periodontal disease (RR 1.58, CI 0.96-2.61). CVD mortality was significantly higher among the dentate with periodontal disease (RR 1.97, CI 1.01-3.85) when compared with dentate without periodontal disease.
Among the edentulous, chronic infections like denture-related mucosal lesions are important determinants of elevated CRP, comparable to periodontal disease in the dentate. Elevated CRP per se and edentulism were not significantly associated with increased mortality. Periodontal disease was, however, still associated with a two-fold CVD mortality in this very old population.
流行病学研究报告称，C反应蛋白（CRP）与心血管疾病（CVD）之间存在密切关联。在患有慢性牙齿感染（如牙周病）的有牙个体以及无牙个体中均观察到CRP水平升高。这些观察结果背后的机制，尤其是无牙个体中CRP升高的原因，目前尚不清楚。关于口腔中这些炎症状况作为CRP水平升高和心血管疾病风险因素的原因的重要性的比较数据也很有限。
确定无牙是否与CRP水平升高相关，并研究这种关联的可能机制；研究牙周病和无牙对10年死亡率的影响。
1990年，在364名年龄分别为76岁、81岁和86岁的研究对象中，196人有牙，168人无牙。到1999年12月，179人死亡，其中近一半（n = 87）死于心血管疾病。
与至少有20颗牙齿的人相比，无牙受试者中CRP水平升高（≥3mg/L）的人数明显更多（p < 0.01）。他们的唾液微生物计数也更高（p < 0.05），并且与至少有20颗牙齿的人相比，黏膜病变更多（p < 0.0001）。在多变量分析中，高微生物计数（OR 2.3，CI 1.06 - 5.05）和黏膜病变（OR 2.18，CI 1.03 - 4.61）与CRP水平升高显著相关。无牙者（RR 1.48，CI 0.95 - 2.31）和患有牙周病的有牙者（RR 1.58，CI 0.96 - 2.61）全因死亡率的风险非显著升高。与无牙周病的有牙者相比，患有牙周病的有牙者的心血管疾病死亡率显著更高（RR 1.97，CI 1.01 - 3.85）。
在无牙者中，与义齿相关的黏膜病变等慢性感染是CRP升高的重要决定因素，与有牙者中的牙周病相当。CRP升高本身和无牙与死亡率增加无显著关联。然而，在这个高龄人群中，牙周病仍与心血管疾病死亡率增加两倍相关。
