Chen Li-Ping, Chiang Chih-Kang, Chan Chiu-Po, Hung Kuan-Yu, Huang Chiung-Shing
Department of Dentistry, Chang Gang Memorial Hospital, Taipei, Taiwan.
Am J Kidney Dis. 2006 May;47(5):815-22. doi: 10.1053/j.ajkd.2006.01.018.
Chronic infection and inflammation, including periodontitis, is linked to an increased risk for atherosclerosis. To investigate the possible adverse effects of periodontitis in maintenance hemodialysis patients, we compared periodontal severity with malnutrition and inflammation, which are associated with poor atherosclerotic outcome in hemodialysis patients.
Two hundred fifty-three hemodialysis patients were included in this study to evaluate clinical periodontal status by using the Plaque Index, Gingival Index, and Periodontal Disease Index. Geographic, hematologic, biochemical, and dialysis-related data also were collected. Values for nutritional and inflammatory markers, such as albumin, blood urea nitrogen, creatinine, transferrin, absolute lymphocyte count, normalized protein catabolic rate, high-sensitivity C-reactive protein, and ferritin, were included for analysis with the Periodontal Index.
Poor oral health status was shown by 80.6% of hemodialysis patients with periodontal disease. In an analysis of geographic and disease-related parameters, we found that aging, smoking, diabetes, and longer dialysis duration were associated with severity of periodontitis. Parameters of malnutrition and inflammation also were associated with poor periodontal status. We next conducted multiple regression analysis and found that age, diabetes, smoking, albumin level, and dialysis duration were associated independently with periodontitis severity in hemodialysis patients. According to the severity of periodontitis, there were higher percentiles of patients with malnutrition (chi-square = 13.055; P = 0.005) and inflammation (chi-square = 10.046; P = 0.018) in the severe group.
Periodontal health is poor in hemodialysis patients and correlates with markers of malnutrition and inflammation. Its diagnosis and treatment deserve better awareness.
包括牙周炎在内的慢性感染和炎症与动脉粥样硬化风险增加有关。为了研究牙周炎对维持性血液透析患者可能产生的不良影响，我们比较了牙周炎严重程度与营养不良和炎症的关系，而营养不良和炎症与血液透析患者不良的动脉粥样硬化结局相关。
本研究纳入了253例血液透析患者，通过菌斑指数、牙龈指数和牙周疾病指数评估临床牙周状况。还收集了地理、血液学、生化和透析相关数据。纳入营养和炎症标志物的值，如白蛋白、血尿素氮、肌酐、转铁蛋白、绝对淋巴细胞计数、标准化蛋白质分解代谢率、高敏C反应蛋白和铁蛋白，用于与牙周指数进行分析。
80.6%患有牙周疾病的血液透析患者口腔健康状况较差。在对地理和疾病相关参数的分析中，我们发现年龄增长、吸烟、糖尿病和透析时间延长与牙周炎严重程度相关。营养不良和炎症参数也与牙周状况较差相关。接下来我们进行了多元回归分析，发现年龄、糖尿病、吸烟、白蛋白水平和透析时间独立与血液透析患者的牙周炎严重程度相关。根据牙周炎的严重程度，严重组中营养不良（卡方=13.055；P=0.005）和炎症（卡方=10.046；P=0.018）患者的百分位数更高。
血液透析患者的牙周健康状况较差，且与营养不良和炎症标志物相关。其诊断和治疗值得更多关注。
