牙周炎对2型糖尿病显性肾病和终末期肾病的影响。

Effect of periodontitis on overt nephropathy and end-stage renal disease in type 2 diabetes.

作者信息

Shultis Wendy A, Weil E Jennifer, Looker Helen C, Curtis Jeffrey M, Shlossman Marc, Genco Robert J, Knowler William C, Nelson Robert G

机构信息

Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institutes of Health, 1550 E. Indian School Rd., Phoenix, AZ 85014-4972, USA.

出版信息

Diabetes Care. 2007 Feb;30(2):306-11. doi: 10.2337/dc06-1184.

DOI:10.2337/dc06-1184

PMID:17259499

Abstract

OBJECTIVE

The purpose of this study was to investigate the effect of periodontitis on development of overt nephropathy, defined as macroalbuminuria, and end-stage renal disease (ESRD) in type 2 diabetes.

RESEARCH DESIGN AND METHODS

Individuals residing in the Gila River Indian Community aged > or =25 years with type 2 diabetes, one or more periodontal examination, estimated glomerular filtration rate > or =60 ml/min per 1.73 m(2), and no macroalbuminuria (urinary albumin-to-creatinine ratio > or =300 mg/g) were identified. Periodontitis was classified as none/mild, moderate, severe, or edentulous using number of teeth and alveolar bone score. Subjects were followed to development of macroalbuminuria or ESRD, defined as onset of renal replacement therapy or death attributed to diabetic nephropathy.

RESULTS

Of the 529 individuals, 107 (20%) had none/mild periodontitis, 200 (38%) had moderate periodontitis, 117 (22%) had severe periodontitis, and 105 (20%) were edentulous at baseline. During follow-up of up to 22 years, 193 individuals developed macroalbuminuria and 68 developed ESRD. Age- and sex-adjusted incidence of macroalbuminuria and ESRD increased with severity of periodontitis. After adjustment for age, sex, diabetes duration, BMI, and smoking in a proportional hazards model, the incidences of macroalbuminuria were 2.0, 2.1, and 2.6 times as high in individuals with moderate or severe periodontitis or those who were edentulous, respectively, compared with those with none/mild periodontitis (P = 0.01). Incidences of ESRD in individuals with moderate or severe periodontitis or in those who were edentulous were 2.3, 3.5, and 4.9 times as high, respectively, compared with those with none/mild periodontitis (P = 0.02).

CONCLUSIONS

Periodontitis predicts development of overt nephropathy and ESRD in individuals with type 2 diabetes. Whether treatment of periodontitis will reduce the risk of diabetic kidney disease remains to be determined.

摘要

目的

本研究旨在调查牙周炎对2型糖尿病患者显性肾病（定义为大量白蛋白尿）和终末期肾病（ESRD）发生发展的影响。

研究设计与方法

纳入居住在吉拉河印第安社区、年龄≥25岁的2型糖尿病患者，这些患者均接受过一次或多次牙周检查，估计肾小球滤过率≥60 ml/min per 1.73 m²，且无大量白蛋白尿（尿白蛋白与肌酐比值≥300 mg/g）。根据牙齿数量和牙槽骨评分，将牙周炎分为无/轻度、中度、重度或无牙。对受试者进行随访，观察其是否发生大量白蛋白尿或ESRD，ESRD定义为开始肾脏替代治疗或因糖尿病肾病死亡。

结果

529名受试者中，107名（20%）无/轻度牙周炎，200名（38%）中度牙周炎，117名（22%）重度牙周炎，105名（20%）基线时无牙。在长达22年的随访期间，193名受试者发生大量白蛋白尿，68名发生ESRD。经年龄和性别调整后，大量白蛋白尿和ESRD的发病率随牙周炎严重程度增加而升高。在比例风险模型中，对年龄、性别、糖尿病病程、体重指数和吸烟进行调整后，中度或重度牙周炎患者或无牙患者发生大量白蛋白尿的发病率分别是无/轻度牙周炎患者的2.0倍、2.1倍和2.6倍（P = 0.01）。中度或重度牙周炎患者或无牙患者发生ESRD的发病率分别是无/轻度牙周炎患者的2.3倍、3.5倍和四倍9倍（P = 0.02）。