Tonetti Maurizio S, D'Aiuto Francesco, Nibali Luigi, Donald Ann, Storry Clare, Parkar Mohamed, Suvan Jean, Hingorani Aroon D, Vallance Patrick, Deanfield John
Department of Oral Health and Diagnostic Sciences, University of Connecticut Health Center, Farmington, USA.
N Engl J Med. 2007 Mar 1;356(9):911-20. doi: 10.1056/NEJMoa063186.
Systemic inflammation may impair vascular function, and epidemiologic data suggest a possible link between periodontitis and cardiovascular disease.
We randomly assigned 120 patients with severe periodontitis to community-based periodontal care (59 patients) or intensive periodontal treatment (61). Endothelial function, as assessed by measurement of the diameter of the brachial artery during flow (flow-mediated dilatation), and inflammatory biomarkers and markers of coagulation and endothelial activation were evaluated before treatment and 1, 7, 30, 60, and 180 days after treatment.
Twenty-four hours after treatment, flow-mediated dilatation was significantly lower in the intensive-treatment group than in the control-treatment group (absolute difference, 1.4%; 95% confidence interval [CI], 0.5 to 2.3; P=0.002), and levels of C-reactive protein, interleukin-6, and the endothelial-activation markers soluble E-selectin and von Willebrand factor were significantly higher (P<0.05 for all comparisons). However, flow-mediated dilatation was greater and the plasma levels of soluble E-selectin were lower in the intensive-treatment group than in the control-treatment group 60 days after therapy (absolute difference in flow-mediated dilatation, 0.9%; 95% CI, 0.1 to 1.7; P=0.02) and 180 days after therapy (difference, 2.0%; 95% CI, 1.2 to 2.8; P<0.001). The degree of improvement was associated with improvement in measures of periodontal disease (r=0.29 by Spearman rank correlation, P=0.003). There were no serious adverse effects in either of the two groups, and no cardiovascular events occurred.
Intensive periodontal treatment resulted in acute, short-term systemic inflammation and endothelial dysfunction. However, 6 months after therapy, the benefits in oral health were associated with improvement in endothelial function.
全身炎症可能损害血管功能，流行病学数据表明牙周炎与心血管疾病之间可能存在联系。
我们将120例重度牙周炎患者随机分为社区牙周护理组（59例）或强化牙周治疗组（61例）。通过测量血流期间肱动脉直径（血流介导的扩张）评估内皮功能，并在治疗前以及治疗后1、7、30、60和180天评估炎症生物标志物以及凝血和内皮激活标志物。
治疗后24小时，强化治疗组的血流介导的扩张明显低于对照治疗组（绝对差异为1.4%；95%置信区间[CI]，0.5至2.3；P = 0.002），C反应蛋白、白细胞介素-6以及内皮激活标志物可溶性E选择素和血管性血友病因子的水平显著更高（所有比较P < 0.05）。然而，治疗后60天（血流介导的扩张的绝对差异为0.9%；95%CI，0.1至1.7；P = 0.02）和治疗后180天（差异为2.0%；95%CI，1.2至2.8；P < 0.001），强化治疗组的血流介导的扩张更大且可溶性E选择素的血浆水平更低。改善程度与牙周疾病测量指标的改善相关（Spearman等级相关r = 0.29，P = 0.003）。两组均未出现严重不良反应，也未发生心血管事件。
强化牙周治疗导致急性、短期的全身炎症和内皮功能障碍。然而，治疗6个月后，口腔健康方面的益处与内皮功能的改善相关。
