Jastrzebski Marek, Zaleska Małgorzata, Klocek Marek, Stolarz Katarzyna, Wojciechowska Wiktoria, Olszanecka Agnieszka, Czarnecka Danuta, Kawecka-Jaszcz Kalina
Int J Cardiol. 2009 Mar 6;132(3):439-41. doi: 10.1016/j.ijcard.2007.08.080. Epub 2007 Dec 4.
While dental treatment has been reported to lower inflammatory marker levels, such studies were small and did not involve subjects with cardiovascular diseases. The present prospective study examined the effect of interventional dental treatment on serum C-reactive protein (CRP) and fibrinogen levels in patients with essential hypertension.
The study enrolled 50 subjects (age: 53.1+/-7; 23 men and 27 women) diagnosed with moderate or severe essential hypertension. Patient clinical characteristics were as follows: 80% had hypercholesterolemia, 72% were obese/overweight, 6% had diabetes mellitus, 16% were current smokers, 40% had target organ damage, and the overall general dental health status was poor. CRP and fibrinogen levels were assessed prior to treatment and again after 6 months. Dental treatment was mainly for periodontal disease and dental caries and its complications, and consisted of extractions of hopeless teeth, supragingival scaling, subgingival curettage, anti-inflammatory rinses and metronidazole treatment. There was a mean 4 treatment sessions per patient over 11 weeks.
Dental treatment resulted in improved sulcus bleeding index (51+/-19 vs. 42+/-17, p<0.001) and approximal plaque index (50+/-23 vs. 42+/-13, p<0.001) scores, but had no effect on CRP (1.66 vs. 1.2 mg/l, p=0.44) or fibrinogen (3.27 vs. 3.22 g/l, p=0.08) levels.
We suggest that the lack of effect of dental treatment on CRP and fibrinogen levels could have resulted from smaller impact of dental disease on the total inflammatory burden in the presence of hypertension and other cardiovascular risk factors.
虽然有报道称牙科治疗可降低炎症标志物水平，但此类研究规模较小，且未纳入心血管疾病患者。本前瞻性研究探讨了介入性牙科治疗对原发性高血压患者血清C反应蛋白（CRP）和纤维蛋白原水平的影响。
该研究纳入了50名被诊断为中度或重度原发性高血压的受试者（年龄：53.1±7岁；男性23名，女性27名）。患者的临床特征如下：80%患有高胆固醇血症，72%肥胖/超重，6%患有糖尿病，16%为当前吸烟者，40%有靶器官损害，总体口腔健康状况较差。在治疗前和6个月后再次评估CRP和纤维蛋白原水平。牙科治疗主要针对牙周病、龋齿及其并发症，包括拔除无保留价值的牙齿、龈上洁治、龈下刮治、抗炎冲洗和甲硝唑治疗。每位患者在11周内平均接受4次治疗。
牙科治疗使龈沟出血指数（51±19对42±17，p<0.001）和邻面菌斑指数（50±23对42±13，p<0.001）得分有所改善，但对CRP（1.66对1.2mg/l，p=0.44）或纤维蛋白原（3.27对3.22g/l，p=0.08）水平无影响。
我们认为，在存在高血压和其他心血管危险因素的情况下，牙科疾病对总炎症负担的影响较小，可能导致牙科治疗对CRP和纤维蛋白原水平没有影响。
