Craig R G
Department of Basic Sciences and Craniofacial Biology, New York University College of Dentistry, New York, NY 10010, USA.
Oral Dis. 2008 Jan;14(1):1-7. doi: 10.1111/j.1601-0825.2007.01430.x.
The incidence of end-stage renal disease (ESRD) is increasing and patients receiving renal replacement therapy including hemodialysis, peritoneal dialysis or renal transplantation will comprise an enlarging segment of the dental patient population. Renal replacement therapy can affect periodontal tissues including gingival hyperplasia in immune suppressed renal transplantation patients and increased levels of plaque, calculus and gingival inflammation and possible increased prevalence and severity of destructive periodontal diseases in ESRD patients on dialysis maintenance therapy. Also, the presence of undiagnosed periodontitis may have significant effects on the medical management of the ESRD patient. Periodontitis has been found to contribute to systemic inflammatory burden including the elevation of C-reactive protein (CRP) in the general population. Atherosclerotic complications including myocardial infarction and stroke are the primary causes of mortality in the ESRD population and, in contrast to that of the general population, the best predictor of all cause and cardiac death in this population is CRP. Consequently, periodontitis may be a covert but treatable source of systemic inflammation in the ESRD population. The objective of this review was to explore the interaction between chronic renal disease, renal replacement therapy and periodontal diseases based upon the results of studies published within the last decade.
终末期肾病（ESRD）的发病率正在上升，接受包括血液透析、腹膜透析或肾移植在内的肾脏替代治疗的患者将在牙科患者群体中占比越来越大。肾脏替代治疗会影响牙周组织，包括免疫抑制的肾移植患者出现牙龈增生，以及接受维持性透析治疗的ESRD患者牙菌斑、牙结石水平增加和牙龈炎症加剧，还有可能增加破坏性牙周疾病的患病率和严重程度。此外，未被诊断出的牙周炎可能会对ESRD患者的医疗管理产生重大影响。在普通人群中，牙周炎已被发现会加重全身炎症负担，包括C反应蛋白（CRP）升高。动脉粥样硬化并发症，包括心肌梗死和中风，是ESRD人群的主要死亡原因，与普通人群不同的是，该人群全因死亡和心脏死亡的最佳预测指标是CRP。因此，牙周炎可能是ESRD人群中一个隐蔽但可治疗的全身炎症来源。本综述的目的是根据过去十年发表的研究结果，探讨慢性肾病、肾脏替代治疗和牙周疾病之间的相互作用。
