Matthews Debora
Dalhousie University School of Dentistry, Dalhousie, Nova Scotia, Canada.
Evid Based Dent. 2008;9(1):8. doi: 10.1038/sj.ebd.6400560.
Medline, Cochrane Library, Embase, Cinahl and the reference lists of published articles were used to identify relevant studies.
Studies were included if the sample sizes were >80 cases, cases were defined as people with fatal or nonfatal coronary artery disease (CAD); described either self-reported periodontal disease (PD) or that diagnosed by clinical assessment of oral health; and provided relative risks (RR) and odds ratios (OR,) or sufficient information for the calculation of RR or OR. Letters, unpublished articles, animal studies, duplicate reports and those providing association between different markers of CAD or particular pathogens involved in PD were excluded.
Data was extracted by two investigators using a standard protocol. Cohort studies, case-control studies and cross-sectional studies were analysed separately using the Comprehensive Meta-Analysis software package (version CM 2.2; Biostat, Englewood, New Jersey, USA). Heterogeneity of the studies was assessed using the Cochrane Q test. As the studies were homogeneous the Mantel-Haenszel fixed-effect model was used to compute common RR and OR.
Meta-analysis of the five prospective cohort studies (86 092 patients) found people with PD had a 1.14-fold higher risk of developing coronary heart disease (CHD) than controls [RR, 1.14; 95% confidence interval (CI), 1.07-1.21; P<0.001]. Case-control studies (1423 patients) showed an even greater risk of developing CHD (OR, 2.22; 95% CI, 1.59-3.117; P<0.001). The prevalence of CHD in the cross-sectional studies (17 724 patients) was significantly greater in individuals with PD than in those with no PD (OR, 1.59; 95% CI, 1.33-1.91; P<0.001). Analysing the relationship between number of teeth and incidence of CHD found a 1.24-fold increased risk (95% CI, 1.14-1.36; P<0.0001) of development of CHD in people who had <10 teeth.
This study suggests a possible association between PD and CHD. Elevated levels of inflammatory mediators in people who have PD suggest a role in atherothrombogenesis leading to CHD. Well-designed prospective cohort studies, with uniform definitions of PD and CHD, investigating the role of periodontal pathogen-burden on the occurrence of CHD and the management of patients with PD to reduce the future risk of development of CHD, are necessary.
使用Medline、Cochrane图书馆、Embase、Cinahl以及已发表文章的参考文献列表来识别相关研究。
若样本量大于80例则纳入研究，病例定义为患有致命或非致命冠状动脉疾病（CAD）的人；描述了自我报告的牙周疾病（PD）或通过口腔健康临床评估诊断出的牙周疾病；并提供了相对风险（RR）和比值比（OR），或提供了计算RR或OR的足够信息。信件、未发表文章、动物研究、重复报告以及那些提供CAD不同标志物之间关联或PD中涉及的特定病原体之间关联的研究均被排除。
由两名研究人员使用标准方案提取数据。使用综合荟萃分析软件包（版本CM 2.2；美国新泽西州恩格尔伍德的Biostat公司）分别对队列研究、病例对照研究和横断面研究进行分析。使用Cochrane Q检验评估研究的异质性。由于研究具有同质性，因此使用Mantel-Haenszel固定效应模型来计算共同的RR和OR。
对五项前瞻性队列研究（86092名患者）进行的荟萃分析发现，患有PD的人患冠心病（CHD）的风险比对照组高1.14倍[RR，1.14；95%置信区间（CI），1.07 - 1.21；P<0.001]。病例对照研究（1423名患者）显示患CHD的风险更高（OR，2.22；95% CI，1.59 - 3.117；P<0.001）。横断面研究（1772名患者）中，患有PD的个体中CHD的患病率显著高于无PD的个体（OR，1
