Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.
J Periodontol. 2012 Mar;83(3):267-78. doi: 10.1902/jop.2011.110227. Epub 2011 Jul 12.
The systemic inflammation in both metabolic syndrome (MetS) and periodontitis is a common denominator of the association of these conditions with higher risk of atherosclerosis. The current study investigates whether periodontal therapy may reduce systemic inflammation in patients with MetS and reduce cardiovascular risk.
A parallel-arm, double-blind, randomized clinical trial of 1-year duration in patients with MetS and periodontitis was conducted. Participants were randomized to an experimental treatment group (ETG) (n = 82) that received plaque control and root planing plus amoxicillin and metronidazole or to a control treatment group (CTG) (n = 83) that received plaque control instructions, supragingival scaling, and two placebos. Risk factors for cardiovascular disease were recorded; serum lipoprotein cholesterol, glucose, body mass index (BMI), C-reactive protein (CRP) and fibrinogen concentrations, and clinical periodontal parameters were assessed at baseline and every 3 months until 12 months after therapy. The primary and secondary outcomes were changes in CRP and fibrinogen levels, respectively.
The baseline patients' characteristics of both groups were similar. No significant changes in lifestyle factors, frequency of hypertension, BMI, serum lipoprotein cholesterol, and glucose levels were observed during the study period. The periodontal parameters significantly improved in both groups 3 months after therapy (P = 0.0001) and remained lower than baseline up to 12 months. The improvement of periodontal status was significantly greater in the ETG (P = 0.0001). A multiple linear regression analysis, controlled for sex, smoking, hypertension, and extent of periodontitis, demonstrated that CRP levels decreased with time and that this reduction was significant at 9 (P = 0.024) and 12 (P = 0.001) months in both groups, without difference between the groups. Fibrinogen levels significantly decreased in the ETG at 6 and 12 months but not in the CTG.
Reduction of periodontal inflammation either with root planing and systemic antibiotics or with plaque control and subgingival scaling significantly reduces CRP levels after 9 months in patients with MetS.
代谢综合征（MetS）和牙周炎的全身炎症是这些疾病与动脉粥样硬化风险增加相关的共同特征。本研究旨在探讨牙周治疗是否可以降低 MetS 患者的全身炎症并降低心血管风险。
一项为期 1 年的、平行臂、双盲、随机临床试验，纳入了患有 MetS 和牙周炎的患者。参与者被随机分配到实验组（ETG）（n = 82），接受菌斑控制和根面平整，外加阿莫西林和甲硝唑治疗，或对照组（CTG）（n = 83），接受菌斑控制指导、龈上洁治和两种安慰剂治疗。记录心血管疾病的危险因素；在基线和治疗后 3 个月，每 3 个月评估一次血清脂蛋白胆固醇、血糖、体重指数（BMI）、C 反应蛋白（CRP）和纤维蛋白原浓度以及临床牙周参数。主要和次要结局分别为 CRP 和纤维蛋白原水平的变化。
两组患者的基线特征相似。在研究期间，生活方式因素、高血压频率、BMI、血清脂蛋白胆固醇和血糖水平没有显著变化。两组患者在治疗后 3 个月牙周参数均显著改善（P = 0.0001），且直至 12 个月仍低于基线水平。ETG 的牙周状况改善更为显著（P = 0.0001）。多元线性回归分析显示，在校正性别、吸烟、高血压和牙周炎程度后，CRP 水平随时间下降，两组在 9 个月（P = 0.024）和 12 个月（P = 0.001）时均显著下降，但两组间无差异。纤维蛋白原水平在 ETG 组在 6 个月和 12 个月时显著下降，但 CTG 组无变化。
通过根面平整和全身抗生素或菌斑控制和龈下刮治来减轻牙周炎症，可使 MetS 患者的 CRP 水平在 9 个月后降低。
