Anand Nithya, S C Chandrasekaran, Alam Md Nazish
Associate Professor, Department of Periodontics.
J Clin Diagn Res. 2013 Apr;7(4):763-7. doi: 10.7860/JCDR/2013/5329.2907. Epub 2013 Feb 6.
The patients who undergo Maintenance Haemodialysis (MHD) have a high prevalence of Protein-Energy Malnutrition (PEM) and inflammation. Because these two conditions often occur concomitantly in the MHD patients, they have been referred to together as the Malnutrition-Inflammation Complex Syndrome (MICS) or Malnutrition-inflammation atherosclerosis, to underscore the atherosclerotic complications of this entity. MICS is also reported to correlate with a poor outcome, including a decreased quality of life, refractory anaemia and significantly greater rates of hospitalization and mortality in the MHD patients .Indeed, MICS may be the major cause of the paradoxical exposure-outcome association, which is also known as reverse epidemiology of the cardiovascular disease risk factors in the maintenance dialysis patients. Periodontitis is a chronic inflammatory disease of the supporting tissues from the dentition, which results from the infection of and the interaction of selected bacterial species with the components of the host response in disease-susceptible individuals as the haemodialysis (HD) patients. Only in recent years, did an emerging evidence link the dental infection, especially periodontitis, to an increased risk of atherosclerosis and thrombosis. In the HD patients, studies have been showing a positive link between periodontal disease and systemic inflammation on correlation between the levels of CRP and immunoglobulin G of Porphyromonas gingivalis. Recent researches have confirmed that the periodontal health is poor in haemodialysis patients and that it correlates with the markers of malnutrition and inflammation.
接受维持性血液透析（MHD）的患者蛋白质 - 能量营养不良（PEM）和炎症的患病率很高。由于这两种情况在MHD患者中经常同时出现，它们被统称为营养不良 - 炎症复合综合征（MICS）或营养不良 - 炎症动脉粥样硬化，以强调该实体的动脉粥样硬化并发症。据报道，MICS也与不良预后相关，包括生活质量下降、难治性贫血以及MHD患者更高的住院率和死亡率。事实上，MICS可能是矛盾的暴露 - 结果关联的主要原因，这也被称为维持性透析患者心血管疾病危险因素的反向流行病学。牙周炎是牙列支持组织的慢性炎症性疾病，它是由特定细菌种类在易感个体（如血液透析（HD）患者）中与宿主反应成分的感染和相互作用引起的。直到最近几年，才有新出现的证据将牙齿感染，尤其是牙周炎，与动脉粥样硬化和血栓形成风险增加联系起来。在HD患者中，研究表明牙周疾病与全身炎症之间存在正相关，以及牙龈卟啉单胞菌的CRP水平和免疫球蛋白G之间存在相关性。最近的研究证实，血液透析患者的牙周健康状况较差，并且与营养不良和炎症标志物相关。
