Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, United States of America.
PLoS One. 2013 Aug 8;8(8):e68592. doi: 10.1371/journal.pone.0068592. eCollection 2013.
In COPD patients, fatal and non-fatal respiratory-related events are influenced by age, severity of respiratory disease, and comorbidities.
Analyze the effects of edentulism, periodontal disease and systemic biomarkers of inflammation on the occurrence of serious fatal and non-fatal respiratory-related events among subjects with COPD.
Cases were identified from Dental Atherosclerosis Risk in Communities study. Edentulism was defined as study participants without any natural teeth or implants. Participants with one or more natural teeth (comprising 11,378 subjects) were studied as dentate subjects. Periodontal disease status among dentate individuals was determined using the consensus definitions published by the joint Center for Disease Control/American Association of Periodontology working group). Adjusted Hazard Models are developed to evaluate the relationship between edentulism/periodontal disease and COPD Related Events. Models were then stratified by GOLD Stage I, II and III/IV. Serum biomarkers were also evaluated to explore the effect of systemic inflammation.
A statistically significant association was found between oral health status and COPD-related events, even adjusting for conditions such as hypertension, smoking and diabetes. Edentulous individuals who had been diagnosed with COPD had a higher incidence and were at greater risk of having a COPD related event (hospitalization and death) than individuals who had teeth and whose mouths had healthy periodontal status. However, being edentulous did not convey excess risk for COPD-related events for those study participants who were classified as GOLD III/IV at baseline. Finally, we showed that individuals who had levels of serum IL-6 in the highest two quartiles were at even higher risk for COPD-related events.
These findings suggest that the risk for COPD-related events after adjusting for potential confounders may be attributable to both edentulism and elevated serum IL-6 levels.
在 COPD 患者中，致命和非致命的呼吸相关事件受年龄、呼吸疾病严重程度和合并症的影响。
分析缺牙、牙周病和全身炎症生物标志物对 COPD 患者严重致命和非致命呼吸相关事件发生的影响。
从社区动脉粥样硬化风险研究中确定病例。缺牙定义为研究参与者没有任何天然牙齿或种植体。有一颗或多颗天然牙齿的参与者（包括 11378 名受试者）被研究为有牙受试者。使用疾病控制与预防中心/美国牙周病协会联合工作组发布的共识定义确定有牙个体的牙周病状况。制定调整后的危险模型来评估缺牙/牙周病与 COPD 相关事件之间的关系。然后按 GOLD 分期 I、II 和 III/IV 对模型进行分层。还评估了血清生物标志物，以探讨全身炎症的影响。
即使调整了高血压、吸烟和糖尿病等状况，口腔健康状况与 COPD 相关事件之间仍存在统计学显著关联。患有 COPD 且缺牙的个体发生 COPD 相关事件（住院和死亡）的发生率更高，风险更高，而有牙齿且口腔牙周健康状况良好的个体则不然。然而，对于那些在基线时被归类为 GOLD III/IV 的研究参与者来说，缺牙并不会带来 COPD 相关事件的额外风险。最后，我们表明，血清 IL-6 水平处于前两个四分位数的个体发生 COPD 相关事件的风险甚至更高。
这些发现表明，在调整潜在混杂因素后，COPD 相关事件的风险可能归因于缺牙和血清 IL-6 水平升高。
