Palm Frederick, Lahdentausta Laura, Sorsa Timo, Tervahartiala Taina, Gokel Pia, Buggle Florian, Safer Anton, Becher Heiko, Grau Armin J, Pussinen Pirkko
Department of Neurology, Klinikum Ludwigshafen, Germany
Institute of Dentistry, University of Helsinki, and Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Innate Immun. 2014 Jul;20(5):511-8. doi: 10.1177/1753425913501214. Epub 2013 Sep 17.
Periodontitis is a common infectious disease associated with increased risk for ischemic stroke though presently unclear mechanisms. In a case-control study, we investigated salivary levels of four periodontal pathogens, as well as systemic and local inflammatory markers. The population comprised 98 patients with acute ischemic stroke (mean ± SD, 68.2 ± 9.7 yrs; 45.9% women) and 100 healthy controls (69.1 ± 5.2 yrs; 47.0% women). Patients were more often edentulous and had fewer teeth than controls (13.8 ± 10.8 versus 16.6 ± 10.1). After adjusting for stroke risk factors and number of teeth, controls had higher saliva matrix metalloproteinase-8 (MMP-8), myeloperoxidase (MPO), IL-1β, Aggregatibacter actinomycetemcomitans, and serum LPS activity levels. Patients had higher serum MMP-8 and MPO, and they were more often qPCR-positive for A. actinomycetemcomitans (37.9% versus 19.0%) and for ≥3 periodontopathic species combined (50.0% versus 33.0%). We conclude that controls more often had evidence of current periodontal infection with higher periodontal pathogen amount, endotoxemia, local inflammation and tissue destruction. Stroke patients more often had evidence of end-stage periodontitis with edentulism and missing teeth. They were more often carriers of several periodontopathic pathogens in saliva, especially A. actinomycetemcomitans. Additionally, inflammatory burden may contribute to high systemic inflammation associated with elevated stroke susceptibility.
牙周炎是一种常见的传染病，与缺血性中风风险增加相关，但其机制目前尚不清楚。在一项病例对照研究中，我们调查了四种牙周病原体的唾液水平以及全身和局部炎症标志物。研究人群包括98例急性缺血性中风患者（平均±标准差，68.2±9.7岁；45.9%为女性）和100名健康对照者（69.1±5.2岁；47.0%为女性）。与对照组相比，患者无牙情况更常见，牙齿数量更少（13.8±10.8颗对16.6±10.1颗）。在调整中风风险因素和牙齿数量后，对照组的唾液基质金属蛋白酶-8（MMP-8）、髓过氧化物酶（MPO）、白细胞介素-1β、伴放线聚集杆菌和血清脂多糖活性水平更高。患者的血清MMP-8和MPO水平更高，伴放线聚集杆菌qPCR检测阳性的比例更高（37.9%对19.0%），≥3种牙周病病原体合并阳性的比例也更高（50.0%对33.0%）。我们得出结论，对照组更常出现当前牙周感染的证据，牙周病原体数量更多、存在内毒素血症、局部炎症和组织破坏。中风患者更常出现伴有无牙和牙齿缺失的晚期牙周炎证据。他们唾液中更常携带几种牙周病病原体，尤其是伴放线聚集杆菌。此外，炎症负担可能导致与中风易感性升高相关的全身炎症加剧。
