牙周病与肾功能下降的关联：MrOS牙科研究的纵向回顾性分析
The association of periodontal disease with kidney function decline: a longitudinal retrospective analysis of the MrOS dental study.
作者信息
Grubbs Vanessa, Vittinghoff Eric, Taylor George, Kritz-Silverstein Donna, Powe Neil, Bibbins-Domingo Kirsten, Ishani Areef, Cummings Steven R
机构信息
Division of Nephrology, University of California, San Francisco/San Francisco General Hospital, San Francisco, CA, USA.
Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
出版信息
Nephrol Dial Transplant. 2016 Mar;31(3):466-72. doi: 10.1093/ndt/gfv312. Epub 2015 Aug 27.
BACKGROUND
Identifying modifiable risk factors for chronic kidney disease (CKD) is essential for reducing its burden. Periodontal disease is common, modifiable and has been implicated as a novel potential CKD risk factor, but evidence of its association with kidney function decline over time is limited.
METHODS
In a longitudinal retrospective cohort of 761 elderly men with preserved kidney function [estimated glomerular filtration rate > 60 mL/min/1.73 m(2) using a calibrated creatinine and cystatin C (eGFRcr-cys) equation] at baseline, we performed multivariable Poisson's regression to examine the association of severe periodontal disease with incident CKD, defined as incident eGFRcr-cys <60 mL/min/1.73 m(2) and rapid (>5% annualized) eGFRcr-cys decline. Severe periodontal disease was defined in two ways: (i) ≥5 mm proximal attachment loss in 30% of teeth examined (European Workshop in Periodontology Group C, European Workshop); and (ii) 2+ interproximal sites with attachment loss ≥6 mm and 1+ interproximal sites with probing depth ≥5 mm (Centers for Disease Control/American Academy of Periodontology, CDC/AAP).
RESULTS
At baseline, the mean age was 73.4 (SD 4.8) years, the median eGFRcr-cys was 82.4 mL/min/1.73 m(2), and 35.5 and 25.4% of participants had severe periodontal disease by European Workshop and CDC/AAP criteria, respectively. After a mean follow-up of 4.9 years (SD 0.3), 56 (7.4%) participants had incident CKD. Severe periodontal disease was associated with a 2-fold greater rate of incident CKD [incidence rate ratio (IRR) 2.01 (1.21-3.44), P = 0.007] after adjusting for confounders compared with not severe periodontal disease by European Workshop criteria but did not reach statistical significance by CDC/AAP criteria [IRR 1.10 (0.63-1.91), P = 0.9].
CONCLUSIONS
Severe periodontal disease may be associated with incident clinically significant kidney function decline among a cohort of elderly men.
背景
确定慢性肾脏病（CKD）的可改变风险因素对于减轻其负担至关重要。牙周病常见且可改变，已被认为是一种新的潜在CKD风险因素，但关于其与肾功能随时间下降之间关联的证据有限。
方法
在一个纵向回顾性队列中，纳入了761名基线时肾功能正常[使用校准的肌酐和胱抑素C（eGFRcr-cys）方程估算的肾小球滤过率>60 mL/min/1.73 m²]的老年男性，我们进行多变量泊松回归，以研究重度牙周病与新发CKD的关联，新发CKD定义为新发eGFRcr-cys<60 mL/min/1.73 m²以及eGFRcr-cys快速下降（年化率>5%）。重度牙周病有两种定义方式：（i）在检查的30%的牙齿中，近中附着丧失≥5 mm（欧洲牙周病研讨会C组，欧洲研讨会）；（ii）2个及以上近中位点附着丧失≥6 mm且1个及以上近中位点探诊深度≥5 mm（疾病控制中心/美国牙周病学会，CDC/AAP）。
结果
基线时，平均年龄为73.4（标准差4.8）岁，eGFRcr-cys中位数为82.4 mL/min/1.73 m²，分别有35.5%和25.4%的参与者根据欧洲研讨会和CDC/AAP标准患有重度牙周病。经过平均4.9年（标准差0.3）的随访，56名（7.4%）参与者发生了新发CKD。根据欧洲研讨会标准，在调整混杂因素后，重度牙周病与新发CKD的发生率高出2倍相关[发病率比（IRR）2.01（1.21 - 3.44），P = 0.007]，而根据CDC/AAP标准未达到统计学意义[IRR 1.10（0.63 - 1.91），P = 0.9]。
结论
在一组老年男性队列中，重度牙周病可能与新发具有临床意义的肾功能下降有关。
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