Department of Periodontology, Faculty of Medicine, School of Dentistry, University of Santiago de Compostela, Rúa Entrerríos, S/N, 15782, Santiago de Compostela, A Coruña, Spain.
Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
Eur J Epidemiol. 2017 Jan;32(1):43-53. doi: 10.1007/s10654-016-0170-6. Epub 2016 Jun 14.
Several observational studies have suggested an association between periodontitis and cerebral ischemia. This meta-analysis aimed to investigate whether this link exists, and if so, the degree to which it is significant. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline for systematic review was used. The search strategy included using electronic databases and hand searching works published up to March 2015. MEDLINE via PubMed, EMBASE, Proceedings Web of Science and Current Contents Connect were searched by two independent reviewers. Case-control, cross-sectional or cohort studies including patients with measures of periodontitis and ischemic stroke were eligible to be included in the analysis. Quality assessments of selected studies were performed. From a total of 414 titles and abstracts, 57 potentially relevant full text papers were identified. After inclusion criteria were applied, 8 studies were included in the present systematic review (5 case-control and 3 cohort studies). Although it was not the intention, cross-sectional studies were excluded due to eligibility criteria were not accomplished. Therefore, meta-analyses were conducted with data retrieved from the 8 studies included. These meta-analyses showed statistically significant association between periodontitis and ischemic stroke in both cohort pooled relative risks at 2.52 (1.77-3.58), and case-control studies pooled relative risks at 3.04 (1.10-8.43). In conclusion, the present meta-analysis demonstrated an association between periodontitis and ischemic stroke. However, well-designed prospective studies should be carried out to provide robust evidence of the link between both diseases. In regards to ischemic stroke subtypes, further case-control studies should be carried out to investigate whether there is any association between the different subtypes of cerebral infarcts and periodontitis.
几项观察性研究表明牙周炎与脑缺血之间存在关联。本荟萃分析旨在探讨这种关联是否存在，如果存在，其关联程度如何。本研究采用了系统评价和荟萃分析的首选报告项目（PRISMA）指南。检索策略包括使用电子数据库和手工检索截至 2015 年 3 月发表的文献。通过两名独立评审员检索 MEDLINE 通过 PubMed、EMBASE、Web of Science 会议录和 Current Contents Connect。纳入了包含牙周炎和缺血性脑卒中患者测量值的病例对照、横断面或队列研究。对选定研究的质量进行了评估。从总共 414 个标题和摘要中，确定了 57 篇可能相关的全文论文。应用纳入标准后，本系统评价纳入了 8 项研究（5 项病例对照研究和 3 项队列研究）。由于纳入标准未完成，尽管并非有意，但由于纳入标准未完成，将横断面研究排除在外。因此，使用纳入的 8 项研究中的数据进行了荟萃分析。这些荟萃分析显示，在队列研究中，牙周炎与缺血性脑卒中之间存在统计学显著关联，汇总相对风险为 2.52（1.77-3.58），病例对照研究汇总相对风险为 3.04（1.10-8.43）。总之，本荟萃分析表明牙周炎与缺血性脑卒中之间存在关联。然而，应该开展设计良好的前瞻性研究，以提供两者之间关联的有力证据。关于缺血性脑卒中亚型，应该开展进一步的病例对照研究，以调查不同类型的脑梗死与牙周炎之间是否存在任何关联。
