Ladegaard Grønkjær Lea, Holmstrup Palle, Schou Søren, Jepsen Peter, Vilstrup Hendrik
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
United European Gastroenterol J. 2018 Feb;6(1):73-80. doi: 10.1177/2050640617715846. Epub 2017 Jun 17.
Periodontitis and edentulism are prevalent in patients with cirrhosis, but their clinical significance is largely unknown.
The objective of this article is to determine the association of severe periodontitis and edentulism with mortality in patients with cirrhosis.
A total of 184 cirrhosis patients underwent an oral examination. All-cause and cirrhosis-related mortality was recorded. The associations of periodontitis and edentulism with mortality were explored by Kaplan-Meier survival plots and Cox proportional hazards regression adjusted for age, gender, cirrhosis etiology, Child-Pugh score, Model for End-Stage Liver Disease score, smoker status, present alcohol use, comorbidity, and nutritional risk score.
The total follow-up time was 74,197 days (203.14 years). At entry, 44% of the patients had severe periodontitis and 18% were edentulous. Forty-four percent of the patients died during follow-up. Severe periodontitis was associated with higher all-cause mortality in the crude analysis (HR 1.56, 95% CI 1.06-2.54), but not in the adjusted analysis (HR 1.45, 95% CI 0.79-2.45). Severe periodontitis was even more strongly associated with higher cirrhosis-related mortality (crude HR 2.19, 95% CI 1.07-4.50 and adjusted HR 2.29, 95% CI 1.04-4.99). No association was found between edentulism and mortality.
The presence of severe periodontitis predicted a more than double one-year cirrhosis mortality. These findings may motivate intervention trials on the effect of periodontitis treatment in patients with cirrhosis.
牙周炎和无牙症在肝硬化患者中很常见，但其临床意义在很大程度上尚不清楚。
本文的目的是确定重度牙周炎和无牙症与肝硬化患者死亡率之间的关联。
共有184例肝硬化患者接受了口腔检查。记录全因死亡率和肝硬化相关死亡率。通过Kaplan-Meier生存曲线和Cox比例风险回归分析牙周炎和无牙症与死亡率之间的关联，并对年龄、性别、肝硬化病因、Child-Pugh评分、终末期肝病模型评分、吸烟状况、当前饮酒情况、合并症和营养风险评分进行校正。
总随访时间为74197天（203.14年）。入组时，44%的患者患有重度牙周炎，18%的患者无牙。44%的患者在随访期间死亡。在粗分析中，重度牙周炎与较高的全因死亡率相关（风险比1.56，95%置信区间1.06-2.54），但在校正分析中无相关性（风险比1.45，95%置信区间0.79-2.45）。重度牙周炎与较高的肝硬化相关死亡率的关联更强（粗风险比2.19，95%置信区间1.07-4.50；校正风险比2.29，95%置信区间1.04-4.99）。未发现无牙症与死亡率之间存在关联。
重度牙周炎的存在预示着肝硬化患者一年死亡率增加一倍以上。这些发现可能会促使开展关于牙周炎治疗对肝硬化患者影响的干预试验。
