Temelli Başak, Yetkin Ay Zuhal, Savaş Hasan Basri, Aksoy Fatih, Kumbul Doğuç Duygu, Uskun Ersin, Varol Ercan
Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey.
Department of Biochemistry, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey.
J Appl Oral Sci. 2018;26:e20170322. doi: 10.1590/1678-7757-2017-0322. Epub 2018 May 7.
Objectives One of the plausible mechanisms in the relationship between periodontitis and coronary artery disease (CAD) is the systemic inflammatory burden comprised of circulating cytokines/mediators related to periodontitis. This study aims to test the hypothesis that periodontal inflamed surface area (PISA) is correlated with higher circulating levels of acute phase reactants (APR) and pro-inflammatory cytokines/mediators and lower anti-inflammatory cytokines/mediators in CAD patients. Material and Methods Patients aged from 30 to 75 years who underwent coronary angiography with CAD suspicion were included. Clinical periodontal parameters (probing depth - PD, clinical attachment loss, and bleeding on probing - BOP) were previously recorded and participants were divided into four groups after coronary angiography: Group 1: CAD (+) with periodontitis (n=20); Group 2: CAD (+) without periodontitis (n=20); Group 3: CAD (-) with periodontitis (n=21); Group 4: CAD (-) without periodontitis (n = 16). Serum interleukin (IL) -1, -6, -10, tumor necrosis factor (TNF)-α, serum amyloid A (SAA), pentraxin (PTX) 3, and high-sensitivity C-reactive protein (hs-CRP) levels were measured with ELISA. Results Groups 1 and 3 showed periodontal parameter values higher than Groups 2 and 4 (p<0.0125). None of the investigated serum parameters were statistically significantly different between the study groups (p>0.0125). In CAD (-) groups (Groups 3 and 4), PISA has shown positive correlations with PTX3 and SAA (p<0.05). Age was found to predict CAD significantly according to the results of the multivariate regression analysis (Odds Ratio: 1.17; 95% Confidence Interval: 1.08-1.27; p<0.001). Conclusions Although age was found to predict CAD significantly, the positive correlations between PISA and APR in CAD (-) groups deserve further attention, which might depend on the higher PISA values of periodontitis patients. In further studies conducted in a larger population, the stratification of age groups would provide us more accurate results.
目的 牙周炎与冠状动脉疾病(CAD)之间关系的一种可能机制是由与牙周炎相关的循环细胞因子/介质构成的全身炎症负担。本研究旨在验证以下假设:在CAD患者中,牙周炎症表面积(PISA)与急性期反应物(APR)、促炎细胞因子/介质的循环水平升高以及抗炎细胞因子/介质水平降低相关。
材料与方法 纳入年龄在30至75岁之间、因怀疑CAD而接受冠状动脉造影的患者。先前已记录临床牙周参数(探诊深度 - PD、临床附着丧失和探诊出血 - BOP),冠状动脉造影后将参与者分为四组:第1组:CAD(+)伴牙周炎(n = 20);第2组:CAD(+)不伴牙周炎(n = 20);第3组:CAD(-)伴牙周炎(n = 21);第4组:CAD(-)不伴牙周炎(n = 16)。采用酶联免疫吸附测定法(ELISA)检测血清白细胞介素(IL)-1、-6、-10、肿瘤坏死因子(TNF)-α、血清淀粉样蛋白A(SAA)、五聚素(PTX)3和高敏C反应蛋白(hs-CRP)水平。
结果 第1组和第3组的牙周参数值高于第2组和第4组(p < 0.0125)。研究组之间所研究的血清参数均无统计学显著差异(p > 0.0125)。在CAD(-)组(第3组和第4组)中,PISA与PTX3和SAA呈正相关(p < 0.05)。根据多变量回归分析结果,年龄被发现是CAD的显著预测因素(比值比:1.17;95%置信区间:1.08 - 1.27;p < 0.001)。
结论 尽管发现年龄是CAD的显著预测因素,但CAD(-)组中PISA与APR之间的正相关值得进一步关注,这可能取决于牙周炎患者较高的PISA值。在更大规模人群中进行的进一步研究中,年龄组分层将为我们提供更准确的结果。