压力、唾液皮质醇与牙周炎：观察性研究的系统评价与荟萃分析。

Stress, salivary cortisol and periodontitis: A systematic review and meta-analysis of observational studies.

机构信息

Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Campus Universitário, Monte da Caparica, 2829-511 Caparica, Portugal.

出版信息

Arch Oral Biol. 2018 Dec;96:58-65. doi: 10.1016/j.archoralbio.2018.08.016. Epub 2018 Aug 30.

DOI:10.1016/j.archoralbio.2018.08.016

PMID:30189327

Abstract

OBJECTIVE

This meta-analysis aims to systematically assess whether periodontitis has a meaningful effect on salivary cortisol, reflecting changes on free blood cortisol levels.

DESIGN

The Cochrane Handbook and the PRISMA statement were used as reporting guidelines. The MEDLINE-PubMed, Google Scholar, EMBASE, and CENTRAL databases were searched until September 2017 to identify eligible studies, screened by seven independent authors and verified by an eighth. Studies comparing salivary cortisol level of periodontitis cases to controls were included. Data were extracted using a predefined table and since all papers were non-randomized clinical trials they were appraised using Downs and Black tool. DerSimonian random effects meta-analysis was performed using OpenMetaAnalyst.

RESULTS

Six cross-sectional studies were included, with 258 participants with chronic periodontitis and 72 with aggressive periodontitis, in a total of 573 participants. Overall results showed that aggressive periodontitis patients have, on average, 53% higher salivary cortisol levels than healthy controls 1.53 (1.11-2.12). Meta-regression exploring the relationship among salivary cortisol levels and periodontal measures, i.e., periodontitis severity, showed a global neutral effect, although this result requires future confirmation due to the low power of the model.

CONCLUSION

Observational studies results suggest that subjects with aggressive periodontitis have higher salivary cortisol levels than healthy ones or patients with chronic periodontitis. Such salivary cortisol response difference may have a negative impact on the periodontium, contributing to worse the burden of aggressive periodontitis disease. In the future, wide and well-designed longitudinal studies should be carried out in order to extensively confirm this possible effect, considering the complex nature of periodontitis and its many confounders factors that may contribute to this outcome.

摘要

目的

本荟萃分析旨在系统评估牙周炎是否对唾液皮质醇有显著影响，从而反映游离血皮质醇水平的变化。

设计

采用 Cochrane 手册和 PRISMA 声明作为报告指南。检索了 MEDLINE-PubMed、Google Scholar、EMBASE 和 CENTRAL 数据库，截至 2017 年 9 月以确定合格的研究，由 7 位独立作者筛选，并由第 8 位作者验证。纳入了比较牙周炎病例和对照组唾液皮质醇水平的研究。使用预设表格提取数据，由于所有论文均为非随机临床试验，因此使用 Downs 和 Black 工具进行评估。使用 OpenMetaAnalyst 进行 DerSimonian 随机效应荟萃分析。

结果

纳入了 6 项横断面研究，共纳入 258 例慢性牙周炎患者和 72 例侵袭性牙周炎患者，共计 573 例患者。总体结果表明，侵袭性牙周炎患者的唾液皮质醇水平平均比健康对照组高 53%，即 1.53（1.11-2.12）。探索唾液皮质醇水平与牙周措施（即牙周炎严重程度）之间关系的元回归分析显示，总体结果呈中性效应，但由于模型的效力较低，因此需要进一步确认。