Zhang Y, Liu C, Chen B, Chen F, Duan J Y, Zhang M J, Jiao J
First Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Department of Oncology, the Seventh Medical Center of PLA General Hospital, Beijing 100700, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Feb 18;52(1):71-76. doi: 10.19723/j.issn.1671-167X.2020.01.011.
To investigate the associations of impaired glucose metabolism and insulin resistance with chronic periodontitis in pre-diabetes patients.
A cross-sectional analysis was conducted and we included a total of 171 pre-diabetes patients aged 30-65 years, free of diabetes. pre-diabetes was defined as impaired fasting glucose (IFG) [fasting glucose (FG): 6.1-7.0 mmol/L] and/or impaired glucose tolerance (IGT) [oral glucose tolerance test (OGTT): 7.8-11.0 mmol/L]. Chronic periodontitis was defined according to Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) definition and the patients were divided into mild, moderate, and severe chronic periodontitis groups [mild: at least two interproximal sites with clinical attachment loss (CAL) ≥3 mm and at least two interproxima sites with probing depth (PD) ≥4 mm or 1 site with PD≥5 mm; moderate: at least two interproximal sites with CAL ≥4 mm and at least two interproxima sites with at least two interproximal sites with PD ≥5 mm; severe: at least two interproximal sites with CAL ≥6 mm and at least one interproxima site with at least two interproximal sites with PD≥5 mm]. A periodontal examination indexes [plaque index (PLI), PD, CAL, and bleeding on probing (BOP)] and glucose metabolism indexes [FG, OGTT, hemoglobinA1c (HbA1c), fasting insulin and homeostasis model assessments of insulin resistance (HOMA-IR)] were measured. The association of glucose metabolism and chronic periodontitis was investigated by multivariable logistic regression analysis.
FG in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, HOMA-IR in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, OGTT in the severe chronic periodntitis group was significantly higher compared with mild chronic peridontitis group and moderate chronic periodontitis groups, and there was no significant difference between moderate and mild chronic periodontitis groups. For the insulin and HbA1c, there was no significant difference among mild, moderate and severe chronic periodontitis groups. After multivariable adjustment of age, gender, smoking status, hypertension and body mass index, IFG (OR=1.39, 95%CI: 1.01-1.98) and HOMA-IR (OR=1.36, 95%CI: 1.04-1.76) were associated with moderate periodontitis; IFG (OR=1.64, 95%CI: 1.17-2.40), IGT (OR=1.65, 95%CI: 1.21-2.26), and HOMA-IR (OR=1.72, 95%CI: 1.23-2.41) were significantly associated with severe periodontitis.
Our data provided evidences that impaired glucose metabolism were associated with chronic periodontitis among pre-diabetes patients.
探讨糖代谢受损及胰岛素抵抗与糖尿病前期患者慢性牙周炎的相关性。
进行一项横断面分析，共纳入171例年龄在30 - 65岁之间、无糖尿病的糖尿病前期患者。糖尿病前期定义为空腹血糖受损（IFG）[空腹血糖（FG）：6.1 - 7.0 mmol/L]和/或糖耐量受损（IGT）[口服葡萄糖耐量试验（OGTT）：7.8 - 11.0 mmol/L]。慢性牙周炎根据疾病控制与预防中心（CDC）/美国牙周病学会（AAP）的定义进行诊断，患者被分为轻度、中度和重度慢性牙周炎组[轻度：至少两个邻面位点临床附着丧失（CAL）≥3 mm且至少两个邻面位点探诊深度（PD）≥4 mm或1个位点PD≥5 mm；中度：至少两个邻面位点CAL≥4 mm且至少两个邻面位点PD≥5 mm；重度：至少两个邻面位点CAL≥6 mm且至少一个邻面位点PD≥5 mm]。测量牙周检查指标[菌斑指数（PLI）、PD、CAL和探诊出血（BOP）]以及糖代谢指标[FG、OGTT、糖化血红蛋白（HbA1c）、空腹胰岛素和胰岛素抵抗稳态模型评估（HOMA - IR）]。通过多变量逻辑回归分析研究糖代谢与慢性牙周炎的相关性。
中度和重度慢性牙周炎组的FG显著高于轻度慢性牙周炎组，中度和重度慢性牙周炎组的HOMA - IR显著高于轻度慢性牙周炎组，重度慢性牙周炎组的OGTT显著高于轻度慢性牙周炎组和中度慢性牙周炎组，中度和轻度慢性牙周炎组之间无显著差异。对于胰岛素和HbA1c，轻度、中度和重度慢性牙周炎组之间无显著差异。在对年龄、性别、吸烟状况、高血压和体重指数进行多变量调整后，IFG（OR = 1.39，95%CI：1.01 - 1.98）和HOMA - IR（OR = 1.36，95%CI：1.04 - 1.76）与中度牙周炎相关；IFG（OR = 1.64，95%CI：1.17 - 2.40）、IGT（OR = 1.65，95%CI：1.21 - 2.26）和HOMA - IR（OR = 1.72，95%CI：1.23 - 2.41）与重度牙周炎显著相关。
我们的数据表明，糖代谢受损与糖尿病前期患者的慢性牙周炎相关。
