Wu Donglei, Lin Zhengshen, Zhang Shiwei, Cao Fengdi, Liang Defeng, Zhou Xincai
Department of Stomatology, Jinan University-Affiliated Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China.
Department of Stomatology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, China.
Front Physiol. 2020 Jan 31;10:1620. doi: 10.3389/fphys.2019.01620. eCollection 2019.
Periodontitis is a chronic inflammatory disease with a possible infectious component. Anemia of inflammation (AI) occurring in various chronic diseases alters the hemoglobin (Hb) concentration and iron status. Currently, the association between periodontitis and AI is still controversial. The aim of this study was to assess the alterations of the level of hematological parameters and iron metabolism markers in patients with or without periodontitis. Electronic databases (MEDLINE, EMBASE, and Cochrane) were searched to identify publications about anemia and periodontitis. Subgroup analyses regarding gender, extent of periodontitis, and sample size were performed using STATA 12.1. Sixteen studies were included in this meta-analysis. Pooled results showed a decrease in Hb [standardized mean difference (SMD) = -0.76, 95% CI = (-1.15, -0.37)], red blood cell [SMD = -0.69, 95% CI = (-1.09, -0.29)], hematocrit [SMD = -1.13, 95% CI = (-1.69, -0.57)], mean corpuscular volume [SMD = -0.16, 95% CI = (-0.32, -0.01)], and mean corpuscular Hb [SMD = -0.16, 95% CI = (-0.28, -0.04)], but upregulation in erythrocyte sedimentation rate [SMD = 0.63, 95% CI = (0.06, 1.19)]. In addition, patients with periodontitis had a higher level of hepcidin [SMD = 0.59, CI = (0.05, 1.12)] and decreased level of transferrin [SMD = -4.6, CI = (-13.1, -3.90)], with high heterogeneity. This meta-analysis indicates that periodontitis decreases Hb concentration and disturbs the balance of iron metabolism, which confirms strength of association between periodontitis and the development tendency of AI, especially for severe periodontitis. More unbiased cohort studies with larger sample sizes are still warranted to make a definitive judgment in the future.
牙周炎是一种可能伴有感染因素的慢性炎症性疾病。各种慢性疾病中出现的炎症性贫血（AI）会改变血红蛋白（Hb）浓度和铁状态。目前，牙周炎与AI之间的关联仍存在争议。本研究的目的是评估有无牙周炎患者血液学参数水平和铁代谢标志物的变化。检索电子数据库（MEDLINE、EMBASE和Cochrane）以识别关于贫血和牙周炎的出版物。使用STATA 12.1进行了关于性别、牙周炎程度和样本量的亚组分析。本荟萃分析纳入了16项研究。汇总结果显示Hb降低[标准化均值差（SMD）=-0.76，95%置信区间=（-1.15，-0.37）]、红细胞降低[SMD=-0.69，95%置信区间=（-1.09，-0.29）]、血细胞比容降低[SMD=-1.13，95%置信区间=（-1.69，-0.57）]、平均红细胞体积降低[SMD=-0.16，95%置信区间=（-0.32，-0.01）]和平均红细胞血红蛋白降低[SMD=-0.16，95%置信区间=（-0.28，-0.04）]，但红细胞沉降率上调[SMD=0.63，95%置信区间=（0.06，1.19）]。此外，牙周炎患者的铁调素水平较高[SMD=0.59，置信区间=（0.05，1.12）]，转铁蛋白水平降低[SMD=-4.6，置信区间=（-13.1，-3.90）]，异质性较高。这项荟萃分析表明，牙周炎会降低Hb浓度并扰乱铁代谢平衡，这证实了牙周炎与AI发展趋势之间的关联强度，尤其是重度牙周炎。未来仍需要更多样本量更大、更无偏倚的队列研究来做出明确判断。
