系统性炎症是否是牙周炎和高血压之间缺失的环节？来自两项大型基于人群的调查的结果。

Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population-based surveys.

机构信息

From the, Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK.

Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.

出版信息

J Intern Med. 2021 Apr;289(4):532-546. doi: 10.1111/joim.13180. Epub 2020 Nov 19.

DOI:10.1111/joim.13180

PMID:32969093

Abstract

OBJECTIVE

The primary objective was to investigate the relationship between periodontitis and hypertension in two independent large surveys. The secondary objective was to ascertain whether systemic inflammation had a mediation effect in the association.

METHODS

This cross-sectional study analysed representative samples of the US (n = 3460; NHANES 2009/10) and Korean (n = 4539; 2015 KNHANES VI-3) populations. The association between periodontitis (exposure), hypertension (outcome) and inflammatory markers [C-reactive protein (CRP) and white blood cell counts (WBC)] (mediators) was assessed using multivariate linear and logistic regression models and mediation analysis.

RESULTS

Participants with periodontitis were more likely to have hypertension (NHANES: OR = 1.3, 95% CI: 1.0-1.6, P = 0.025; KNHANES: OR = 1.2, 95% CI: 1.0-1.4, P = 0.041) and actual systolic blood pressure ≥ 140 mmHg (NHANES: OR = 1.6, 95% CI: 1.1-2.3, P < 0.001; KNHANES: OR = 1.3, 95% CI :1.0-1.6, P < 0.031) than those without the disease. These associations were independent of age, gender, BMI, education level, smoking, alcohol consumption, creatinine, physical activity, presence of other comorbidities and confirmed in participants not taking antihypertensive medications. Diagnosis of periodontitis was directly associated with WBC (in both surveys: NHANES: β ± SE = 0.3 ± 0.1, P < 0.004; KNHANES: β ± SE = 0.3 ± 0.1, P < 0.001) and with CRP levels (in one survey: NHANES: β ± SE = 0.1 ± 0.03, P < 0.007; KNHANES: β ± SE = 0.1 ± 0.04, P > 0.213). Mediation analyses confirmed that CRP acted as a mediator in the association between periodontitis and hypertension in both populations (mediated effect: NHANES: β ± SE = 0.010 ± 0.003, P < 0.001; KNHANES: β ± SE = 0.003 ± 0.001, P = 0.015). WBC acted as a mediator in the KNHANES (mediated effect: β ± SE = 0.004 ± 0.001, P = 0.004) whilst in the NHANES, its effect was dependent of CRP inclusion in the model (mediated effect WBC + CRP: β ± SE = 0.002 ± 0.001, P = 0.001).

CONCLUSIONS

These findings suggest that periodontitis is closely linked to hypertension and systemic inflammation is, in part, a mediator of this association.

摘要

目的

本研究旨在通过两项独立的大型调查，探究牙周炎与高血压之间的关系。本研究的次要目的是确定系统性炎症是否在这种关联中具有中介作用。

方法

本横断面研究分析了美国（n=3460；NHANES 2009/10）和韩国（n=4539；2015 年 KNHANES VI-3）人群的代表性样本。使用多元线性和逻辑回归模型以及中介分析评估了牙周炎（暴露）、高血压（结局）和炎症标志物[C 反应蛋白（CRP）和白细胞计数（WBC）]（中介物）之间的关联。

结果

患有牙周炎的参与者更有可能患有高血压（NHANES：比值比[OR] = 1.3，95%置信区间[CI]：1.0-1.6，P=0.025；KNHANES：OR=1.2，95%CI：1.0-1.4，P=0.041）和实际收缩压≥140mmHg（NHANES：OR=1.6，95%CI：1.1-2.3，P<0.001；KNHANES：OR=1.3，95%CI：1.0-1.6，P<0.031），而非该疾病患者。这些关联独立于年龄、性别、BMI、教育程度、吸烟、饮酒、肌酐、身体活动、其他合并症的存在，并在未服用抗高血压药物的参与者中得到证实。牙周炎的诊断与 WBC（两项研究均为：NHANES：β±SE=0.3±0.1，P<0.004；KNHANES：β±SE=0.3±0.1，P<0.001）和 CRP 水平（一项研究中为：NHANES：β±SE=0.1±0.03，P<0.007；KNHANES：β±SE=0.1±0.04，P>0.213）呈直接相关。中介分析证实，CRP 在两个人群中均作为牙周炎与高血压之间关联的中介物（中介效应：NHANES：β±SE=0.010±0.003，P<0.001；KNHANES：β±SE=0.003±0.001，P=0.015）。WBC 在 KNHANES 中作为中介物（中介效应：β±SE=0.004±0.001，P=0.004），而在 NHANES 中，其效应依赖于 CRP 是否纳入模型（中介效应 WBC+CRP：β±SE=0.002±0.001，P=0.001）。