Patel Urvish K, Malik Preeti, Kodumuri Nishanth, Patel Priyadarshee, Pitti Varun, Tyagi Gaurav, Chauhan Bindi, Lunagariya Abhishek, Kothari Ravish, Sen Souvik
Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA.
Public Health, Icahn School of Medicine at Mount Sinai, New York, USA.
Cureus. 2020 Nov 7;12(11):e11373. doi: 10.7759/cureus.11373.
Introduction Chronic periodontitis and atherosclerosis share common risk factors and produce the same inflammatory markers. Many studies found a high prevalence of chronic periodontitis in patients with atherosclerosis but there is no strong evidence to support a specific association of chronic periodontitis with cerebral atherosclerosis. We aimed to study the concurrent prevalence and association of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases among the US population. Methods We performed a cross-sectional analysis of a Nationwide Inpatient Sample with adult hospitalizations to identify the primary diagnosis of cerebrovascular diseases [acute ischemic stroke (AIS), hemorrhagic stroke (HS), and transient ischemic attack (TIA)] with concurrent cerebral atherosclerosis and chronic periodontitis. Multivariate survey logistic regression models were fitted to evaluate the linkage of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases. Results Of total 56,499,788 hospitalizations, 0.01% had chronic periodontitis. Prevalence of chronic periodontitis was higher in 50-64 years (36.18% vs. 23.91%), males (59.19% vs. 41.06% in females), Afro-Americans (25.93% vs. 15.21%), and 0-25th percentile median-household-income-category (38.31% vs. 30.15%) compared to non-chronic periodontitis. There was significantly higher prevalence of cerebral atherosclerosis (0.71% vs. 0.41%; p<0.0001) with weak evidence of high prevalence of cerebrovascular diseases (AIS:2.21% vs. 1.97%; p=0.1563; HS:0.57% vs. 0.46%; p=0.1560) among chronic periodontitis compared to non-chronic periodontitis. In regression analysis, odds of having cerebral atherosclerosis were 2.48-folds higher in patients with chronic periodontitis compared to that without-chronic periodontitis, and cerebral atherosclerosis patients were associated with higher odds of TIA (aOR:2.40; p<0.0001), AIS (aOR:3.35; p<0.0001), and HS (aOR:1.51; p<0.0001) compared to without-cerebral atherosclerosis. No significant relationship between chronic periodontitis and cerebrovascular diseases was observed. Conclusion Although chronic periodontitis may not directly increase the risk of cerebrovascular diseases, it increases the burden of cerebrovascular diseases by evidently increasing the risk of cerebral atherosclerosis. Early identification of chronic periodontitis and atherosclerotic risk factors may help to mitigate the risk of cerebrovascular diseases.
引言 慢性牙周炎和动脉粥样硬化具有共同的危险因素，并产生相同的炎症标志物。许多研究发现动脉粥样硬化患者中慢性牙周炎的患病率很高，但没有强有力的证据支持慢性牙周炎与脑动脉粥样硬化之间存在特定关联。我们旨在研究美国人群中慢性牙周炎与脑动脉粥样硬化和脑血管疾病的并发患病率及关联。方法 我们对全国住院患者样本进行了横断面分析，纳入成年住院患者，以确定伴有脑动脉粥样硬化和慢性牙周炎的脑血管疾病（急性缺血性卒中[AIS]、出血性卒中[HS]和短暂性脑缺血发作[TIA]）的主要诊断。采用多变量调查逻辑回归模型评估慢性牙周炎与脑动脉粥样硬化和脑血管疾病之间的联系。结果 在总共56,499,788例住院病例中，0.01%患有慢性牙周炎。与非慢性牙周炎患者相比，50 - 64岁人群（36.18%对23.91%）、男性（59.19%对女性的41.06%）、非裔美国人（25.93%对15.21%）以及家庭收入处于第0 - 25百分位数的人群（38.31%对30.15%）中慢性牙周炎的患病率更高。与非慢性牙周炎相比，慢性牙周炎患者中脑动脉粥样硬化的患病率显著更高（0.71%对0.41%；p<0.0001），而脑血管疾病（AIS：2.21%对1.97%；p = 0.15.. 3；HS：0.57%对0.46%；p = 0.1560）患病率虽有升高但证据较弱。在回归分析中，与无慢性牙周炎的患者相比，患有慢性牙周炎的患者发生脑动脉粥样硬化的几率高出2.48倍，与无脑动脉粥样硬化的患者相比，脑动脉粥样硬化患者发生TIA（调整后比值比[aOR]：2.40；p<0.0001）、AIS（aOR：3.35；p<0.0001）和HS（aOR：1.51；p<0.0001）的几率更高。未观察到慢性牙周炎与脑血管疾病之间存在显著关系。结论 虽然慢性牙周炎可能不会直接增加脑血管疾病的风险，但它通过显著增加脑动脉粥样硬化风险，增加了脑血管疾病的负担。早期识别慢性牙周炎和动脉粥样硬化危险因素可能有助于降低脑血管疾病风险。 （注：原文中“AIS:2.21% vs. 1.97%; p=0.1563; HS:0.57% vs. 0.46%; p=0.1560”处“p=0.15.. 3”表述有误，按正常理解补充完整翻译）
