Postgraduate Program in Dentistry, Department of Individuals With Special Needs, Cruzeiro do Sul University, São Paulo, Brazil.
Department of Genomic Medicine and Infectious Diseases, J. Craig Venter Institute, La Jolla, CA, United States.
Front Immunol. 2021 Feb 25;12:619262. doi: 10.3389/fimmu.2021.619262. eCollection 2021.
Oral-gut inflammation has an impact on overall health, placing subjects at risk to acquire chronic conditions and infections. Due to neuromotor disturbances, and medication intake, cerebral palsy (CP) subjects present intestinal constipation, impacting their quality of life (QOL). We aimed to investigate how oral inflammatory levels predicted gut phenotypes and response to therapy. A total of 93 subjects aging from 5 to 17 years were included in the study, and assigned into one of the 4 groups: CP with constipation (G1, = 30), CP without constipation (G2, = 33), and controls without CP with constipation (G3, = 07) and without CP and without constipation (G4, = 23). In addition to characterizing subjects' clinical demographics, medication intake, disease severity levels, salivary cytokine levels [TNF-α, interleukin (IL)-1β, IL-6, IL-8, IL-10], and Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Statistical significance was evaluated by Shapiro-Wilks, Student's -Test, ANOVA, and ANCOVA analysis. Salivary proinflammatory cytokines were highly correlated with the severe form of gut constipation in G1 ( < 0.001), and out of all cytokines IL-1β levels demonstrated highest correlation with all gut constipation < 0.05). A significant relationship was found between the type of medication, in which subjects taking Gamma-Aminobutyric Acid (GABA) and GABA+ (GABA in association with other medication) were more likely to be constipated than the other groups ( < 0.01). Cleary salivary inflammatory levels and gut constipation were correlated, and impacted QOL of CP subjects. G1 presented a lower QOL mean score of CPCHILD (49.0 ± 13.1) compared to G2 (71.5 ± 16.7), when compared to G3 (88.9 ± 7.5), and G4 (95.5 ± 5.0) ( < 0.01). We accounted for gingival bleeding as a cofounder of oral inflammation, and here were no differences among groups regarding gender ( = 0.332) and age ( = 0.292). Collectively, the results suggest that saliva inflammatory levels were linked to gut constipation, and that the clinical impact of medications that controlled gut was reliably monitored via oral cytokine levels, providing reliable and non-invasive information in precision diagnostics.
口腔-肠道炎症会对整体健康产生影响，使患者面临患上慢性疾病和感染的风险。由于神经运动障碍和药物摄入，脑瘫（CP）患者会出现肠道便秘，影响其生活质量（QOL）。我们旨在研究口腔炎症水平如何预测肠道表型和对治疗的反应。
共有 93 名年龄在 5 至 17 岁的患者参与了这项研究，并分为以下 4 组：便秘型脑瘫（G1，n = 30）、非便秘型脑瘫（G2，n = 33）、无 CP 且无便秘的对照组（G3，n = 7）和无 CP 且无便秘的对照组（G4，n = 23）。除了描述患者的临床人口统计学、药物摄入、疾病严重程度水平、唾液细胞因子水平[肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-1β、IL-6、IL-8、IL-10]和照顾者优先事项和残疾儿童生活质量指数（CPCHILD）。通过 Shapiro-Wilks、Student's t 检验、方差分析和协方差分析评估统计学意义。
唾液前炎症细胞因子与 G1 中严重形式的肠道便秘高度相关（<0.001），在所有细胞因子中，IL-1β 水平与所有肠道便秘的相关性最高（<0.05）。在药物类型方面存在显著关系，服用γ-氨基丁酸（GABA）和 GABA+（GABA 与其他药物联合使用）的患者比其他组更有可能便秘（<0.01）。很明显，唾液炎症水平与肠道便秘相关，并影响 CP 患者的生活质量。与 G2（71.5 ± 16.7）相比，G1（49.0 ± 13.1）的 CPCHILD 平均得分较低，与 G3（88.9 ± 7.5）和 G4（95.5 ± 5.0）相比（<0.01）。我们将牙龈出血作为口腔炎症的混杂因素进行了考虑，但各组在性别（=0.332）和年龄（=0.292）方面没有差异。
总之，研究结果表明，唾液炎症水平与肠道便秘有关，通过口腔细胞因子水平可靠地监测控制肠道的药物的临床影响，为精准诊断提供可靠和非侵入性的信息。
