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2型糖尿病患者不同血糖水平与牙周炎关系的初步研究

[Preliminary study on the relationship between different blood glucose levels and periodontitis in patients with diabetes mellitus type 2].

作者信息

Ge L H, Wang N J, Xia Y R, Zhang Z Y, Lu Y L, Shu R

机构信息

Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology, Shanghai 200011, China.

Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.

出版信息

Zhonghua Kou Qiang Yi Xue Za Zhi. 2021 Jun 9;56(6):517-524. doi: 10.3760/cma.j.cn112144-20210128-00045.

DOI:10.3760/cma.j.cn112144-20210128-00045
PMID:34098666
Abstract

To determine the correlation between the diabetes mellitus control and periodontitis. This study was a cross-sectional survey using stratified system sampling model design. The target population was the patients with diabetes investigated from May to July 2018 in Huangpu District of Shanghai. In the present study, severe periodontitis was defined as at least at two sites in different quadrants with probing depth (PD)≥6 mm and clinical attachment loss (CAL)≥ 5 mm. Edentulous induced by periodontitis were also classified as severe periodontitis and the others were classified as non-severe periodontitis subjects. Diabetes control levels were divided into the following three groups: poorly controlled group [glycated hemoglobin (HbA1c)>7.5% and fasting blood glucose (FPG)>7.0 mmol/L], well controlled group (6.5%≤HbA1c≤7.5% or 6.1 mmol/L≤FPG≤7.0 mmol/L) and ideally controlled group (HbA1c<6.5% and FPG<6.1 mmol/L). SPSS 25.0 was used for statistical analysis. Chi square test was used for demographic data and frequency distribution, α=0.05, two-sided test. Ordinal regression model was used for PD and diabetes control status to balance confounding factors (including age, gender, education and smoking status). After matching the propensity scores between severe periodontitis group and non-severe periodontitis group, logistic regression analysis was used to analyze the level of diabetes control and periodontitis. A total of 5 220 adults over the age of 18 with a medical history of diabetes participated in the survey, of which 3 064 subjects with diabetes mellitus type 2 (T2DM) who were given both oral and laboratory examinations and were included in this study. Statistics showed that the prevalence of moderate and severe periodontitis was 10.57% (324/3 064). In the severe periodontitis group, 79.01% (256/324) of the subjects were over 65 years old, 55.56% (180/324) were male, 58.33% (189/324) had lower education level than high school level, and 21.91% (71/324) were smokers, which were significantly higher than those in the non-severe periodontitis group (0.01). In different T2DM status groups, the percentage of severe periodontitis increased with the aggravation of T2DM status. In severe periodontitis group, the proportion of patients with poor glycemic control was higher. T2DM patients with poor glycemic control accounted for 68.52% (222/324) in severe periodontitis group, which was significantly higher than the proportion of non-severe periodontitis group of 60.99% (1 671/2 740) (0.05). The regression coefficient of PD was 0.191, and PD had a significant negative effect on the level of blood glucose (0.01). There was a significant positive correlation between diabetes glycemic control and severe periodontitis (2.800, 0.05). In Huangpu District of Shanghai, among T2DM patients, the age of severe periodontitis group was higher than that of non-severe periodontitis group, most of them were male, with lower education level and higher proportion of smoking. The severity of diabetes was related to periodontitis and the proportion of severe periodontitis was higher in patients with poor glycemic control.

摘要

确定糖尿病控制与牙周炎之间的相关性。本研究采用分层系统抽样模型设计进行横断面调查。目标人群为2018年5月至7月在上海黄浦区调查的糖尿病患者。在本研究中,重度牙周炎定义为不同象限至少两个部位探诊深度(PD)≥6 mm且临床附着丧失(CAL)≥5 mm。因牙周炎导致的无牙颌也被归类为重度牙周炎,其他则归类为非重度牙周炎患者。糖尿病控制水平分为以下三组:控制不佳组[糖化血红蛋白(HbA1c)>7.5%且空腹血糖(FPG)>7.0 mmol/L]、控制良好组(6.5%≤HbA1c≤7.5%或6.1 mmol/L≤FPG≤7.0 mmol/L)和理想控制组(HbA1c<6.5%且FPG<6.1 mmol/L)。使用SPSS 25.0进行统计分析。卡方检验用于人口统计学数据和频率分布,α=0.05,双侧检验。有序回归模型用于PD和糖尿病控制状态,以平衡混杂因素(包括年龄、性别、教育程度和吸烟状况)。在匹配重度牙周炎组和非重度牙周炎组的倾向得分后,使用逻辑回归分析来分析糖尿病控制水平和牙周炎。共有5220名18岁以上有糖尿病病史的成年人参与了调查,其中3064名2型糖尿病(T2DM)患者接受了口腔和实验室检查并纳入本研究。统计显示,中度和重度牙周炎的患病率为10.57%(324/3064)。在重度牙周炎组中,79.01%(256/324)的受试者年龄超过65岁,55.56%(180/324)为男性,58.33%(189/324)的教育程度低于高中水平,21.91%(71/324)为吸烟者,均显著高于非重度牙周炎组(P<0.01)。在不同的T2DM状态组中,重度牙周炎的百分比随着T2DM状态的加重而增加。在重度牙周炎组中,血糖控制不佳的患者比例更高。重度牙周炎组中血糖控制不佳的T2DM患者占68.52%(222/324),显著高于非重度牙周炎组的60.99%(1671/2740)(P<0.05)。PD的回归系数为0.191,PD对血糖水平有显著的负向影响(P<0.01)。糖尿病血糖控制与重度牙周炎之间存在显著的正相关(P=0.05)。在上海黄浦区的T2DM患者中,重度牙周炎组的年龄高于非重度牙周炎组,大多数为男性,教育程度较低且吸烟比例较高。糖尿病的严重程度与牙周炎相关,血糖控制不佳的患者中重度牙周炎的比例更高。

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