Storjord Elin, Airila-Månsson Stella, Karlsen Katarzyna, Madsen Martin, Dahl Jim André, Landsem Anne, Fure Hilde, Ludviksen Judith Krey, Fjøse Johannes Østrem, Dickey Amy K, Karlsen Bård Ove, Waage Nielsen Erik, Mollnes Tom Eirik, Brekke Ole-Lars
Department of Laboratory Medicine, Nordland Hospital Trust, 8092 Bodø, Norway.
Department of Clinical Medicine, UiT-The Arctic University of Norway Tromsø, 9019 Tromsø, Norway.
Life (Basel). 2022 Aug 19;12(8):1270. doi: 10.3390/life12081270.
In the inherited metabolic disorder acute intermittent porphyria (AIP), high sugar intake prevents porphyric attacks due to the glucose effect and the following high insulin levels that may lower AIP disease activity. Insulin resistance is a known risk factor for periodontitis and sugar changes diabetogenic hormones and affects dental health. We hypothesized differences in homeostasis model assessment (HOMA) scores for insulin resistance in AIP cases vs. controls and in those with periodontitis. Our aim was to systematically study dental health in AIP as poor dental health was previously only described in case reports. Further, we aimed to examine if poor dental health and kidney failure might worsen AIP as chronic inflammation and kidney failure might increase disease activity. In 47 AIP cases and 47 matched controls, X-rays and physical examination of clinical attachment loss (CAL), probing pocket depth (PPD), and decayed missing filled teeth (DMFT) were performed. Dietary intake was evaluated through a diet logbook. Plasma cytokines and diabetogenic hormones were measured using multiplex technology and urine porphobilinogen and kidney and liver function by routine methods. An excel spreadsheet from the University of Oxford was used to estimate HOMA scores; beta cell function, HOMA%B (%B), insulin sensitivity, HOMA%S (%S), and insulin resistance HOMA-IR (IR), based on glucose and plasma (P) C-peptide. The Wilcoxon matched-pairs signed rank test, the Mann−Whitney U-test, and Spearman’s non-parametric correlation were used. Insulin (p = 0.007) and C-peptide (p = 0.006) were higher in the AIP cases with periodontitis versus those without. In AIP patients, the liver fibrosis index 4 correlated with DMFT (p < 0.001) and CAL ≥4 mm (p = 0.006); the estimated glomerular filtration rate correlated with DMFT (p < 0.001) and CAL ≥4 mm (p = 0.02). CAL ≥4 mm was correlated with chemokine ligand 11 and interleukin (IL)-13 (p = 0.04 for both), and PPD >5 mm was correlated with plasminogen activator inhibitor-1 (p = 0.003) and complement component 3 (p = 0.02). In conclusion, dental health in AIP cases was correlated with insulin resistance, inflammatory markers, and biomarkers of kidney and liver function, demonstrating that organ damage in the kidney and liver are associated with poorer dental health.
在遗传性代谢紊乱急性间歇性卟啉病（AIP）中，高糖摄入可因葡萄糖效应及随之而来的高胰岛素水平预防卟啉病发作，而高胰岛素水平可能降低AIP疾病活性。胰岛素抵抗是牙周炎的已知危险因素，糖会改变致糖尿病激素并影响牙齿健康。我们推测AIP病例与对照组以及患有牙周炎者之间的胰岛素抵抗稳态模型评估（HOMA）评分存在差异。我们的目的是系统研究AIP患者的牙齿健康状况，因为此前牙齿健康状况不佳仅在病例报告中有描述。此外，我们旨在研究牙齿健康状况不佳和肾衰竭是否会使AIP病情恶化，因为慢性炎症和肾衰竭可能会增加疾病活性。对47例AIP病例和47例匹配的对照进行了X线检查，并对临床附着丧失（CAL）、探诊深度（PPD）和龋失补牙数（DMFT）进行了体格检查。通过饮食日志评估饮食摄入量。使用多重技术测量血浆细胞因子和致糖尿病激素，通过常规方法测量尿卟胆原以及肾脏和肝脏功能。使用牛津大学的一个Excel电子表格根据血糖和血浆（P）C肽估算HOMA评分；β细胞功能、HOMA%B（%B）、胰岛素敏感性、HOMA%S（%S）以及胰岛素抵抗HOMA-IR（IR）。采用Wilcoxon配对符号秩检验、Mann-Whitney U检验和Spearman非参数相关性分析。患有牙周炎的AIP病例的胰岛素（p = 0.007）和C肽（p = 0.006）水平高于未患牙周炎的病例。在AIP患者中，肝脏纤维化指数4与DMFT（p < 0.001）和CAL≥4 mm（p = 0.006）相关；估计肾小球滤过率与DMFT（p < 0.001）和CAL≥4 mm（p = 0.02）相关。CAL≥4 mm与趋化因子配体11和白细胞介素（IL）-13相关（两者p = 0.04），PPD>5 mm与纤溶酶原激活物抑制剂-1（p = 0.003）和补体成分3（p = 0.02）相关。总之，AIP病例的牙齿健康状况与胰岛素抵抗、炎症标志物以及肾脏和肝脏功能的生物标志物相关，表明肾脏和肝脏的器官损伤与较差的牙齿健康状况有关。
