Du Mi, Deng Ke, Cai Qingqing, Hu Shixian, Chen Yuntao, Xu Shulan, Tjakkes Geerten-Has E, Ge Shaohua, Ge Minghua, Li An
Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, China.
J Periodontol. 2024 May;95(5):502-514. doi: 10.1002/JPER.23-0079. Epub 2023 Nov 21.
This study evaluated the mediating role of systemic inflammation in the association between exposure to heavy metals and periodontitis in a nationwide sample of adults.
Pooled cross-sectional data from the National Health and Nutrition Examination Survey (NHANES 2009-2014) were used (n = 8993). Periodontitis was defined by a full-mouth examination and classified as no/mild and moderate/severe (mod/sev) groups. Blood and urinary heavy metal levels were investigated, including cadmium (Cd), lead (Pb), and mercury (Hg). In addition, systemic inflammation was assessed using circulatory leukocyte counts and C-reactive protein (CRP) levels.
Multivariable logistic regression analysis revealed the positive associations of blood and urinary levels of Cd and Pb with mod/sev periodontitis. In contrast,blood Hg levels did not show a significant association. The odds of having periodontitis were 1.233 and 1.311 times higher for each one-unit increment in Ln-transformed blood Cd (95% confidence interval [CI]: 1.109-1.371) and Pb (95% CI: 1.170-1.470), respectively. Mediation analysis suggested a 6.3% to 11.5% contribution of leucocyte counts in the association of blood Cd and Pb levels with periodontitis. Sensitivity analyses for urinary Cd levels yielded consistent mediating effects. However, no significant mediating effect of CRP was detected.
Higher exposures to Cd and Pb were positively associated with periodontitis risk. These associations might be partially mediated by the elevated levels of leukocytes rather than CRP. Further longitudinal studies are needed to elucidate the discordant results of the systemic inflammatory biomarkers.
本研究在全国范围内的成年样本中评估了全身炎症在重金属暴露与牙周炎关联中的中介作用。
使用了来自国家健康与营养检查调查（2009 - 2014年NHANES）的汇总横断面数据（n = 8993）。通过全口检查定义牙周炎，并分为无/轻度和中度/重度（中/重度）组。调查了血液和尿液中的重金属水平，包括镉（Cd）、铅（Pb）和汞（Hg）。此外，使用循环白细胞计数和C反应蛋白（CRP）水平评估全身炎症。
多变量逻辑回归分析显示血液和尿液中Cd和Pb水平与中/重度牙周炎呈正相关。相比之下，血液Hg水平未显示出显著关联。Ln转换后的血液Cd（95%置信区间[CI]：1.109 - 1.371）和Pb（95%CI：1.170 - 1.470）每增加一个单位，患牙周炎的几率分别高出1.233倍和1.311倍。中介分析表明白细胞计数在血液Cd和Pb水平与牙周炎的关联中贡献了6.3%至11.5%。尿液Cd水平的敏感性分析产生了一致的中介效应。然而，未检测到CRP的显著中介作用。
较高的Cd和Pb暴露与牙周炎风险呈正相关。这些关联可能部分由白细胞水平升高而非CRP介导。需要进一步的纵向研究来阐明全身炎症生物标志物的不一致结果。
