慢性牙周炎患者早期动脉粥样硬化指标检测

Detection of the parameters for early atherosclerosis in patients with chronic periodontitis

目的明确慢性牙周炎患者动脉粥样硬化早期临床指标的改变,探索慢性牙周炎与动脉粥样硬化关系。方法纳入59名无系统疾病的牙周科就诊患者,其中无或轻度牙周炎者30名和中重度牙周炎患者29名,由同一检查者记录口内缺失牙、存留牙近中颊、远中舌2个位点菌斑指数(plaque index,PLI)、出血指数(bleeding index,BI)、探诊深度(probing depth,PD)、附着丧失(attachment loss,AL);彩色多普勒超声分别检测双侧颈总动脉内中膜厚度(intima-media thickness,IMT)和血流介导的血管舒张反应(flow-mediated dilatation,FMD),以这两项指标反映动脉粥样硬化早期血管改变。结果两组研究对象在性别、年龄、体重指数和受教育程度上无统计学差异。牙周炎组的双侧颈动脉IMT均显著高于对照组[左侧IMT:(0.84±0.22mm)vs.(0.70±0.28mm),P<0.05,右侧:(0.82±0.31 mm)vs.(0.64±0.20 mm),P<0.05],牙周炎组斑块检出率与对照组无统计学差异(左侧:10.34%vs.13.33%P=0.77;右侧:6.90%vs.10%P=0.71),牙周炎组血流介导的血管舒张反应显著低于对照组[(10.00±6.50%)vs.(13.44±6.41%),P=0.04]。多因素分析显示调整性别、年龄、吸烟、体重指数、血脂、血糖、血压等因素后,PD和AL仍是影响颈动脉IMT的重要因素,PLI、PD和BI仍是影响血管内皮功能的重要因素。结论中重度慢性牙周炎患者较无/轻度牙周炎者早期动脉粥样硬化指标差,慢性牙周炎可能与动脉粥样硬化相关。

Objective To observe early atherosclerotic condition in patients with chronic periodontitis（CP）and investigate the correlation between CP and atherosclerosis. Methods According to physical and chemical examination of nearest 6 months, 59 general healthy subjects were enrolled in this study, among them, 29 were moderate/severe periodontitits patients and 30 were non/mild periodontitis patients. The periodontal status including plaque index（PLI）,bleeding index（BI）, probing depth（PD） and attachment loss（AL） as well as missing teeth number were recorded.Intima-media thickness（IMT）and prevalence of atherosclerotic plaque of bilaterally carotid common arteries and flowmediated dilatation（FMD） were measured by high-frequency color Doppler. Results IMT of bilateral carotid common arteries was statistically higher in moderate/severe periodontitits group than that in control group, [left：IMT：（0.84 ±0.22mm）vs（.0.70±0.28mm）, P〈0.05,right：（0.82±0.31 mm）vs（.0.64±0.20 mm）,P〈0.05], prevalence of atherosclerotic plaque in carotid common arteries was not significantly different between severe/moderate periodontitis group and control group（left：10.34% vs. 13.33%, P=0.77, right：6.90% vs.10% P=0.71）, FMD was significantly lower in moderate/severe periodontitits group than that in control group（[10.00 ±6.50%） vs.（13.44 ±6.41%）, P =0.04）. Multivariate linear regression showed after adjusting age, gender, smoking, body mass index, serum glucose, serum lipid, blood pressure, AL and PD were significant impact factors to IMT, PLI, PD and BI were significant impact factors to FMD. Conclusion Carotid IMT increased and endothelial function was deteriorate in patients with moderate/severe CP, CP may act on the progression of atherosclerosis.