牙周炎与脑小血管病相关认知障碍的相关性研究

On Correlation between Periodontitis and Cognitive Impairment related to Cerebral Small Vessel Disease

目的探索脑小血管病(CSVD)患者中不同严重程度牙周炎与认知障碍的相关性及其外周血清炎症标志物水平的变化。方法纳入CSVD老年患者264例,评估牙周状况及认知功能,检测血清C反应蛋白(CRP)、白细胞介素-10(IL-10)和肿瘤坏死因子-α(TNF-α)水平。根据牙周炎严重程度分为四组,探讨各项指标的组间差异,并采用逻辑回归评估牙周炎与认知障碍之间的相关性。结果四组间的认知功能评分和血清炎症标志物水平均存在显著性差异。与无牙周炎组相比,重度牙周炎组的MMSE评分(P<0.000)和MoCA评分(P<0.000)显著降低;血清CRP(P=0.027)和TNF-α(P<0.000)水平显著升高,而抗炎因子IL-10(34.742vs66.819,P<0.000)水平显著降低。在逻辑回归分析中,校正混杂因素后,与无牙周炎相比,重度牙周炎(OR=6.35,95%CI:2.43~16.57,P<0.000)与认知障碍的发生存在显著的正相关。结论牙周炎与CSVD患者的认知功能下降与血清炎症标志物的改变有关,牙周炎是CSVD相关认知障碍的独立危险因素,可能是通过对全身炎症的影响来介导的。

Objective:To explore the correlation between different severity levels of periodontitis and cognitive impairment in patients with cerebral small vessel disease(CSVD),as well as the changes in peripheral serum inflammatory marker levels.Method:264 elderly patients with CSVD were included to evaluate their periodontal condition and cognitive function.Serum levels of C-reactive protein(CRP),interleukin-10(IL-10),and tumor necrosis factor alpha(TNF-α)were measured.According to the severity of periodontitis,it is divided into four groups,and the inter group differences of various indicators are explored.Logistic regression is used to evaluate the correlation between periodontitis and cognitive impairment.There were significant differences in cognitive function scores and serum inflammatory markers levels among the four groups.Compared with the non periodontitis group,the MMSE score(P<0.000)and MoCA score(P<0.000)in the severe periodontitis group were significantly reduced;The levels of serum CRP(P=0.027)and TNF-α(P<0.000)significantly increased,while the level of anti-inflammatory factor IL-10(34.742 vs 66.819,P<0.000)significantly decreased.In logistic regression analysis,after adjusting for confounding factors,there was a significant positive correlation between severe periodontitis(OR=6.35,95%CI:2.43-16.57,P<0.000)and the occurrence of cognitive impairment compared to no periodontitis.Conclusion:Periodontitis is associated with cognitive decline and changes in serum inflammatory markers in CSVD patients.Periodontitis is an independent risk factor for CSVD related cognitive impairment,which may be mediated by its impact on systemic inflammation.