Effect of periodontitis on overt nephropathy and end-stage renal disease in type 2 diabetes
Effect of periodontitis on overt nephropathy and end-stage renal disease in type 2 diabetes
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DOI：
10.2337/dc06-1184
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发表时间：
2007-02-01
期刊：
影响因子：
16.2
通讯作者：
Nelson, Robert G.
中科院分区：
文献类型：
--
作者：
Shultis, Wendy A.;Weil, E. Jennifer;Nelson, Robert G.
目的-本研究的目的是调查牙周炎对显性肾病发展的影响，显性肾病定义为大量白蛋白尿和2型糖尿病的终末期肾病（ESRD）。研究设计和方法-居住在吉拉河印第安社区的年龄≥ 25岁的2型糖尿病患者，进行一次或多次牙周检查，估计肾小球滤过率>= 60 ml/min/1.73 m2，无大量白蛋白尿（尿白蛋白/肌酐比值>= 300 mg/g）。根据牙齿数量和牙槽骨评分，将牙周炎分为无/轻度、中度、重度或无牙。受试者被跟踪到大量白蛋白尿或终末期肾病的发展，定义为肾脏替代治疗或死亡归因于diabetic nephropathy.RESULTS -的529个人，107（20%）没有/轻度牙周炎，200（38%）有中度牙周炎，117（22%）有严重牙周炎，105（20%）是缺牙在基线。在长达22年的随访中，193人发生了大量白蛋白尿，68人发生了终末期肾病。年龄和性别校正的大量白蛋白尿和终末期肾病的发病率随着牙周炎的严重程度而增加。在比例风险模型中调整年龄、性别、糖尿病病程、BMI和吸烟后，与无/轻度牙周炎的个体相比，中度或重度牙周炎或无牙颌的个体的大量白蛋白尿的发生率分别高2.0、2.1和2.6 Limes（P = 0.01）。与无/轻度牙周炎的患者相比，中度或重度牙周炎患者或无牙颌患者终末期肾病的发生率分别为2.3、3.5和4.9倍（P 0.02）。结论：牙周炎可预测2型糖尿病患者明显肾病和终末期肾病的发生。牙周炎的治疗是否会降低糖尿病肾病的风险仍有待确定。
OBJECTIVE - The purpose of this study was to investigate the effect of periodontitis on development of overt nephropathy, defined as macroalbuminuria, and end-stage renal disease (ESRD) in type 2 diabetes.RESEARCH DESIGN AND METHODS - individuals residing in the Gila River Indian Community aged >= 25 years with type 2 diabetes, one or more periodontal examination, estimated glomerular filtration rate >= 60 ml/min per 1.73 m(2), and no macroalbuminuria (urinary albumin-to-creatinine ratio >= 300 mg/g) were identified. Periodontitis was classified as none/mild, moderate, severe, or edentulous using number of teeth and alveolar bone score. Subjects were followed to development of macroalbuminuria or ESRD, defined as onset of renal replacement therapy or death attributed to diabetic nephropathy.RESULTS - Of the 529 individuals, 107 (20%) had none/mild periodontitis, 200 (38%) had moderate periodontitis, 117 (22%) had severe periodontitis, and 105 (20%) were edentulous at baseline. During follow-up of up to 22 years, 193 individuals developed macroalbuminuria and 68 developed ESRD. Age- and sex-adjusted incidence of macroalbuminuria and ESRD increased with severity of periodontitis. After adjustment for age, sex, diabetes duration, BMI, and smoking in a proportional hazards model, the incidences of macroalbuminuria were 2.0, 2.1, and 2.6 Limes as high in individuals With moderate or severe periodontitis or those Who were edentulous, respectively, compared with those with none/mild periodontitis (P = 0.01). Incidences of ESRD in individuals with moderate or severe periodontitis or in those who were edentulous were 2.3, 3.5, and 4.9 times as high, respectively, compared with those with none/mild periodontitis (P 0.02).CONCLUSIONS - Periodontitis predicts development of overt nephropathy and ESRD in individuals with type 2 diabetes. Whether treatment of periodontitis will reduce the risk of diabetic kidney disease remains to be determined.