Periodontitis is associated with significant hepatic fibrosis in patients with non-alcoholic fatty liver disease.
Periodontitis is associated with significant hepatic fibrosis in patients with non-alcoholic fatty liver disease.
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DOI：
10.1371/journal.pone.0185902
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Turner W
中科院分区：
文献类型：
--
作者：
Alazawi W;Bernabe E;Tai D;Janicki T;Kemos P;Samsuddin S;Syn WK;Gillam D;Turner W
非酒精性脂肪肝（NAFLD）与代谢综合征具有双向关联。它影响了高达 30% 的普通人群、70% 的糖尿病患者和 90% 的肥胖患者。进行性NAFLD的主要组织学标志是纤维化。牙周炎和代谢综合征之间存在双向流行病学联系。 NAFLD、牙周炎和糖尿病具有共同的危险因素，均以炎症为特征，并与共生细菌的变化有关。因此，我们在两个研究组中检验了牙周炎与 NAFLD 以及显着纤维化相关的假设。我们分析了基于人群的调查和基于患者的研究的数据。提取具有腹部超声和社会人口学、临床和口腔检查数据的 NHANES III 参与者并应用适当的权重。在另一项以患者为基础的研究中，经活检证实患有 NAFLD（或肝脏指数太轻微而无法进行活检）的患者在同意的情况下接受了牙科检查。记录基本牙周检查分数。在 NHANES 中，即使在调整了社会人口学因素后，牙周炎与 8172 名成年人的脂肪变性显着相关。然而，在考虑了代谢综合征的特征后，相关性得到了充分的解释。在这项以患者为基础的研究中，经活检证实患有 NASH 和任何纤维化 (F0-F4) 的患者中，牙周炎的发生率明显高于无 NASH 的患者 (p = 0.009)。牙周炎在 NASH 和显着纤维化 (F2-4) 患者中比轻度或无纤维化 (F0-1, p = 0.04) 更常见。流行病学调查和临床研究的补充证据表明，NAFLD 与牙周炎相关，并且与显着的肝纤维化的相关性更强。
Non-alcoholic fatty liver disease (NAFLD) has a bidirectional association with metabolic syndrome. It affects up to 30% of the general population, 70% of individuals with diabetes and 90% with obesity. The main histological hallmark of progressive NAFLD is fibrosis. There is a bidirectional epidemiological link between periodontitis and metabolic syndrome. NAFLD, periodontitis and diabetes share common risk factors, are characterised by inflammation and associated with changes in commensal bacteria. Therefore we tested the hypothesis that periodontitis is associated with NAFLD and with significant fibrosis in two study groups. We analyzed data from a population-based survey and a patient-based study. NHANES III participants with abdominal ultrasound and sociodemographic, clinical, and oral examination data were extracted and appropriate weighting applied. In a separate patient-based study, consenting patients with biopsy-proved NAFLD (or with liver indices too mild to justify biopsy) underwent dental examination. Basic Periodontal Examination score was recorded. In NHANES, periodontitis was significantly associated with steatosis in 8172 adults even after adjusting for sociodemographic factors. However, associations were fully explained after accounting for features of metabolic syndrome. In the patient-based study, periodontitis was significantly more common in patients with biopsy-proven NASH and any fibrosis (F0-F4) than without NASH (p = 0.009). Periodontitis was more common in patients with NASH and significant fibrosis (F2-4) than mild or no fibrosis (F0-1, p = 0.04). Complementary evidence from an epidemiological survey and a clinical study show that NAFLD is associated with periodontitis and that the association is stronger with significant liver fibrosis.
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DOI：
10.1136/bmj.d6891
发表时间：
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