Periodontal infections contribute to elevated systemic C-reactive protein level
Periodontal infections contribute to elevated systemic C-reactive protein level
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DOI：
10.1902/jop.2000.72.9.1221
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发表时间：
2001-09-01
影响因子：
4.3
通讯作者：
De Nardin, E
中科院分区：
文献类型：
--
作者：
Noack, B;Genco, RJ;De Nardin, E
背景：牙周炎是一种局部炎症过程介导的破坏牙周组织由细菌侵袭。然而，这种疾病的特征还在于全身性炎症宿主反应，这可能部分导致最近报道的牙周炎患者中心血管疾病（CVD）的风险较高。已发现C-反应蛋白（CRP）的中度升高是CVD风险增加的预测因子。牙周病患者CRP水平升高已被几个团体报道。在这项研究中，我们研究了CRP血浆水平是否在牙周炎中增加，以及是否与牙周疾病的严重程度和牙周菌群有关。方法：使用放射免疫扩散法评估了174名受试者的CRP血清水平，59例中度平均临床附着丧失（AL）（2.39 +/- 0.29 mm）和50例高度AL（3.79 +/- 0.86 mm），65例牙周健康对照（AL，1.74 +/- 0.18 mm）。测量临床附着丧失、探诊深度和大于或等于5 mm的牙周袋部位百分比。牙周病原体牙龈卟啉单胞菌（Pg.），中间普雷沃氏菌（PL），直弯曲杆菌（Cr.），和拟杆菌Bacteroides acetylthus（B.f.）结果：牙周病患者血清CRP水平显著高于健康对照组（P=0.036）。平均临床依恋丧失水平高的受试者的平均CRP水平（4.06 +/- .55 mg/I）显著高于对照组（1.70 +/- 1.91 mg/I），P=0.011。CRP水平根据已知与CRP升高相关的因素进行调整，包括年龄、吸烟、体重指数（BMI）、甘油三酯和胆固醇。发现年龄和BMI是显著协变量。CRP作为CVD、外周血管疾病或卒中的风险因素的报告范围为1.34 mg/l至6.45 mg/l，该范围的平均值为3 mg/l。与对照组（16. 9%; 95% CI：9. 25%，24. 5%）相比，高临床AL组中CRP水平升高≥ 3 mm的受试者百分比（38%; 95% CI：26. 7%，49. 3%）显著更高，P= 0. 011。牙周病原体Pg.，π，Cr和B. f.结论：在调整年龄、吸烟、体重指数、甘油三酯和胆固醇后，牙周炎患者CRP水平的升高程度取决于疾病的严重程度。此外，CRP水平升高与龈下微生物感染有关，这些微生物通常与牙周病有关，包括Pg.，PL、C.r和B.f.最近的研究强调了CRP血浆水平中度升高作为CVD危险因素的作用。CRP与牙周病之间的正相关性可能是牙周病与这些患者中观察到的CVD高风险之间的关联的潜在途径。
Background: Periodontitis is a local inflammatory process mediating destruction of periodontal tissues triggered by bacterial insult. However, this disease is also characterized by systemic inflammatory host responses that may contribute, in part, to the recently reported higher risk for cardiovascular disease (CVD) among patients with periodontitis. Moderate elevation of C-reactive protein (CRP) has been found to be a predictor of increased risk for CVD. Elevated CRP levels in periodontal patients have been reported by several groups. In this study, we examined whether CRP plasma levels are increased in periodontitis and if there is a relation to severity of periodontal disease and to the periodontal microflora.Methods: CRP serum levels were assessed using radial immunodiffusion assay in 174 subjects, 59 with moderate mean clinical attachment loss (AL) (2.39 +/- 0.29 mm) and 50 with high AL (3.79 +/- 0.86 mm) as compared to 65 periodontally healthy controls (AL, 1.74 +/- 0.18 mm). Clinical attachment loss, probing depths, and percentage of periodontal pocket sites greater than or equal to5 mm were measured. The presence of periodontal pathogens Porphyromonas gingivalis (Pg.), Prevotella intermedia (PL), Campylobacter recta (Cr.), and Bacteroides forsythus (B.f.) in subgingival plaque samples was measured by immunofluorescence microscopy.Results: Statistically significant increases in CRP levels were observed in subjects with periodontal disease when compared to healthy controls (P=0.036). Subjects with high levels of mean clinical attachment loss had significantly higher mean CRP levels (4.06 +/- .55 mg/I) than controls (1.70 +/- 1.91 mg/I), P=0.011. The CRP levels were adjusted for factors known to be associated with elevated CRP, including age, smoking, body mass index (BMI), triglycerides, and cholesterol. Age and BMI were found to be significant covariates. The reported range for CRP as a risk factor for CVD, peripheral vascular diseases, or stroke is 1.34 mg/l to 6.45 mg/l and the mean of this range is 3 mg/l. The percentage of subjects with elevated levels of CRP greater than or equal to3 mm was significantly higher in the high clinical AL group (38%; 95% CI: 26.7%, 49.3%) when compared to the control group (16.9%; 95% CI: 9.25%, 24.5%), P=0.011. The presence of periodontal pathogens Pg., Pi., Cr, and B.f. in subgingival samples was positively associated with elevated CRP levels (P=0.029).Conclusions: The extent of increase in CRP levels in periodontitis patients depends on the severity of the disease after adjusting for age, smoking, body mass index, triglycerides, and cholesterol. Also, there are elevated levels of CRP associated with infection with subgingival organisms often associated with periodontal disease, including Pg., PL, C.r, and B.f. Recent investigations emphasized the role of moderate elevated CRP plasma levels as a risk factor for CVD. The positive correlation between CRP and periodontal disease might be a possible underlying pathway in the association between periodontal disease and the observed higher risk for CVD in these patients.