Relationships among clinical measures of periodontal disease and their associations with systemic markers.
Relationships among clinical measures of periodontal disease and their associations with systemic markers.
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DOI：
10.1902/annals.2002.7.1.79
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发表时间：
2002-12-01
期刊：
影响因子：
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通讯作者：
Offenbacher, Steven
中科院分区：
文献类型：
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作者：
Beck, James D;Offenbacher, Steven
背景：最近对牙周炎与全身性疾病之间关系的研究要求，牙周病也必须被视为一种疾病过程，是全身性疾病或病症（结果）的暴露，而不是结果本身。当将牙周病视为一种暴露时，研究人员必须考虑牙周炎的临床、微生物和炎症成分，这些成分可能会给感兴趣的系统结果带来风险，这可能与用于定义牙齿疾病的评估相关，也可能不同。另一个重要的考虑因素是暴露和感兴趣的结果之间的时间关系。方法：为了探讨牙周病的定义或临床症状的聚集对于全身炎症应激暴露来说很重要，我们检查了临床牙周病测量值与心血管疾病风险增加的 2 种全身炎症标志物之间的关系：血清可溶性细胞间粘附分子（sICAM），它是血管应激的测量值；血清 C 反应蛋白（CRP），它是肝脏疾病的测量值。急性期反应。社区牙动脉硬化风险 (ARIC) 研究是一项关于牙周病和心血管疾病之间关系的横断面研究，构成了本次调查中使用的示例的基础。 结果：我们的研究结果表明，虽然附着丧失、探诊深度 (PD) 和探诊出血 (BOP) 分别与 sICAM 和 CRP 相关，但当所有 3 项都在模型中时，只有 BOP 对 sICAM 仍然显着，而对于 CRP，只有 PD 仍然显着。这两个临床参数在估计全身炎症程度方面比传统的轻度、中度和重度牙周炎分类或其他疾病严重程度（如附着丧失）测量方法更可靠。结论：在选择“系统性牙周炎”（代表全身性疾病的牙周病）的定义时，将牙周病视为具有许多临床症状的慢性口腔感染，而不是以牙齿为中心定义的实体牙周病是有帮助的。因此，“系统性牙周炎”的定义应基于最能代表可能影响系统性结果的潜在机制和时间顺序的临床体征。
BACKGROUND: Recent investigations of the relationship between periodontitis and systemic disease require that periodontal disease also must be thought of as a disease process that is an exposure for a systemic disease or condition (outcome), rather than as the outcome itself. When viewing periodontal disease as an exposure, investigators must consider the clinical, microbiological, and inflammatory components of periodontitis that potentially convey risk for the systemic outcome of interest, which may or may not be the same as those associated with the assessments used to define tooth-based disease. Another important consideration is the temporal relationship between the exposure and the outcome of interest.METHODS: To explore which definitions of periodontal disease or clustering of clinical signs are important with regards to systemic exposure to inflammatory stress, we examined the relationship between clinical periodontal disease measures and 2 systemic inflammatory markers of increased risk for cardiovascular disease: serum soluble intercellular adhesion molecule (sICAM), which is a measure of vascular stress and serum C-reactive protein (CRP), which is a measure of hepatic acute-phase response. The Dental Arteriosclerosis Risk in Communities (ARIC) study, a cross-sectional study of the relationship between periodontal disease and cardiovascular disease, forms the basis for the examples used in this investigation.RESULTS: Our findings demonstrated that while attachment loss, probing depth, (PD) and bleeding on probing (BOP) are individually associated with sICAM and CRP, only BOP remains significant for sICAM when all 3 are in the model and, for CRP, only PD remains significant. Both of these clinical parameters were more robust in estimating the degree of systemic inflammation than traditional classifications of mild, moderate, and severe periodontitis or other measures of disease severity such as attachment loss.CONCLUSIONS: When selecting a definition of "systemic periodontitis" (periodontal disease that represents an exposure for a systemic condition), it is helpful to think of periodontal disease as a chronic oral infection with a number of clinical signs, rather than as the dento-centrically defined entity, periodontal disease. Thus, "systemic periodontitis" should be defined predicated upon those clinical signs that best represent the underlying mechanisms and temporal sequence that may affect that systemic outcome.