Association Among Oral Health Parameters, Periodontitis, and Its Treatment and Mortality in Patients Undergoing Hemodialysis
Association Among Oral Health Parameters, Periodontitis, and Its Treatment and Mortality in Patients Undergoing Hemodialysis
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DOI：
10.1902/jop.2013.130427
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发表时间：
2014-06-01
影响因子：
4.3
通讯作者：
Pecoits-Filho, Roberto
中科院分区：
文献类型：
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作者：
de Souza, Cleber M.;Braosi, Ana Paula R.;Pecoits-Filho, Roberto
背景：慢性牙周炎（CP）是一种持续的、可逆的炎症来源，对接受血液透析（HD）患者的死亡率有潜在影响。本研究调查了口腔健康指标、CP 及其治疗对一组接受 HD 的患者生存率的影响。方法：临床稳定的接受 HD 的患者被转诊进行牙科检查。所有患者均在透析诊所进行前瞻性随访，并记录全因死亡率。分析了三组患者：接受 CP 治疗的患者、未接受 CP 治疗的患者以及未接受 CP 治疗的患者作为对照组。 结果：共有 122 名患者（男 79 例，女 43 例，年龄 23 至 77 岁；平均年龄：50 岁；范围：23 至 77 岁）入组。 40% 的人表示很少接受牙医评估，59% 的人患有 CP。平均随访时间为 64.1 +/- 11.2 个月，共发生 34 起致命事件。单变量分析中与死亡相关的口腔因素是看牙医的频率减少；不使用牙线；腐烂、缺失和补牙指数增加； CP 的存在；以及缺乏 CP 治疗。在未经治疗的患者的单变量分析中，与无 CP 的患者相比，患有 CP 的患者因各种原因死亡的风险较高（风险比 2.65 [95% 置信区间 1.06 至 6.59]；P = 0.036），而治疗患者的风险比较低（2.36 [1.01 至 5.59]；P = 0.047）。在对多变量模型中的混杂因素进行调整后，这些显着差异并未得到维持。结论：这些结果表明口腔健康状况不佳（包括 CP）是接受 HD 的患者的常见发现。本研究的结果要求进行干预试验来检验以下假设：CP 治疗可提高 HD 患者维持期的生存率。
Background: Chronic periodontitis (CP) is a continuous, reversible source of inflammation with a potential impact on mortality in patients undergoing hemodialysis (HD). This study investigates the impact of oral health indicators, CP, and its treatment on survival rates in a group of patients undergoing HD.Methods: Clinically stable patients undergoing HD were referred for a dental examination. All patients were prospectively followed in the dialysis clinic, and all-cause mortality was recorded. Three groups of patients were analyzed: those who received CP treatment, those who did not, and patients without CP as a control group.Results: A total of 122 patients (79 males and 43 females, aged 23 to 77 years; mean age: 50 years; range: 23 to 77 years) were enrolled. Forty percent reported having rarely been evaluated by a dentist, and 59% had CP. There were 34 fatal events during a mean follow-up time of 64.1 +/- 11.2 months. Oral factors associated with death in the univariate analysis were decreased frequency of dental visits; non-use of dental floss; increased decayed, missing, and filled teeth index; presence of CP; and absence of CP treatment. Patients with CP had a higher risk of death from all causes compared with patients without CP in the univariate analysis for untreated patients (hazard ratio 2.65 [95% confidence interval 1.06 to 6.59]; P = 0.036) and to a lesser extent for treated patients (2.36 [1.01 to 5.59]; P = 0.047). These significant differences were not maintained after adjustments for confounders in the multivariate model.Conclusions: These results suggest that poor oral health, including CP, is a common finding in patients undergoing HD. The results of this study call for intervention trials to test the hypothesis that treatment of CP improves survival in maintenance of patients undergoing HD.