Periodontal disease and diabetes mellitus: a two-way relationship.
Periodontal disease and diabetes mellitus: a two-way relationship.
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DOI：
10.1902/annals.1998.3.1.51
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发表时间：
1998-07-01
期刊：
影响因子：
--
通讯作者：
Genco, R J
中科院分区：
文献类型：
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作者：
Grossi, S G;Genco, R J
严重的牙周病往往与严重的糖尿病并存。糖尿病是严重牙周病的危险因素。提出了一个模型，严重的牙周病增加了糖尿病的严重程度，并使代谢控制复杂化。我们认为，感染介导的细胞因子合成和分泌在慢性刺激下的上调周期可能会放大糖尿病患者晚期糖基化终产物(AGE)介导的细胞因子反应的幅度。在这个模型中，感染和年龄介导的细胞因子上调这两个途径的结合，有助于解释糖尿病牙周炎中组织破坏的增加，以及牙周感染如何使糖尿病的严重程度和代谢控制程度复杂化，导致糖尿病和牙周疾病/感染之间的双向关系。这一提出的组织破坏的双重途径表明，控制慢性牙周感染对于实现糖尿病的长期控制至关重要。有证据支持这样的假设，即通过使用全身抗生素消除牙周感染可以改善糖尿病的代谢控制，其定义是糖化血红蛋白的减少或胰岛素需求的减少。
Severe periodontal disease often coexists with severe diabetes mellitus. Diabetes is a risk factor for severe periodontal disease. A model is presented whereby severe periodontal disease increases the severity of diabetes mellitus and complicates metabolic control. We propose that an infection-mediated upregulation cycle of cytokine synthesis and secretion by chronic stimulus from lipopolysaccharide (LPS) and products of periodontopathic organisms may amplify the magnitude of the advanced glycation end product (AGE)-mediated cytokine response operative in diabetes mellitus. In this model, the combination of these 2 pathways, infection and AGE-mediated cytokine upregulation, helps explain the increase in tissue destruction seen in diabetic periodontitis, and how periodontal infection may complicate the severity of diabetes and the degree of metabolic control, resulting in a 2-way relationship between diabetes mellitus and periodontal disease/infection. This proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection is essential for achieving long-term control of diabetes mellitus. Evidence is presented to support the hypothesis that elimination of periodontal infection by using systemic antibiotics improves metabolic control of diabetes, defined by reduction in glycated hemoglobin or reduction in insulin requirements.