Systemic effects of periodontitis: lessons learned from research on atherosclerotic vascular disease and adverse pregnancy outcomes.
Systemic effects of periodontitis: lessons learned from research on atherosclerotic vascular disease and adverse pregnancy outcomes.
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DOI：
10.1111/idj.12185
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发表时间：
2015-12
影响因子：
3.3
通讯作者：
Papapanou PN
中科院分区：
文献类型：
--
作者：
Papapanou PN
在过去的25年里，研究集中在牙周炎的作用上，牙周炎是一种微生物病因性炎症，破坏牙齿支撑组织，作为一种系统性炎症应激源，可以作为动脉粥样硬化性血管疾病（AVSD）和不良妊娠结局（APOs）的独立危险因素。有研究表明，牙周炎相关的细菌血症和牙周组织中产生的炎症介质的全身传播可能导致全身炎症和内皮功能障碍，而口腔来源的细菌可能会转移到胎儿-胎盘单位。流行病学研究在很大程度上支持牙周炎与ASVD / APOs之间的关联，独立于已知的混杂因素；事实上，在多变量调整中，牙周炎已被证明与ASVD和apo相关的临床事件的风险在统计学上显著升高。另一方面，干预研究表明，虽然牙周治疗可以减少全身炎症，改善内皮功能，但对apo的发生率没有积极作用。目前缺乏关于牙周干预对asvd相关临床事件影响的研究。本综述总结了机制、关联和干预研究的主要发现，并试图调和来自不同调查线的看似矛盾的证据。
Studies conducted over the past 25 years have focused on the role of periodontitis, an inflammatory condition of microbial etiology that destroys the tooth supporting tissues, as a systemic inflammatory stressor that can act as an independent risk factor of atherosclerotic vascular disease (AVSD) and adverse pregnancy outcomes (APOs). It has been suggested that periodontitis-associated bacteremias and systemic dissemination of inflammatory mediators produced in the periodontal tissues may result in systemic inflammation and endothelial dysfunction, while bacteria of oral origin may translocate into the feto-placental unit. Epidemiologic studies largely support an association between periodontitis and ASVD / APOs independent of known confounders; indeed, periodontitis has been shown to confer statistically significantly elevated risk for clinical events associated with ASVD and APOs in multivariable adjustments. On the other hand, intervention studies demonstrate that although periodontal therapy reduces systemic inflammation and improves endothelial function, it has no positive effect on the incidence of APOs. Studies of the effects of periodontal interventions on ASVD-related clinical events are lacking. This review summarizes key findings from mechanistic, association and intervention studies and attempts to reconcile the seemingly contradictory evidence that originates from different lines of investigation.