Is it possible to prevent cerebral apoplexy by periodontal therapy?

为了通过前瞻性干预检查探讨牙周病与脑卒中的关系，我们于2003年开始进行牙周疾病评估和颈动脉超声、头颅MRI、空腹血检和病史采集，并于2004年和2005年进行牙周治疗，作为牙周治疗后的再评估。2003年至2004年，共有16名患者入选，其中4名患者退出。对2003~2005年12例患者的3分资料进行Friedman检验，存活牙数由21.7颗明显减少至20.2颗。1年后，探诊深度大于6 mm或4 mm、探诊出血的部位明显减少，并保存下来。空腹血检中，白细胞计数下降，Hb升高，-γGTP改善。单因素回归分析显示，超声测量的右颈总动脉最大内中膜厚度与PD≧4 mm部位数、白细胞计数、红细胞计数、糖化血红蛋白、空腹血糖、糖化血红蛋白相关。对这些因素进行多元回归分析，仅保留HbA1c。在脑MRI中，5人在2003年就已经接受了动脉粥样硬化的改变，但其中一人在一年后改善了，此后没有改变(改善组)。4个余数连续两年不变(恒定组)。2例患者在1年后新出现动脉粥样硬化改变，此后无改变(加重组)。由于牙周治疗在改善组和加重组均有效，因此，脑部MRI的改变与牙周治疗之间似乎没有任何关系，因此，我们无法发现牙周治疗对脑部检查的改变有明显的影响。

To investigate the relationship between the periodontal disease and cerebral apoplexy by a prospective intervention examination, we did periodontal disease evaluation and carotid artery ultrasonography, brain MRI, fasting blood examination, and history taking, and then started a periodontal therapy in 2003.In 2004 and 2005, we performed all these examinations as a reevaluation after a periodontal therapy again. From 2003 to 2004, total 16 patients were enrolled, and then four patients dropped out. We analyzed 12 patients' data of 3 points from 2003 to 2005 by Friedman test.The number of the survival teeth decreased from 21.7 to 20.2 significantly. After one year, number of sites where the pocket depth (PD) was more than 6mm or 4mm, bleeding on probing (BOP), decreased significantly, and were preserved afterwards.In fasting blood examination, white blood cell count decreased, Hb increased, and-γGTP improved. Maximal intima-media thickness (IMT) of right common carotid artery measured by ultrasonography, were related with number of sites of PD≧4mm, white blood cell count, red blood cell count, Hb, fasting blood glucose and HbA1c by single regression analysis. By multiple regression analysis of these factors, only HbA1c remained. In brain MRI, five people already accepted an atherosclerotic change at 2003, but one of them improved it one year later and did not change afterwards (improvement group). Four remainders were constant for two years (constant group). An atherosclerotic change appeared to two patients newly one year later and did not change afterwards (aggravation group). Since periodontal therapy was effective in both of improvement group and aggravation group, there seems to be not any relation between a change of brain MRI and periodontal therapy.As a result, we were not able to find the apparent influence of a periodontal therapy on a change of cerebral examinations.