Periodontal Disease and Prematurity

描述：早产和/或出生时体重过轻的婴儿在一岁生日之前死亡的可能性要高出20-80倍。相当大比例的早产发生在没有已知风险因素的女性身上。牙周病正在成为一个潜在的危险因素，尽管人类研究的结果是模棱两可的。本研究的长期目标是进一步评估牙周源性感染在早产中的作用程度。本项目的主要目标是1)测量孕妇宫颈和阴道标本中牙周病原体与早产的关系；2)测量产前孕妇血清中特定牙周病原体抗体水平与早产的关系。这些目标将通过在纽约大学医学院正在进行的大型队列研究(3月-of-Dimes研究)内进行嵌套病例对照研究来实现。本研究提供了冰冻的血清和宫颈阴道样本、IL-6、IL-8、肿瘤坏死因子α和凝血酶-抗凝血酶复合体等生化标志物的数据，以及关于生活质量的有效问卷数据。截至2003年10月1日，有1579名受试者参加了这项研究，其中1054人已经分娩(7%的早产和10%的低出生体重)。69%的人是西班牙裔，85%的人年龄在19-34岁之间。这项研究还剩下两年的注册时间，估计每年有215名新成员。因此，我们估计，到2005年10月，可能会有140次早产和1869次足月分娩。每个早产病例的三个配对对照将根据年龄、种族和分娩日期从足月分娩受试者中选择。牙周病原体将在宫颈阴道样本中使用棋盘试验进行检测，牙周病原体特异性免疫球蛋白水平将在血清样本中使用酶联免疫吸附试验(ELISA)进行检测。数据分析采用条件Logistic回归分析。作为第二个目标，在探索性的基础上，口腔、宫颈和阴道样本中的牙周病原体水平和牙周病原体特异性血清免疫球蛋白水平将相互关联，并与早产相关，使用的新鲜样本将在这项申请获得资助后(10月4日至2005年10月；N=215)招募到研究对象中。这项拟议的研究很重要，因为它将有助于确定早产和牙周病相关因素之间的联系的性质和强度，与大多数产科风险因素相比，这些因素是可以改变的，而大多数产科风险因素不那么容易改变。这些相关性在早产的早期诊断和预防中具有潜在的应用价值。这项研究的一个主要优势是通过利用现有数据和来自大型队列研究的样本获得的疗效。调查团队的集体专业知识以及出色的临床和研究设施是额外的优势。

DESCRIPTION: Babies who are born prematurely and/or are underweight at birth are 20-80 times more likely to die before their first birthday. A significant proportion of preterm deliveries occur in women who are free of known risk factors. Periodontal disease is emerging as a potential risk factor although the results from human studies are equivocal. The long-term objective of this research is to further evaluate the extent to which the infections of periodontal origin play a role in preterm delivery. The primary Specific Aims of this project are 1) to measure the association between periodontal pathogens in cervical and vaginal samples of pregnant women and preterm birth, and 2) to measure the association between prenatal maternal serum IgG levels against specific periodontal pathogens and preterm birth. These Aims will be accomplished by conducting a nested case-control study within a large ongoing cohort study at the New York University Medical School (March-of-Dimes Study). Frozen serum and cervico-vaginal samples, data on biochemical markers such as IL-6, IL-8, TNFalpha, and Thrombin-antithrombin complexes, and validated questionnaire data on quality-of-life are available from this study. As of October 1,2003, there were 1579 subjects enrolled in this study and 1054 have already delivered (7% preterm deliveries and 10% low birth weight). Sixty-nine percent were Hispanic and 85% were 19-34 years of age. This study has two more years of enrollment remaining with an estimated 215 new recruits per year. Accordingly, we estimate that by October 2005 there will likely be 140 preterm and 1869 full term deliveries. Three pair-matched controls for each preterm delivery case will be selected from the full-term delivery subjects based on age, race, and date of delivery. Periodontal pathogens will be measured in cervico-vaginal samples using a checkerboard assay, and periodontal pathogen-specific IgG levels will be measured in serum samples using ELISA. Conditional logistic regression analysis will be used in the data analysis. As a secondary Aim, on an exploratory basis, levels of periodontal pathogens in oral, cervical, and vaginal samples, and periodontal pathogen specific serum IgG levels will be correlated with each other and also with preterm birth using fresh samples collected from the subjects that will be recruited to the March-of-Dimes Study after this application is funded (October 04-Oct 05; N=215). The proposed research is important because it will help identify the nature and the strength of the association between preterm delivery and periodontal disease-related factors which are modifiable in comparison to a majority of obstetrical risk factors that are not as easily changed. These associations have potential application in the early diagnosis and prevention of preterm deliveries. A major strength of the study is the efficacy gained by utilizing existing data and samples from a large cohort study. The collective expertise of the investigative team and the excellent clinical and research facilities are additional strengths.