Periodontal Disease and Prematurity

描述：早产和/或出生时体重不足的婴儿在一周岁前死亡的可能性要高出20-80倍。很大一部分早产发生在没有已知危险因素的妇女身上。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。这项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。该项目的主要目的是1)测量孕妇宫颈和阴道样本中牙周病原体与早产之间的关系；2)测量产前孕妇血清中针对特定牙周病原体的IgG水平与早产之间的关系。这些目标将通过在纽约大学医学院正在进行的一项大型队列研究（March-of-Dimes研究）中进行一项嵌套病例对照研究来实现。冷冻血清和宫颈阴道样本，生化标志物如IL-6、IL-8、TNFalpha和凝血酶-抗凝血酶复合物的数据，以及生活质量的有效问卷数据，均可从本研究中获得。截至2003年10月1日，共有1579名受试者参加了这项研究，其中1054名已经分娩（7%早产，10%低出生体重）。69%为西班牙裔，85%为19-34岁。这项研究还有两年的注册期，估计每年有215名新招募者。因此，我们估计到2005年10月可能会有140个早产儿和1869个足月分娩。根据年龄、种族和分娩日期，从足月分娩受试者中选择三个配对的对照。使用棋盘法检测宫颈阴道样本中的牙周病原体，使用ELISA检测血清样本中的牙周病原体特异性IgG水平。数据分析将采用条件逻辑回归分析。作为次要目的，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以及牙周病原体特异性血清IgG水平将相互关联，并与早产相关，使用从本申请获得资助后将被招募到March-of-Dimes研究的受试者收集的新鲜样本（10月04日至10月05日；N=215）。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，与大多数不易改变的产科风险因素相比，这些因素是可以改变的。这些关联在早产的早期诊断和预防中具有潜在的应用价值。该研究的一个主要优势是通过利用来自大型队列研究的现有数据和样本获得的有效性。调查团队的集体专业知识和优秀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.