Periodontal Disease and Prematurity

描述：早产和/或出生时体重不足的婴儿在一岁生日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中。虽然人类研究的结果不明确，但牙周病正在成为一个潜在的风险因素。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。该项目的主要具体目的是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联，以及2）测量产前母体血清IgG水平对特定牙周病原体与早产之间的关联。这些目的将通过在纽约大学医学院正在进行的大型队列研究（March-of-Dimes研究）中进行巢式病例对照研究来实现。本研究提供了冷冻血清和宫颈阴道样本、IL-6、IL-8、TNF α和凝血酶-抗凝血酶复合物等生化标志物数据以及经验证的生活质量问卷数据。截至2003年10月1日，共有1579例受试者入组本研究，1054例已分娩（7%早产和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招募期，估计每年有215名新招募人员。因此，我们估计到2005年10月，可能会有140名早产和1869名足月分娩。根据年龄、人种和分娩日期，从足月分娩受试者中为每例早产病例选择3个配对对照。将使用棋盘测定法测量宫颈阴道样本中的牙周病病原体，并使用ELISA测量血清样本中的牙周病病原体特异性IgG水平。将在数据分析中使用条件logistic回归分析。作为第二个目的，在探索性基础上，口腔、宫颈和阴道样本中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，使用从受试者中采集的新鲜样本，这些受试者将在本申请获得资助后招募到March-of-Dimes研究（2004年10月至2005年10月; N=215）。拟议的研究是重要的，因为它将有助于确定早产和牙周病相关因素之间的关联的性质和强度，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疗效。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.