维持性血液透析患者慢性牙周疾病与营养不良-炎症复合性综合征相关性的研究
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摘要
目的探讨维持性血液透析(MHD)患者慢性牙周疾病与营养不良-炎症复合性综合征(MICS)的相关性。方法选择2016年1月至2017年12月在武汉市中心医院肾内科血液净化中心维持性血液透析的符合实验纳入及排除标准的患者共64例,根据牙周病的诊断标准,分为无牙周病组(No)16例、轻度牙周病组(Mild) 18例、中度牙周病组(Moderate)15例、重度牙周病组(Severe)15例,各组患者均进行血红蛋白(Hb)、血清白蛋白(Alb)、血清铁(Fe)、铁蛋白(Ferritin)、营养不良-炎症评分(MIS)等营养相关指标检测以及血清超敏C蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)相关炎症指标检测。采用多因素线性回归评估并比较各组营养状况指标及炎症相关指标的差异,采用偏相关分析评估MIS与炎症相关指标、牙周病严重程度的相关性。结果与重度牙周病组相比,其他各组Hb、Alb、Fe水平、hs-CRP、TNF-α、Ferritin水平均显著下降,差异具有统计学意义(P<0.01)。无牙周病组MIS值为(8.8±1.2);轻度牙周病组MIS值为(14.0±1.2);中度牙周病组MIS值为(17.7±1.4);重度牙周病组MIS值为(22.0±1.1);各组MIS值与重度牙周病组相比均有统计学意义(P<0.05)。在控制了年龄、糖尿病与否、透析时间后采用偏相关分析牙周病指数(PDI)和MIS值与炎症指标之间的关系,结果显示PDI与血清超敏C蛋白之间显著相关(r=0.258,P<0.05),MIS值与血清超敏C蛋白(r=0.297,P<0.01)、TNF-α水平(r=0.243,P<0.01)、PDI(r=0.328,P<0.01)显著相关。结论牙周病的严重程度、炎症因子水平增加,均可加重MICS。对于MHD患者需积极的防治慢性牙周疾病.
Objective To explore the correlation between chronic periodontal disease and malnutrition-inflammation atherosclerosis syndrome(MICS)in hemodialysis patients. Methods A total of 64 patients with maintenance hemodialysis(MHD)conducting in Blood Purification Center of Department of Nephropathy of Wuhan Municipal Central Hospital from January 2106 to December 2017, who complied with inclusion and exclusion criteria, were divided into no periodontal disease group(No)(16 patients), mild periodontal disease group(mild)(18 patients), moderate periodontal disease group(Moderate)(15 patients), and severe periodontal disease group(Severe)(15 patients). For the patients in each group, the nutrition-related indices including hemoglobin(Hb, serum albumin(Alb), serum iron(Fe), Ferritin and malnutrition-inflammation score(MIS), and the inflammation indices including serum hypersensitive protein C(hs-CRP) and tumor necrosis factor-a(TNF-a) were detected. Multivariate linear regression analysis was adopted to assess and compare the nutrition-related indices and the inflammation-related indices in each group, and partial correlation analysis was used to assess the correlations of MIS, with the inflammation-related indices,and the periodontal disease severity. Results Compared with the severe periodontal disease group, the levels of Hb, Alb, Fe, hs CRP, TNF-α and Ferritin all significantly declined in other groups, with statistically significant difference(P<0.01). The MIS value with the No group was(8.8±1.2); that with the Mild group,(14.0±1.2); that with the Moderate group,(17.7±1.4); that with the Severe group,(22.0±1.1). There was statistically significant difference between the MIS values with the other three groups and that with the Severe group(P<0.05). After controlling age, diabetes and dialysis period partial correlation analysis was used to assess the correlation between periodontal disease index(PDI) and the inflammation-related indices. The results showed significant correlation between PDI and hs-CRP(r=0.258, P<0.05), and significant correlation between MIS values and hs-CRP(r=0.297, P<0.01), between TNF-a levels and PDI(r=0.328, P<0.01). Conclusions Increases in periodontal disease severity and inflammatory factor level both can aggravate MICS. Chronic periodontal disease should be actively prevented and treated in those patients with MHD.
Objective To explore the correlation between chronic periodontal disease and malnutrition-inflammation atherosclerosis syndrome(MICS)in hemodialysis patients. Methods A total of 64 patients with maintenance hemodialysis(MHD)conducting in Blood Purification Center of Department of Nephropathy of Wuhan Municipal Central Hospital from January 2106 to December 2017, who complied with inclusion and exclusion criteria, were divided into no periodontal disease group(No)(16 patients), mild periodontal disease group(mild)(18 patients), moderate periodontal disease group(Moderate)(15 patients), and severe periodontal disease group(Severe)(15 patients). For the patients in each group, the nutrition-related indices including hemoglobin(Hb, serum albumin(Alb), serum iron(Fe), Ferritin and malnutrition-inflammation score(MIS), and the inflammation indices including serum hypersensitive protein C(hs-CRP) and tumor necrosis factor-a(TNF-a) were detected. Multivariate linear regression analysis was adopted to assess and compare the nutrition-related indices and the inflammation-related indices in each group, and partial correlation analysis was used to assess the correlations of MIS, with the inflammation-related indices,and the periodontal disease severity. Results Compared with the severe periodontal disease group, the levels of Hb, Alb, Fe, hs CRP, TNF-α and Ferritin all significantly declined in other groups, with statistically significant difference(P<0.01). The MIS value with the No group was(8.8±1.2); that with the Mild group,(14.0±1.2); that with the Moderate group,(17.7±1.4); that with the Severe group,(22.0±1.1). There was statistically significant difference between the MIS values with the other three groups and that with the Severe group(P<0.05). After controlling age, diabetes and dialysis period partial correlation analysis was used to assess the correlation between periodontal disease index(PDI) and the inflammation-related indices. The results showed significant correlation between PDI and hs-CRP(r=0.258, P<0.05), and significant correlation between MIS values and hs-CRP(r=0.297, P<0.01), between TNF-a levels and PDI(r=0.328, P<0.01). Conclusions Increases in periodontal disease severity and inflammatory factor level both can aggravate MICS. Chronic periodontal disease should be actively prevented and treated in those patients with MHD.
引文
[1] Marrs JC,Saseen JJ.Effects of lipid-lowering therapy on reduction of cardiovascular events in patients with end-stage renal disease requiring phemodialysis[J].Pharmacotherapy,2010,30(8):823-829.
[2] Kalantar-Zadeh K,Kopple JD,Block G,et al.A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients[J].Am J Kidney Dis,2001,38(6):1251-1263.
[3] Rambod M,Bross R,Zitterkoph J,et al.Association of Malnutrition-Inflammation Score with quality of life and mortality in hemodialysis patients:a 5-year prospective cohort study[J].Am J Kidney Dis,2009,53(2):298-309.
[4] Fang F,Wu B,Qu Q,et al.The clinical response and systemic effects of non-surgical periodontal therapy in end-stage renal disease patients:a 6-month randomized controlled clinical trial[J].J Clin Periodontol,2015,42(6):537-546.
[5] Palmer SC,Ruospo M,Wong G,et al.Patterns of oral disease in adults with chronic kidney disease treated with hemodialysis[J].Nephrol Dial Transplant,2016,31(10):1647-1653.
[6] Iwasaki M,Taylor GW,Awano S,et al.Periodontal disease and pneumonia mortality in hemodialysis patients:A 7-year cohort study[J].J Clin Periodontol,2018,45(1):38-45.
[7] 中华医学会肾脏病学分会.重组人促红细胞生成素在肾性贫血中合理应用的专家共识.2010修订版.
[8] 中国医师协会肾内科医师分会肾性贫血诊断和治疗共识专家组.肾性贫血诊断与治疗中国专家共识(2014修订版)[J].中华肾脏病杂志,2014,30(9):714-715.
[9] Ramfjord SP.The Periodontal Disease Index(PDI)[J].J Periodontol,1967,38(6 suppl):602-610.
[10] Bayraktar G,Kurtulus I,Duraduryan A,et al.Dental and periodontal findings in hemodialysis patients [J].Oral Dis,2007,13(4):393-397.
[11] Ricardo AC,Athavale A,Chen J,et al.Periodontal disease,chronic kidney disease and mortality:results from the third national health and nutrition examination survey[J].BMC Nephrol,2015,16:97.
[12] Kshirsagar AV,Craig RG,Moss KL,et al.Periodontal disease adversely affects the survival of patients with end-stage renal disease[J].Kidney Int,2009,75(7):746 -751.
[13] Stenvinkel P,Heimbürger O,Paultre F,et al.Strong association between malnutrition,inflammation and atherosclerosis in chronic renal failure[J].Kidney Int,1999,55(5):1899-1911.
[14] 李萍,杨杰,蔡明玉.营养不良-炎症-动脉粥样硬化综合征对维持性血液透析患者预后的影响[J].临床肾脏病杂志,2017,17(7):411-414.
[15] Rambod M,Bross R,Zitterkoph J,et al.Association of Malnutrition-Inflammation Score with quality of life and mortality in hemodialysis patients:a 5-year prospective cohort Study[J].Am J Kidney Dis,2009,53(2):298-309.
[16] D'Aiuto F,Parkar M,Andreou G,et al.Periodontitis and systemic inflammation:control of the local infection is associated with a reduction in serum inflammatory markers[J].Dent Res,2004,83(2):156-160.
[17] Franek E,Blaschyk R,Kolonko A,et al.Chronic periodontitis in hemodialysis patients with chronic kidney disease is associated with elevated serum C-reactive protein concentration and greater intima-media thickness of the carotid artery[J].J Nephrol,2006,19(3):346-351.
[2] Kalantar-Zadeh K,Kopple JD,Block G,et al.A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients[J].Am J Kidney Dis,2001,38(6):1251-1263.
[3] Rambod M,Bross R,Zitterkoph J,et al.Association of Malnutrition-Inflammation Score with quality of life and mortality in hemodialysis patients:a 5-year prospective cohort study[J].Am J Kidney Dis,2009,53(2):298-309.
[4] Fang F,Wu B,Qu Q,et al.The clinical response and systemic effects of non-surgical periodontal therapy in end-stage renal disease patients:a 6-month randomized controlled clinical trial[J].J Clin Periodontol,2015,42(6):537-546.
[5] Palmer SC,Ruospo M,Wong G,et al.Patterns of oral disease in adults with chronic kidney disease treated with hemodialysis[J].Nephrol Dial Transplant,2016,31(10):1647-1653.
[6] Iwasaki M,Taylor GW,Awano S,et al.Periodontal disease and pneumonia mortality in hemodialysis patients:A 7-year cohort study[J].J Clin Periodontol,2018,45(1):38-45.
[7] 中华医学会肾脏病学分会.重组人促红细胞生成素在肾性贫血中合理应用的专家共识.2010修订版.
[8] 中国医师协会肾内科医师分会肾性贫血诊断和治疗共识专家组.肾性贫血诊断与治疗中国专家共识(2014修订版)[J].中华肾脏病杂志,2014,30(9):714-715.
[9] Ramfjord SP.The Periodontal Disease Index(PDI)[J].J Periodontol,1967,38(6 suppl):602-610.
[10] Bayraktar G,Kurtulus I,Duraduryan A,et al.Dental and periodontal findings in hemodialysis patients [J].Oral Dis,2007,13(4):393-397.
[11] Ricardo AC,Athavale A,Chen J,et al.Periodontal disease,chronic kidney disease and mortality:results from the third national health and nutrition examination survey[J].BMC Nephrol,2015,16:97.
[12] Kshirsagar AV,Craig RG,Moss KL,et al.Periodontal disease adversely affects the survival of patients with end-stage renal disease[J].Kidney Int,2009,75(7):746 -751.
[13] Stenvinkel P,Heimbürger O,Paultre F,et al.Strong association between malnutrition,inflammation and atherosclerosis in chronic renal failure[J].Kidney Int,1999,55(5):1899-1911.
[14] 李萍,杨杰,蔡明玉.营养不良-炎症-动脉粥样硬化综合征对维持性血液透析患者预后的影响[J].临床肾脏病杂志,2017,17(7):411-414.
[15] Rambod M,Bross R,Zitterkoph J,et al.Association of Malnutrition-Inflammation Score with quality of life and mortality in hemodialysis patients:a 5-year prospective cohort Study[J].Am J Kidney Dis,2009,53(2):298-309.
[16] D'Aiuto F,Parkar M,Andreou G,et al.Periodontitis and systemic inflammation:control of the local infection is associated with a reduction in serum inflammatory markers[J].Dent Res,2004,83(2):156-160.
[17] Franek E,Blaschyk R,Kolonko A,et al.Chronic periodontitis in hemodialysis patients with chronic kidney disease is associated with elevated serum C-reactive protein concentration and greater intima-media thickness of the carotid artery[J].J Nephrol,2006,19(3):346-351.