第二型糖尿病病人牙周健康狀況與血液中TNF-α、CRP的相關性

研究目的: 大部分的臨床和流行病學研究已證實牙周病和糖尿病之間有著密切的關係，牙周病已被視為糖尿病的第六個併發症。發炎反應在糖尿病和牙周病皆扮演著重要的角色，α型腫瘤壞死因子( tumor necrosis factor-alpha ，TNF-α )和C-反應蛋白( C-reactive protein ，CRP) 是系統發炎的標記物，本研究將評估第二型糖尿病患者的牙周健康狀況，並探討這些發炎標記物和牙周炎之間的關係。研究設計和方法: 本研究採橫斷式研究，針對139名第二型糖尿病患者，進行相關資料收集，包括問卷資料、口腔檢查資料(社區牙周指數及牙菌斑指數)及血液採集。結果: 103人(74.1%)有牙周炎情形，有牙周炎的糖尿病患者有較高的TNF-α和hsCRP濃度，但統計分析結果不顯著。邏輯迴歸分析顯示牙周炎和抽菸(OR=2.97，95% CI=1.13~8.93，p= 0.0361)及HbA1c＞7.5% (OR=2.45，95% CI= 1.04~6.08， p= 0.0451)有顯著相關。經多重線性迴歸發現身體質量指數及HbA1c與hsCRP呈顯著性相關(p=0.0106，p=0.0045)。結論: 第二型糖尿病患者的牙周炎盛行率很高(74.1%)，而血糖的控制好壞與牙周的健康狀態是有相關的；有牙周炎患者相較於無牙周炎的糖尿病患者，其發炎標記物( TNF-α和hsCRP )濃度較高(但不顯著)，因此需要更大樣本數進一步去研究及探討之間的關係。

關鍵字

糖尿病；牙周炎； α型腫瘤壞死因子； C-反應蛋白

並列摘要

Objective: The association between periodontal diseases (PDs) and diabetes mellitus (DM) was reported by many epidemiological and clinical studies and periodontal diseases have been considered as the sixth complication of diabetes. Inflammation plays an important role in both DM and PDs and tumor necrosis factor-alpha (TNF-α) and C-reactive protein (CRP) are markers of systemic inflammation. Hence, we assessed periodontitis among patients with type 2 diabetes and further explored the relationship between the inflammatory markers (CRP and TNF-α) and periodontitis in this study. Materials and Methods: We designed a cross-sectional study of 139 type 2 diabetic patients and collected the data using a structured questionnaire and medical chart review. All diabetic patients received oral examinations including Community Periodontal Index (CPI) and plaque index (PLI). Blood samples were also collected. Results: 103 diabetic patients (74.1%) had periodontitis (CPI≧3). Diabetic patients with periodontitis had higher serum hsCRP and TNF-α levels but the differences were not statistically significant from DM patients without periodontitis. In the logistic regression analysis including potential risk factors, we found that smoking (OR=2.97，95% CI= 1.13~8.93，p=0.0361) and HbA1c＞7.5% (OR=2.45，95% CI= 1.04~6.08， p=0.0451) were associated with periodontitis in diabetic patients. Multiple linear regression analysis showed that BMI and HbA1c were positively associated with hsCRP level (p=0.0106，p=0.0045 respectively). Conclusion: The prevalence of periodontitis is high (74.1%) in type 2 diabetes. The level of sugar-control is related to the condition of oral health. The inflammatory markers (hsCRP and TNF-α) were higher (but not significantly) in diabetic patients with periodontitis as compared to those without periodontitis. However, we need a further study and more samples to determine the more vigorous relationship between oral health and TNF-α and hsCRP concentrations among diabetic patients.