台灣地區牙周病與消化系統疾病風險之相關性

Risks of Periodontitis in Patients with Diseases of the Digestive System: A Nationwide Population-based Study in Taiwan

游惠捷(Hui-Chieh Yu)

指導教授 ： 張育超

中山醫學大學/口腔醫學院/牙醫學系博士班/博士(2018年)

摘要

研究背景與目的：牙周病是最常見的口腔疾病之一，也是盛行率最高的非傳染性慢性感染疾病，而發炎性腸道疾病（inflammatory bowel disease，IBD）與牙周病之間，致病機轉與自體免疫有關。發炎性腸道疾病主要分為潰瘍性大腸炎 （ulcerative colitis，UC）和克隆氏症（Crohn's disease，CD），消化性潰瘍（peptic ulcers disease，PUD），包括胃與十二指腸潰瘍，也可能與牙周病之間有相關性，但仍然沒有定論。本研究想藉由全民健保資料庫，分析台灣地區牙周病盛行率的趨勢，以及牙周病與常見的消化道疾病，如消化性潰瘍、發炎性腸道疾病之間的相關性，並且探討相關風險因子所扮演的角色。
研究方法：回顧分析台灣地區全民健保資料庫（National Health Insurance Research database，NHIRD），針對發炎性腸道疾病，使用2005年百萬歸人檔進行世代研究，發炎性腸道疾病世代以1：4比例條件配對出對照世代，進行Cox比例風險模型分析，計算研究世代與對照世代之間罹患牙周病的發生風險。針對消化性潰瘍，使用2010百萬歸人檔進行病例對照研究，病例組與對照組以1:1比例調控配對，並利用卡方檢定分析勝算比。
研究結果：研究期間台灣地區全人口與男、女性的牙周病盛行率逐漸增加，1997年，牙周病的的平均罹病年齡為54.46±14.47歲，直到2013年研究期間結束，牙周病的平均罹病年齡為45.51±16.58歲，逐年遞減。針對發炎性腸道疾病，調整干擾因素後，發炎性腸道疾病研究世代發生牙周病的風險仍高於對照世代（aHR 1.82，95％CI：1.09-3.03），結果顯示，相對於潰瘍性大腸炎（aHR：1.39，95％CI：0.69-2.46），克隆氏症有較高的風險比值發展為牙周病（aHR：3.95，95％CI：1.59-9.82）。針對消化性潰瘍，病例組中患有牙周病的勝算比，為對照組的1.15倍（OR：1.15，95% CI：1.12-1.18），消化性潰瘍與牙周病間有顯著相關性。
研究結論：本回顧性研究顯示，研究期間台灣地區牙周病的盛行率顯著增加，但是平均罹病年齡呈下降趨勢。與一般人相比，發炎性腸道疾病患者罹患牙周病的風險會增加，特別是在克隆氏症患者，此外，消化性潰瘍和牙周病間之間呈現顯著正相關。綜上所述，常見的消化道疾病與牙周病與之間存在有相關性，值得進一步深入探討。

關鍵字

牙周病 ； 發炎性腸道疾病 ； 潰瘍性大腸炎 ； 克隆氏症 ； 消化性潰瘍 ； 全民健保資料庫

並列摘要

Background and Objective: Periodontitis (PD) is one of the most prevalent oral diseases. Inflammatory bowel disease (IBD), comprised Crohn’s disease and ulcerative colitis, is a mucosal immune response that affects gastroenterological tract. The association between IBD and PD was inconclusive. Peptic ulcers disease (PUD), including stomach and duodenal ulcers, might be associated with PD; however, no clear conclusions have been reached so far. Therefore, this study aimed to assess the time trends of prevalence of PD in Taiwan, investigate the association between PD and common gastrointestinal diseases, such as PUD and IBD, and explore the role of related risk factors by using a register-based dataset.
Material and Methods: A retrospective study was conducted to analyze the registered database obtained from the National Health Insurance Research Database (NHIRD) in Taiwan. For IBD, a population-based retrospective cohort study was conducted using the Longitudinal Health Insurance Database 2005 (LHID2005) derived from the NHIRD. For IBD group, conditionally selected control subjects were matched in 1:4 ratio from general population. The risk of PD among IBD group comparing with non-IBD group was calculated by multivariable Cox proportional hazards model. For PUD, a population-based case control study was conducted using the LHID2010. The case and control group were matched with gender, age, urbanization level, socioeconomic status and Charlson comorbidity index (CCI) at a 1:1 ratio. The odds ratio (OR) was analyzed by chi-square test.
Results: The prevalence of PD significantly increased from 11.5% in 1997 to 19.59 % in 2013 (p for trend <0.0001). The mean age ± standard deviation with PD from 1997 to 2013 was 54.46 ± 14.47 and 45.51 ± 16.58 y/o, respectively. After adjusting for several confounding factors, IBD group had higher risk for developing periodontitis than non-IBD group (adjusted HR: 1.82; 95 % CI: 1.09-3.03). To further stratification with subtype, Crohn’s disease group had significantly higher risk of periodontitis (adjusted HR: 3.95; 95 % CI: 1.59-9.82). The risk of PD for patients diagnosed with PUD was 1.15-fold compared with those without PUD (OR: 1.15; 95% CI: 1.12-1.18).
Conclusions: The prevalence of PD significantly increased in Taiwan over past 17 years. The mean age with PD was shown in a decreased pattern. Taken together, this retrospective study showed that patients with IBD increase risk of having PD comparing with non-IBD group, especially in Crohn’s disease subgroup. In addition, This study also demonstrated a significantly positive association between PUD and PD.

並列關鍵字

periodontitis ； inflammatory bowel disease ； ulcerative colitis ； Crohn’s disease ； peptic ulcers disease ； National Health Insurance Research Database

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