台灣南部某鄉鎮居民口腔狀況、心血管疾病危險因子與心血管疾病之相關性探討

The Relationship between Oral Health Condition Cardiovascular Risk Factors and Cardiovascular Disease in a Community of Southern Taiwan

李清傑(Ching-Chieh Lee)

指導教授 ： 林英助

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2006年)

https://doi.org/10.6832/KMU.2006.00018

摘要

背景：
目前的心血管疾病相關研究仍著重探討血脂肪如何引起疾病發生，流行病學的資料顯示牙周病與血脂肪組成改變和心血管疾病的發生是有關的，但牙周病對血脂肪組成改變或心血管疾病的形成機轉仍不清楚，不同研究顯示三者間的相關性仍不是非常一致。就台灣目前而言對其相關的研究仍不多，值得進一步探討。
研究目的：
探討牙周炎是否與總膽固醇、三酸甘油脂異常、心電圖異常和冠狀動脈硬化有關。
研究方法：
本研究是以高雄縣某鄉鎮年滿40歲（含）以上且戶籍設於該鄉鎮的居民為對象，採用分層多階段集束抽樣調查法與等比隨機抽樣方法進行抽樣，預計收集1300位居民，參加者需空腹八小時，抽取周邊血液20 ml作為相關的血液和生化檢查（包含三酸甘油脂、總膽固醇檢測）所需，完成一份問卷來收集基本資料、疾病史和菸、酒、檳榔使用情形。口腔檢查是以兩位經過標準化流程訓練的牙醫師進行，以社區牙周指數(CPI)來鑑別牙周炎；心血管疾病診斷則以胸部X光、心電圖的結果加以鑑別。所有資料輸入EXCEL檔案後，排除BMI>30、糖尿病患者、服用降血脂藥者、無法完成問卷或相關檢查者，以統計軟體JMP5.1.2進行統計危險因子的分析。
結果：
1300位居民在排除可能的干擾因子後，共有755位居民進入本研究，女性392（51.92%）位，男性363（48.08%）位。分析發現調查對象牙齒缺損比例會隨著年齡增加而惡化，且有劑量相關效應的情形，牙周炎病患的教育程度在國中或國中以下的比例高於其他兩組（p<0.0001），牙齒缺損者有較高頻率的喝酒習慣（p=0.0182），而牙周炎病患有較長的檳榔嚼食年數（p=0.0001） 和抽菸菸齡（p<0.0001），牙周炎病患的飯前血糖（AC sugar）、尿酸（uric acid）、總膽固醇（total- cholesterol）有明顯高於沒有牙周炎的人（p=0.0109, p=0.0003, p=0.0034, respectively），牙周炎病患的周邊血液中monocyte數目異常的頻率（p=0.047）、HCV test positive的頻率（p=0.0370）有顯著高於沒有牙周病的人，經多變項邏輯式迴歸分析發現，在調整性別、年齡及相關因子後，牙周炎（OR=2.64, 95%CI =1.11~7.31）是HCV test positive的危險因子；牙周炎（OR=2.19，95%CI=1.28~3.89，p=0.0052）是飯前血糖³ 113 mg/dl的危險因子；牙周炎（OR= 1.77, 95%CI =1.24~2.54）和牙齒缺損（OR=1.87, 95%CI=1.17~3.01） 是總膽固醇≧220mg/dl的危險因子，進一步分析，發現總膽固醇≧220mg/dl與心臟肥大合併冠狀動脈硬化有關。
結論：
本研究中，調整其可能干擾因素，發現牙周炎是總膽固醇≧220 mg/dl的危險因子，牙周炎是飯前血糖³ 113 mg/dl的危險因子，牙周炎可能透過對血脂肪及系統性疾病之危險性的增加，進而促使牙周炎成為心血管疾病的危險因子，但需要更多的調查來驗證。

關鍵字

牙周病 ； 心血管疾病 ； 總膽固醇 ； 三酸甘油脂

並列摘要

Background：

Epidemiological studies have shown the periodontitis is a risk factor for cardiovascular disease and an increase level of blood lipid. However the mechanism of cardiovascular disease development and content change in blood lipid remains unknown. Few studies about this topic were found in Taiwan. The relationships between periodontitis and content of blood lipid or cardiovascular disease were not consistent in the previous studies. It needs more studies to verify its association.

Objectives：
Our aim was to evaluate the association between periodontitis, levels of total cholesterol and triglyceride, electrocardiography（EKG）, cardiomegaly and Cardiovascular Disease（CAD）.
Materials and Methods：
There were 1300 people who lived in Kaoshiung County invited to participant the present study. All participants were≧40 years old. We collected 20 ml peripheral blood for biological examinations. The CXR and EKG were applied to identify cardiovascular disease. Periodontitis was determined by CPI index and oral examinations were completed by two dentists with standardized protocol. A questionnaire was used to collect demographic data, environmental exposure, family disease histories, and medical records. Participants with self-reported diabetes mellitus, BMI > 30, drug uptake for hypercholesterolaemia, and uncompleted data collections were excluded from the present study.

Results：
A total of subjects 363 males and 392 females were recruited into the present study. The frequencies of teeth number < 20 or CPI index = x were increasing with age and low education level. Participants with periodontitis had significantly longer duration for betel quid chewing (p=0.0001) and smoking (p<0.0001). Participants with periodontitis had higher levels of AC Sugar, uric acid, and total cholesterol (TC) than the controls did (p=00109, p=00003, p=00034 respectively). Participants with periodontitis had higher frequencies of abnormal monocyte counts and HCV positive test than the controls did (p=0047, p=00370 respectively). Multivariate logic regression analysis revealed that periodontitis (OR=2.64, 95%CI =1.11~7.31) was a risk factor for HCV positive test. Periodontitis (OR=2.19，95%CI=1.28~3.89) was a risk factor for AC Sugar ≧113 mg/dl .Periodontitis (OR= 1.77, 95%CI =1.24~2.54）and numbers of teeth < 20 (OR=1.87, 95%CI=1.17~3.01) were risk factors for TC≧220 mg/dl. No association was found between periodontitis and cardiovascular disease. Further to combine participants with atherosclerosis and/or Ventricular Hypertrophy (cardiovascular disease), TC≧220 mg/dl was associated with cardiovascular disease.

Conclusion：
We suggest that periodontitis is associated with high levels of total cholesterol (T-CHO≧220 mg/dl). Periodontitis is a risk factor for AC Sugar ≧113 mg/dl. Periondontitis may increase blood levels of TC to associate with the development of cardiovascular disease.

並列關鍵字

periodontitis ； cardiovascular cisease ； total cholesterol ； triglyceride

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