冠狀動脈阻塞患者之口腔狀況與全身性生理指標之相關性

背景牙周病是成人常見的慢性病，近年來許多的研究發現，不良的口腔清潔與心血管疾病有關。冠狀性心臟病除了與年紀、抽菸、飲食、高血壓、糖尿病、高血脂等因素有關，還與口腔衛生習慣有關，有研究發現缺牙超過10顆以上，得到冠狀性心臟病的風險增加為1.67倍，而國內對於此兩種疾病的相關研究有限，因此本研究以冠狀動脈阻塞與口腔健康狀況來進行相關性之分析，以瞭解兩者之間的相關性。研究目的研究口腔狀況與冠狀動脈阻塞患者之相關性，探討口腔狀況與該類患者全身性生理指標之相關性。研究方法本研究經由對南部某醫學中心體檢患者，進行全身性生理指標檢查、口腔DMFT檢查、齒槽骨缺損(alveolar bone loss)及心臟電腦斷層檢查，共計83人為研究對象，統計分析以SPSS12.0中文版及JMP6.0軟體進行分析。研究結果統計結果顯示缺牙、DMFT與年紀有關，女性平均齲齒顆數較男性多，男性平均缺牙顆數較女性多，冠狀動脈阻塞情形男性相較於女性高。經單變量對數迴歸分析，發現年齡每增加一歲得到冠狀動脈阻塞40％以上的機率增加為1.1倍（95%CI＝1.03-1.17），糖化血色素(HbA1c)每增加1％得到冠狀動脈阻塞40%以上的機率增加為2.57倍(95%CI＝1.30-5.07)，飯前血糖(glucose)每增加1mg/dl得到冠狀動脈阻塞40%以上的機率增加為1.04倍(95%CI＝1.01-1.08)，經多變量分析後，年齡每增加一歲得到冠狀動脈阻塞＞40%的機率增加為1.10倍(95%CI＝1.01-1.21)，DMFT、齒槽骨缺損、性別、血糖與冠狀動脈阻塞＞40%均呈現正向相關性，因為樣本數有限其相關性未達顯著差異。結論此研究結果顯示口腔疾病狀況與心血管疾病之正向相關性，然而未達統計上顯著性差異冠狀動脈阻塞與年齡有關。後續進一步的研究將有助於臨床上對此類患者之治療。同時有良好的口腔健康才能保有良好的咀嚼功能，才能攝食均衡的營養維持全身性的健康。

關鍵字

心血管疾病；口腔狀況；高血脂症

並列摘要

Background Periodontal disease is a common chronic oral disease among adults which might be caused by poor oral hygiene. According to Joshipuraet (1996), those people who reported pre-existing periodontal disease, with 10 or fewer teeth were at increased risk of coronary heart disease compared with men with 25 or more teeth ( 95% CI=1.03 to 2.71), However, the study of the relative risks between oral diseases and coronary heart diseases are limited in our country. Therefore, the relationship coronary heart disease and oral hygiene condition is the focus of this research. Objectives The aim of this study was to investigate the relation between oral condition and coronary heart diseases and the relationship between oral hygiene and physical condition in patients. Materials and methods A total of 83 patients were recruited. The oral health status of decayed, missing and filled teeth and alveolar bone loss was recorded by dental department. The systemic physiological index: height, weight body mass index, blood pressure, triglyceride, cholesterol, HDL-C, TC/HDL, LDL-C, glucose, HbA1c, calcium related protein and CRP were carried out in the physical examination center of a medical center in southern Taiwan. The results were analyzed by statistical software SPSS 12.0 and JMP6.0. Result The result revealled the relationship among the missing teeth, DMFT and age. On average, the caries index in females is higher than in males, and number of missing tooth in males is higher than in females. Coronary artery stenosis was positively related to tooth loss. A statistically significant relationship was found for increasing age with increasing higher risk of coronary artery stenosis (OR=1.1, 95% CI＝1.03-1.18), and HbA1c (OR=2.57, 95％CI＝1.30-5.07). One unit of glucose increment is associated with a risk of 1.04 for developing coronary artery stenosis (adjusted odds ratio=1.04, 95%CI＝1.01-1.08). The measures of DMFT, alveolar bone loss, sex and blood sugar were all positively associated with coronary artery stenosis, but the statistical significance was not reached due to small sample size. Conclusion The results of this study illustrated the relationship between oral condition and coronary artery stenosis. Although it was not statistically significant, further studies will be helpful to determine the clinical disease of those (group) patients.