Hypertension:注意!牙周炎患者发生高血压的概率是正常人的2倍!

2021-03-30 MedSci原创 MedSci原创

促进良好的口腔健康有助于减少牙龈疾病和高血压及其并发症的风险。

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既往的研究已经发现了高血压和牙周炎之间的联系,然而,证实这种联系的细节的研究很少。牙周炎是一种牙龈组织的感染,可导致进行性炎症、骨质疏松或牙齿脱落。牙周炎的预防和治疗具有很高的成本效益,可以减少全身炎症标志物,改善内皮细胞(心脏和血管内部的薄膜)的功能。

根据近日发表在美国心脏协会期刊Hypertension上的一项新研究显示,患有牙周炎(一种严重的牙龈感染)的成年人与牙龈健康的人相比,血压可能更高。

患有牙龈疾病的患者通常表现为血压升高,尤其是当牙龈有活动性炎症或牙龈出血时,”研究的主要作者Eva Muñoz Aguilera博士指出,“血压升高通常是没有症状的,许多人可能没有意识到他们有心血管并发症的风险增加。我们的目的是在没有明确诊断为高血压的健康成年人中调查严重牙周炎和高血压之间的关系。”他是英国伦敦大学学院伊士曼牙科研究所的高级研究员。

这项研究包括250名患有广泛性严重牙周炎的成年人(50%的牙齿被测量为牙龈感染)和一个由250名没有严重牙龈疾病的成年人组成的对照组,这些人在其他方面都很健康,没有其他慢性健康问题。受试者的中位年龄为35岁,女性占52.6%。这项研究是与西班牙巴塞罗那加泰罗尼亚国际大学牙科部门合作完成的。

所有参与者都接受了全面的牙周检查,包括牙龈疾病严重程度的详细测量,如全口牙菌斑、牙龈出血和感染牙龈袋的深度。为确保准确性,对每个参与者进行了三次血压评估。研究人员还采集了空腹血液样本,并对其进行了高水平的白细胞和高敏c反应蛋白(hsCRP)分析,因为这两者都是体内炎症增加的标志。作为混杂因素分析的其他信息包括心血管疾病家族史、年龄、体重指数、性别、种族、吸烟和体力活动水平。

研究结果显示,牙龈疾病的诊断与高血压的较高几率相关,独立于常见的心血管危险因素。牙龈疾病患者的收缩压高值(140mmHg)是健康牙龈患者的2倍(分别为14%和7%)。研究人员还发现:

  • 活跃的牙龈炎症(通过牙龈出血确定)与较高的收缩压有关。
  • 与对照组相比,牙周炎患者的血糖、低密度脂蛋白、hsCRP和白细胞水平升高,高密度脂蛋白(“好”胆固醇)水平降低。
  • 近50%患有牙龈疾病的参与者和42%的对照组达到高血压诊断标准,定义为130/80 mmHg

这一证据表明,牙周细菌会损害牙龈,也会引发炎症反应,影响包括高血压在内的全身性疾病的发展,这意味着牙龈疾病和血压升高之间的联系发生在患者出现高血压之前。

牙周炎与收缩压(A)和舒张压(B)相关性的中介分析。doi:10.3390/jcm9051585

在牙科医生中增加高血压筛查意识,以及在心内科医生中加强牙周病筛查与牙周病医师的转诊相结合,可以改善这两种疾病的检测和治疗,从而改善口腔健康,减轻高血压及其并发症的负担。口腔健康策略,如每天刷牙两次,被证明能非常有效的管理和预防常见的口腔疾病,也可帮助预防高血压。

参考文献:Eva Muñoz Aguilera, Jean Suvan, Marco Orlandi, Queralt Miró Catalina, Jose Nart, Francesco D’Aiuto. Association Between Periodontitis and Blood Pressure Highlighted in Systemically Healthy IndividualsHypertension, 2021; DOI: 10.1161/HYPERTENSIONAHA.120.16790

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