牙周炎与全身系统性疾病的思考与探索

doi:10.19723/j.issn.1671-167X.2025.05.007

摘要/Abstract

摘要： 牙周炎已成为全球广泛流行的慢性炎症性疾病, 全球范围内约11%成年人患有重度牙周炎, 我国35岁以上人群牙周健康率不足10%, 中老年牙周炎患病率高达82.6%。在公共卫生视角下, 牙周炎不仅侵蚀口腔健康, 更与心血管疾病、糖尿病、认知障碍等慢性系统性疾病存在较强关联。大量队列研究和meta分析表明, 牙周炎患者发生心血管事件的风险显著增加, 糖尿病患者中牙周炎发展更快, 且具有双向因果关联。北京大学口腔医院牙周科长期致力于我国社区人群牙周炎与全身系统性疾病关系的研究, 本文系统回顾了我国社区人群牙周炎与心血管疾病、代谢综合征、认知障碍等系统性疾病的相关性, 通过动物学研究发现了实验性牙周炎可导致糖耐量异常、加重动脉粥样硬化进程, 并在深入探讨相应分子机制的基础上, 初步验证了线粒体DNA外溢、牙周致病菌入血可能是联系牙周炎与全身系统性疾病的桥梁。本文旨在深化关于牙周炎对全身影响的认知, 为我国口腔健康的公共卫生管理与慢性病预防提供科学指导。

关键词: 牙周炎, 全身系统性疾病, 心血管疾病, 糖尿病, 认知障碍, 线粒体DNA, 致病菌播散

Abstract: Periodontitis has become one of the most widespread chronic inflammatory diseases worldwide, affecting roughly 11% of the adult population. In China, periodontal health is notably poor, with less than 10% of individuals over the age of 35 maintaining periodontal health, while the prevalence of periodontitis in middle-aged and elderly populations reaches as high as 82.6%. From a public health perspective, periodontitis not only seriously compromises oral health but is also closely linked to multiple chronic systemic diseases, including cardiovascular disease, diabetes mellitus, and cognitive impairment. A substantial body of cohort studies and meta-analyses consistently demonstrate that patients with periodontitis are at a significantly increased risk of cardiovascular events. Moreover, periodontitis tends to progress more rapidly in individuals with diabetes, highlighting a bidirectional causal relationship between these two conditions. Our research team has maintained a long-term focus on elucidating the relationship between periodontitis and systemic diseases within Chinese community populations. In this review, we comprehensively summarize epidemiological findings on the associations between periodontitis and cardiovascular disease, metabolic syndrome, and cognitive decline, specifically drawing on data from Chinese cohorts. Complementing these observations, animal experiments provide evidence that experimental periodontitis can induce glucose intolerance and accelerate the development of atherosclerotic lesions. At the mechanistic level, we preliminarily validate that mitochondrial DNA efflux and the hematogenous spread of periodontal pathogens may act as biological conduits bridging local periodontal inflammation with systemic pathologies. We also address current challenges in the field, including difficulties in disentangling causal relationships due to confounding comorbidities like diabetes and cardiovascular diseases, which often coexist and influence each other. To advance understanding, there is an urgent need for well-designed longitudinal and interventional studies employing advanced causal inference methods. Ultimately, this work aims to deepen the current knowledge of periodontitis ' systemic effects and to support the development of evidence-based public health strategies for integrating oral health into chronic disease prevention efforts in China.

Key words: Periodontitis, Systemic diseases, Cardiovascular disease, Diabetes mellitus, Cognitive impairment, Mitochondrial DNA, Pathogen dissemination

中图分类号:

R781.42

曹沛, 栾庆先. 牙周炎与全身系统性疾病的思考与探索[J]. 北京大学学报（医学版）, 2025, 57(5): 852-858.

Pei CAO, Qingxian LUAN. Periodontitis and systemic diseases: Thinking and explorations[J]. Journal of Peking University (Health Sciences), 2025, 57(5): 852-858.

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