糖尿病前期患者糖代谢异常与慢性牙周炎的相关性

doi:10.19723/j.issn.1671-167X.2020.01.011

北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (1): 71-76. doi: 10.19723/j.issn.1671-167X.2020.01.011

糖尿病前期患者糖代谢异常与慢性牙周炎的相关性

张勇(),刘畅²,陈彬³,陈帆⁴,段晋瑜¹,张孟钧¹,焦剑¹

1. 北京大学口腔医学院·口腔医院,门诊部　国家口腔疾病临床医学研究中心　口腔数字化医疗技术和材料国家工程实验室　口腔数字医学北京市重点实验室,北京　100081
2. 中国人民解放军总医院第七医学中心肿瘤科,北京 100700
3. 中国人民解放军总医院第七医学中心内分泌科,北京　100700
4. 北京大学人民医院口腔科,北京　100044

收稿日期:2018-10-07 出版日期:2020-02-18 发布日期:2020-02-20
通讯作者: 张勇 E-mail:zhangyong_1019@163.com
基金资助:
国家自然科学基金(81800978)

Associations of impaired glucose metabolism with chronic peridontitis in pre-diabetes patients

Yong ZHANG(),Chang LIU²,Bin CHEN³,Fan CHEN⁴,Jin-yu DUAN¹,Meng-jun ZHANG¹,Jian JIAO¹

1. First Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
2. Department of Oncology, the Seventh Medical Center of PLA General Hospital, Beijing 100700, China
3. Department of Endocrinology and Metabolism, the Seventh Medical Center of PLA General Hospital, Beijing 100700, China
4. Department of Stomatology, Peking University People’s Hospital, Beijing 100044, China

Received:2018-10-07 Online:2020-02-18 Published:2020-02-20
Contact: Yong ZHANG E-mail:zhangyong_1019@163.com
Supported by:
Supported by the National Natural Science Foundation of China(81800978)

摘要/Abstract

摘要：

目的:研究糖尿病前期患者糖代谢水平与慢性牙周炎的相关性。方法:对符合《中国2型糖尿病防治指南》糖尿病前期诊断标准的171例患者进行牙周检查,根据美国疾病控制和预防中心与美国牙周病学会制定的标准分为轻度、中度和重度慢性牙周炎组,检测各组糖代谢指标(空腹血糖、糖耐量、空腹胰岛素、胰岛素抵抗及糖化血红蛋白)及牙周检查指标(菌斑指数、牙周袋深度、附着丧失、探诊出血比例),对混杂因素(年龄、性别、高血压、肥胖、吸烟等)进行校正后用多因素回归分析方法研究糖代谢指标与慢性牙周炎的相关性。结果:中、重度慢性牙周炎组患者的空腹血糖与胰岛素抵抗水平明显高于轻度慢性牙周炎组,差异有统计学意义,重度慢性牙周炎组患者的糖耐量水平显著高于轻度慢性牙周炎组,糖化血红蛋白及空腹胰岛素两组差异无统计学意义。多因素回归分析表明,随着空腹血糖水平的升高,患者患有中度或重度慢性牙周炎的概率显著增加(OR=1.39,95%CI:1.01~1.98;OR=1.64,95%CI:1.17~2.40);随着胰岛素抵抗水平的升高,患者患有中度或重度慢性牙周炎的概率也显著增加(OR=1.36,95%CI:1.04~1.76;OR=1.72,95%CI:1.23~2.41);随着糖耐量水平的升高,患有重度慢性牙周炎的概率显著升高(OR=1.65,95%CI:1.21~2.26)。结论:糖尿病前期患者的糖代谢水平与牙周炎有相关性。

关键词: 糖尿病前期, 慢性牙周炎, 糖代谢异常, 胰岛素抵抗

Abstract:

Objective: To investigate the associations of impaired glucose metabolism and insulin resis-tance with chronic periodontitis in pre-diabetes patients. Methods: A cross-sectional analysis was conducted and we included a total of 171 pre-diabetes patients aged 30-65 years, free of diabetes. Pre-diabetes was defined as impaired fasting glucose (IFG) [fasting glucose (FG): 6.1-7.0 mmol/L] and/or impaired glucose tolerance (IGT) [oral glucose tolerance test (OGTT): 7.8-11.0 mmol/L]. Chronic periodontitis was defined according to Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) definition and the patients were divided into mild, moderate, and severe chronic periodontitis groups [mild: at least two interproximal sites with clinical attachment loss (CAL) ≥3 mm and at least two interproxima sites with probing depth (PD) ≥4 mm or 1 site with PD≥5 mm; moderate: at least two interproximal sites with CAL ≥4 mm and at least two interproxima sites with at least two interproximal sites with PD ≥5 mm; severe: at least two interproximal sites with CAL ≥6 mm and at least one interproxima site with at least two interproximal sites with PD≥5 mm]. A periodontal examination indexes [plaque index (PLI), PD, CAL, and bleeding on probing (BOP)] and glucose metabolism indexes [FG, OGTT, hemoglobinA1c (HbA1c), fasting insulin and homeostasis model assessments of insulin resistance (HOMA-IR)] were measured. The association of glucose meta-bolism and chronic periodontitis was investigated by multivariable logistic regression analysis. Results: FG in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, HOMA-IR in the moderate and severe chronic periodontitis groups was signi-ficantly higher compared with mild chronic periodontitis group, OGTT in the severe chronic periodntitis group was significantly higher compared with mild chronic peridontitis group and moderate chronic pe-riodontitis groups, and there was no significant difference between moderate and mild chronic periodontitis groups. For the insulin and HbA1c, there was no significant difference among mild, moderate and severe chronic periodontitis groups. After multivariable adjustment of age, gender, smoking status, hypertension and body mass index, IFG (OR=1.39, 95%CI: 1.01-1.98) and HOMA-IR (OR=1.36, 95%CI: 1.04-1.76) were associated with moderate periodontitis; IFG (OR=1.64, 95%CI: 1.17-2.40), IGT (OR=1.65, 95%CI: 1.21-2.26), and HOMA-IR (OR=1.72, 95%CI: 1.23-2.41) were significantly associated with severe periodontitis. Conclusion: Our data provided evidences that impaired glucose metabolism were associated with chronic periodontitis among pre-diabetes patients.

Key words: Pre-diabetes, Chronic periodontitis, Impaired glucose metabolism, Insulin resistance

中图分类号:

R781.4

张勇,刘畅,陈彬,陈帆,段晋瑜,张孟钧,焦剑. 糖尿病前期患者糖代谢异常与慢性牙周炎的相关性[J]. 北京大学学报（医学版）, 2020, 52(1): 71-76.

Yong ZHANG,Chang LIU,Bin CHEN,Fan CHEN,Jin-yu DUAN,Meng-jun ZHANG,Jian JIAO. Associations of impaired glucose metabolism with chronic peridontitis in pre-diabetes patients[J]. Journal of Peking University(Health Sciences), 2020, 52(1): 71-76.

图/表 4

表1

表2

各组患者的一般情况、牙周情况及糖代谢水平的比较"

Items	Mild chronic periodontitis (n=74)	Moderate chronic periodontitis (n=55)	Severe chronic periodontitis (n=42)
Age/years, $x ?$ ±s	49.54±6.76	51.92±6.61	51.72±6.80
Gender (Male/Female), n	32/42	23/32	24/18
Smoking	11 (15%)	8 (15%)	7 (17%)
Hypertension	42 (57%)	30 (55%)	24 (57%)
BMI, $x ?$ ±s	22.34±4.65	22.68±4.52	23.27±3.61
Number of lost tooth, $x ?$ ±s	0.63±1.35	1.82±1.28^*	2.50±1.20^*
PLI, $x ?$ ±s	0.63±0.54	0.91±0.61^*	1.38±0.65^*#
PD/mm, $x ?$ ±s	2.42±0.15	3.31±0.21^*	3.64±0.72^*#
CAL/mm, $x ?$ ±s	1.09±0.51	2.22±0.71^*	2.83±1.23^*#
BOP/%, $x ?$ ±s	11±14	20±17^*	44±26^*#
FG/(mmol/L), $x ?$ ±s	5.89±0.44	6.22±0.43^*	6.61±0.50^*#
OGTT/(mmol/L), $x ?$ ±s	8.13±0.65	8.32±0.91	8.95±0.67^*#
HbA1c/%, $x ?$ ±s	5.55±0.52	5.57±0.51	5.65±0.47
Fasting insulin/(mIU/L), $x ?$ ±s	10.47±7.51	10.41±5.43	10.37±7.50
HOMA-IR, $x ?$ ±s	2.47±0.87	2.59±1.37^*	2.74±1.72^*#

表2

表3

表4

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Glucose metabolism	Mild chronic periodontitis (n=74)	Moderate chronic periodontitis (n=55)	Severe chronic periodontitis (n=42)
IFG	13 (18%)	7 (13%)	2 (5%)
IGT	46 (62%)	26 (47%)	10 (24%)
IFG+IGT	15 (20%)	22 (40%)^*	30 (71%)^*#

Items	Mild chronic periodontitis (n=74)	Moderate-severe chronic periodontitis (n=97)
Items	Mild chronic periodontitis (n=74)	OR	95%CI	P value
Fasting glucose	1	1.53	1.13-2.10	0.003
OGGT	1	1.35	1.04-1.75	0.018
HbA1c	1	1.17	0.88-1.55	0.828
Fasting insulin	1	0.95	0.90-1.00	0.056
HOMA-IR	1	1.57	1.17-2.10	0.004

糖尿病前期患者糖代谢异常与慢性牙周炎的相关性

Associations of impaired glucose metabolism with chronic peridontitis in pre-diabetes patients

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