今回は歯周病の重症度とHbA1cの悪化度との関連性を
調べています。
対象患者は東ドイツポメラニア地区住民2973名で
暴露要因にはPPD、アタッチメントロス、DFT指数
hs-CRP値を設け、HbA1cの変化を調べています。
Infection may be a type 2 diabetes risk factor. Periodontal disease is a chronic infection. We hypothesized that periodontal disease was related to A1C progression in diabetes-free participants.
The Study of Health in Pomerania (SHIP) is a population-based cohort in Germany including 2,973 diabetes-free participants (53% women; aged 20-81 years). Participants were categorized into four groups according to increasing baseline periodontal disease levels (percentage of sites per mouth with attachment loss >or=5 mm, determined a priori); sample sizes for each respective category were 1,122, 488, 463, and 479 (241 participants were edentulous). Mean absolute changes (year 5 minus baseline) in A1C (DeltaA1C) were regressed across periodontal categories while adjusting for confounders (e.g., age, sex, smoking, obesity, physical activity, and family history).
Across baseline periodontal disease categories, DeltaA1C +/- SEM values were 0.023 +/- 0.02, 0.023 +/- 0.02, 0.065 +/- 0.03, and 0.106 +/- 0.03 (P(trend) = 0.02), yielding an approximate fivefold increase in the absolute difference in DeltaA1C when dentate participants in the highest versus lowest periodontal disease category were compared; these results were markedly stronger among participants with high-sensitivity C-reactive protein >or=1.0 mg/l (P(interaction) = 0.01). When individuals who had neither baseline periodontal disease nor deterioration in periodontal status at 5 years were compared with individuals with both poor baseline periodontal health and longitudinal periodontal deterioration, mean DeltaA1C values were 0.005 vs. 0.143% (P = 0.003).
Periodontal disease was associated with 5-year A1C progression, which was similar to that observed for a 2-SD increase in either waist-to-hip ratio or age in this population.
結果は
歯周病コードの上値とHbA1cの悪化は有意に相関し
hs-CRP値 1mg/L以上の群では
この相関がより顕著でした。
結論は、ベースライン時の歯周病の重症度は
HbA1cの悪化要因となる
ということです。
引用文献
Demmer RT1, Desvarieux M, Holtfreter B, Jacobs DR Jr, Wallaschofski H, Nauck M, Völzke H, Kocher T.
Periodontal status and A1C change: longitudinal results from the study of health in Pomerania (SHIP).
Diabetes Care. 2010 May;33(5):1037-43.