2型糖尿病患者不同血糖控制状态与牙周炎相关性初探  

Preliminary study on the relationship between different blood glucose levels and periodontitis in patients with diabetes mellitus type 2

作　　者：葛琳华[1] 王宁荐[2] 夏一如 张志愿[3] 陆颖理[2] 束蓉[1] Ge Linhua;Wang Ningjian;Xia Yiru;Zhang Zhiyuan;Lu Yingli;Shu Rong(Department of Periodontology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine&College of Stomatology,Shanghai Jiao Tong University&National Center for Stomatology&National Clinical Research Center for Oral Diseases&Shanghai Key Laboratory of Stomatology,Shanghai 200011,China;Department of Endocrinology and Metabolism,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Oral&Maxillofacial-Head&Neck Oncology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine&College of Stomatology,Shanghai Jiao Tong University&National Center for Stomatology&National Clinical Research Center for Oral Diseases&Shanghai Key Laboratory of Stomatology,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院牙周病科上海交通大学口腔医学院国家口腔医学中心国家口腔疾病临床医学研究中心上海市口腔医学重点实验室,200011 [2]上海交通大学医学院附属第九人民医院内分泌科,200011 [3]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科上海交通大学口腔医学院国家口腔医学中心国家口腔疾病临床医学研究中心上海市口腔医学重点实验室,200011

出　　处：《中华口腔医学杂志》2021年第6期517-524,共8页Chinese Journal of Stomatology

基　　金：国家自然科学基金(81991503);上海市临床重点专科项目(shs1czdzk01601);上海市口腔疾病临床医学研究中心项目(19MC1910600);上海交通大学医学院2018年高水平地方高校创新团队建设项目(SSMU-ZDCX20180900)。

摘　　要：目的探讨2型糖尿病患者的血糖控制状态与牙周炎之间的相关性。方法本研究为横断面调查,目标人群是2018年5至7月调查的上海市黄浦区糖尿病人群,使用分层系统抽样模型设计。本研究中的重度牙周炎被定义为不同象限至少有2个位点探诊深度≥6 mm,且临床附着丧失≥5 mm,因牙周炎致缺牙的无牙颌患者也计入重度牙周炎组,其余纳入者计入非重度牙周炎组。糖尿病血糖控制状态分为以下3类:控制不佳[糖化血红蛋白(glycated hemoglobin,HbA1c)>7.5%且空腹血糖>7.0 mmol/L]、控制良好(HbA1c≥6.5%且≤7.5%或空腹血糖≥6.1 mmol/L且≤7.0 mmol/L)及控制理想(HbA1c<6.5%且空腹血糖<6.1 mmol/L)。使用SPSS 25.0统计软件对结果数据进行统计学分析,对人口统计学资料以及频数分布采用卡方检验,检验水准为双侧α=0.05,对探诊深度与糖尿病控制状态采用有序Logistic回归模型,平衡混杂因素(包括年龄、性别、受教育程度和吸烟状况),对重度牙周炎组与非重度牙周炎组进行倾向性得分匹配后,对糖尿病控制状态及牙周炎状态进行Logistic回归分析。结果共有5220例有糖尿病病史的18岁以上成年患者参与了调查,其中3064例2型糖尿病受试者完成了完善的口腔和实验室检查,并纳入本项研究。纳入调查的糖尿病人群中重度牙周炎的患病率为10.57%(324/3064)。在重度牙周炎组中,79.01%(256/324)的纳入者年龄超过65岁,55.56%(180/324)为男性,58.33%(189/324)受教育程度低于高中水平,21.91%(71/324)为吸烟者,重度牙周炎组上述指标的占比均显著高于非重度牙周炎组(P<0.01)。2型糖尿病血糖控制理想、良好和不佳状态下,重度牙周炎患者的百分比依次增加,分别为8.95%(29/324)、22.53%(73/324)和68.52%(222/324),血糖控制状态不佳时重度牙周炎的占比最高。血糖控制不佳的2型糖尿病患者在重度牙周炎中占比[68.52%(222/324)]显著高于在非重度牙周炎�Objective To determine the correlation between the diabetes mellitus control and periodontitis.Methods This study was a cross-sectional survey using stratified system sampling model design.The target population was the patients with diabetes investigated from May to July 2018 in Huangpu District of Shanghai.In the present study,severe periodontitis was defined as at least at two sites in different quadrants with probing depth(PD)≥6 mm and clinical attachment loss(CAL)≥5 mm.Edentulous induced by periodontitis were also classified as severe periodontitis and the others were classified as non-severe periodontitis subjects.Diabetes control levels were divided into the following three groups:poorly controlled group[glycated hemoglobin(HbA1c)>7.5%and fasting blood glucose(FPG)>7.0 mmol/L],well controlled group(6.5%≤HbA1c≤7.5%or 6.1 mmol/L≤FPG≤7.0 mmol/L)and ideally controlled group(HbA1c<6.5%and FPG<6.1 mmol/L).SPSS 25.0 was used for statistical analysis.Chi square test was used for demographic data and frequency distribution,α=0.05,two-sided test.Ordinal regression model was used for PD and diabetes control status to balance confounding factors(including age,gender,education and smoking status).After matching the propensity scores between severe periodontitis group and non-severe periodontitis group,logistic regression analysis was used to analyze the level of diabetes control and periodontitis.Results A total of 5220 adults over the age of 18 with a medical history of diabetes participated in the survey,of which 3064 subjects with diabetes mellitus type 2(T2DM)who were given both oral and laboratory examinations and were included in this study.Statistics showed that the prevalence of moderate and severe periodontitis was 10.57%(324/3064).In the severe periodontitis group,79.01%(256/324)of the subjects were over 65 years old,55.56%(180/324)were male,58.33%(189/324)had lower education level than high school level,and 21.91%(71/324)were smokers,which were significantly higher than those in the non-severe pe

关 键 词：牙周炎 糖尿病 慢性病 横断面研究 风险评估 

分 类 号：R781.42[医药卫生—口腔医学] R587.1[医药卫生—临床医学]