中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (06): 320-324.doi: 10.3969/j.issn.1671-4091.2015.06.001

• 临床研究 •    下一篇

维持性血液透析患者口腔卫生状况与微炎症状态相关因素分析

刘涛,李根,卢锦莲,胡爱霞,刘情操   

  1. 湖北省黄石市黄石二医院
  • 收稿日期:2015-01-12 修回日期:2015-04-23 出版日期:2015-06-12 发布日期:2015-05-29
  • 基金资助:

    湖北省自然科学基金面上项目(NO.2014CFC1038)

The relationship between oral health condition and micro-inflammatory state in maintenance hemodialysis patients

  • Received:2015-01-12 Revised:2015-04-23 Online:2015-06-12 Published:2015-05-29

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摘要： 【摘要】目的调查维持性血液透析(MHD)患者口腔卫生情况，寻找MHD 患者口腔疾病与透析微炎症状态和营养状态之间的关系。方法选择MHD 患者85 名，健康对照组85 名。记录一般情况,测取hsCRP、实验室指标及口腔状况检查。对MHD 患者组的牙周病指数(PDI)与hsCRP 进行相关性分析。将患者分为牙列健康和轻度龋病组(A 组)和严重龋病组(B 组)、牙周健康和轻度牙周病组(C 组)和中、重度牙周病组(D 组)。2 种分组方法，分别比较MHD 组和健康对照组实验室检验指标。结果MHD 患者龋病患病率68.2%。MHD 患者组龋齿患病率、已龋损尚未充填的牙(D)、缺失牙(M)、和龋失补指数(DMFT)与健康对照组之间无统计学意义(P＞0.05)。MHD 患者组充填牙(F)1.3(1.7)明显低于健康对照组(P＜0.05)。牙周病患病率83.5%、软垢指数(DI)2.1(1.2)、牙石指数(CI)1.5(0.8)、PDI 3.9(1.9)均明显高于健康对照组(P＜0.05)。MHD 患者牙周病加重与性别、糖尿病、与透析时间相关(P＜0.05)。Logistic 回归分析，透析时间和糖尿病是MHD 患者牙周病加重危险因素(P＜0.01)。透析时间与PDI 之间呈正相关(P＜0.05)。MHD 患者hsCRP 水平A 组与B 组之间无统计学意义(P＞0.05)。D 组hsCRP(16.0±6.9mmol/L)高
于C 组 (11.1±7.4mmol/L)(P＜0.01)。hsCRP 与PDI 水平呈正相关(P＜0.05)。营养状况指标中D 组BMI24.2±1.3、ALB 40.8±4.5g/L 低于C 组BMI 22.1±1.5、ALB 38.7±3.6g/L(P＜0.05)。结论MHD 患者口腔卫生状况差，牙周病发生率明显增加，程度较重。随透析龄增加，其牙周病程度进一步加重。慢性严重的牙周炎可能是引起MHD患者微炎症状态的因素之一。

关键词: 维持性血液透析, 牙周病, 龋病, C反应蛋白, 微炎症状态

Abstract: 【Abstract】Objective To investigate oral changes and oral diseases and the relationship between oral health condition and micro- inflammatory state in maintenance hemodialysis (MHD) patients. Methods We recruited 85 MHD patients and 85 healthy adults as controls for this study. Their general condition, serum hsCRP, other laboratory examinations, and oral status were recorded. The relationship between periodontal disease index (PDI) and hsCRP was analyzed in MHD patients. MHD patients were then divided into healthy dental condition with mild caries group (group A), and healthy dental condition with severe caries group (group B), healthy periodontal condition or mild periodontal disease group (group C), and moderate and severe periodontal disease group (group D). Results of laboratory examinations were compared between MHD patients and healthy controls. Results The prevalence of caries was 68.2% in MHD patients. There were no statistically differences in prevalence of caries, caries not filled yet, missing teeth, and decayed, missing and filled teeth index (DMFT) between MHD patients and healthy controls (P>0.05). Filled teeth were lower in MHD patients (1.3) than in healthy controls (1.7) (P<0.05). The prevalence of periodontal disease was 83.5% in MHD patients. Debris index was 2.1 and 1.2, calculus index was 1.5 and 0.8, PDI was 3.9 and 1.9 in MHD patients group and healthy control group, respectively, significantly higher in MHD patients group (P<0.05). In MHD patients, the aggravation of periodontal disease was related to gender, diabetes mellitus, and dialysis age (P<0.05). Logistic regression demonstrated that dialysis age and diabetes mellitus were the risk factors for the aggravation of periodontal disease (P＜0.01) in MHD patients. Dialysis age was positively correlated with PDI (P＜0.05). Serum hsCRP was indifferent between group A and group B (P＞0.05), but was higher in group D (16.0±6.9 mmol/L) than in group C (11.1±7.4 mmol/L) (P＜0.01). Serum hsCRP and PDI were positively correlated (P＜0.05). In the nutrition indices, MBI was 24.2±1.3 and 22.1±1.5, ALB was 40.8±4.5g/L and 38.7±3.6g/L in group D and group C, respectively (P＜0.05). Conclusions Poor oral hygiene and higher prevalence of periodontal disease were frequently seen in MHD patients. Their periodontal
disease aggravated with the increase of dialysis age. Chronic and severe periodontal disease may be one of the factors resulting in micro-inflammation status in MHD patients.

Key words: maintenance hemodialysis, periodontal disease, dental decay, C reactive protein, micro-inflammation.