歯周病菌と高血圧：口腔感染症および血管疾患疫学研究（INVEST）

Periodontal bacteria and hypertension: the oral infections and vascular disease epidemiology study (INVEST).

抄録

目的:

歯周感染症を含む慢性感染症は心血管疾患の素因となる可能性がある。歯周病細菌叢と高血圧の関係を調査した。

OBJECTIVE: Chronic infections, including periodontal infections, may predispose to cardiovascular disease. We investigated the relationship between periodontal microbiota and hypertension.

方法と結果:

脳卒中または心筋梗塞の既往歴のない歯列矯正男女653名をINVESTに登録した。4533個の歯肉縁下プラークサンプルを採取した（参加者1人当たり平均7サンプル）。DNA-DNAチェッカーボードハイブリダイゼーションを用いて11種類の歯周病菌を定量的に評価した。心血管危険因子の測定を行った。血圧および高血圧（SBP＞＝140mmHg，DBP＞＝90mmHg，または降圧薬服用中，または自己申告による既往歴）は，それぞれ歯周病の原因と考えられる細菌（病因的細菌負荷），歯周病と関連する細菌（推定的細菌負荷），歯周病の健康と関連する細菌（健康関連細菌負荷）のレベルで回帰した．すべての解析は，年齢，人種/民族，性，教育，BMI，喫煙，糖尿病，低比重リポ蛋白，高比重リポ蛋白コレステロールで調整した．病因菌負担は血圧および高血圧有病率のいずれとも正の相関を示した。病因菌負担の最高値と最低値の3分位を比較すると、SBPは9mmHg高く、DBPは5mmHg高く（線形傾向のPはいずれも0.001未満）、多変量調整後の高血圧有病者のオッズ比は3.05（95％信頼区間1.60-5.82）であった。

METHODS AND RESULTS: Six hundred and fifty-three dentate men and women with no history of stroke or myocardial infarction were enrolled in INVEST. We collected 4533 subgingival plaque samples (average of seven samples per participant). These were quantitatively assessed for 11 periodontal bacteria using DNA-DNA checkerboard hybridization. Cardiovascular risk factor measurements were obtained. Blood pressure and hypertension (SBP > or =140 mmHg, DBP > or =90 mmHg or taking antihypertensive medication, or self-reported history) were each regressed on the level of bacteria: considered causative of periodontal disease (etiologic bacterial burden); associated with periodontal disease (putative bacterial burden); and associated with periodontal health (health-associated bacterial burden). All analyses were adjusted for age, race/ethnicity, sex, education, BMI, smoking, diabetes, low-density lipoprotein and high-density lipoprotein cholesterol. Etiologic bacterial burden was positively associated with both blood pressure and prevalent hypertension. Comparing the highest and lowest tertiles of etiologic bacterial burden, SBP was 9 mmHg higher, DBP was 5 mmHg higher (P for linear trend was less than 0.001 in each case), and the odds ratio for prevalent hypertension was 3.05 (95% confidence interval 1.60-5.82) after multivariable adjustment.

結論:

本データは、歯肉縁下歯周病細菌レベルとSBPおよびDBPならびに高血圧有病率との間に直接的な関係があることを示す証拠となった。

CONCLUSION: Our data provide evidence of a direct relationship between the levels of subgingival periodontal bacteria and both SBP and DBP as well as hypertension prevalence.