慢性閉塞性肺疾患および歯周炎患者における歯周病状態と微生物学的病原体．ケースコントロール研究

Periodontal Status and Microbiologic Pathogens in Patients with Chronic Obstructive Pulmonary Disease and Periodontitis: A Case-Control Study.

抄録

目的:

慢性閉塞性肺疾患（COPD）および歯周炎患者における歯周病の臨床状態と微生物学的病原体を評価すること。

Purpose: To evaluate clinical periodontal status and microbiologic pathogens in patients with chronic obstructive pulmonary disease (COPD) and periodontitis.

対象者および方法:

COPD を有する歯周炎患者 60 名（症例群）と肺機能正常の歯周炎患者 60 名（対照群）を対象とした症例対照研究を実施した。歯周病の状態および呼吸機能を臨床的に検討した．リアルタイムポリメラーゼ連鎖反応法を用いて，歯肉縁下歯垢中の5種類の歯科用病原体と4種類の呼吸器用病原体を測定した．Spearmanの順位相関係数（r）を算出し，病原体間の相関を評価した．主成分分析（PCA）を用いて，2群間の細菌多様性の類似性を評価した．歯周病変数および病原体と COPD リスクの関連性を調べるためにロジスティック回帰を行った．

Patients and Methods: We conducted a case-control study of 60 periodontitis patients with COPD (case group) and 60 periodontitis patients with normal pulmonary function (control group). Their periodontal status and respiratory function were clinically examined. Real-time polymerase chain reaction assays were used to measure five dental pathogens and four respiratory pathogens in subgingival dental plaque. Spearman's rank correlation coefficients (r) were calculated to assess correlations of pathogens. Principal component analysis (PCA) was employed to assess the similarity of bacterial diversity between the two groups. Logistic regression was performed to examine the associations of periodontal variables and pathogens with COPD risk.

結果:

COPD患者は対照群に比べ，残存歯数が少なく，プラーク指数（PLI）が高く，臨床的付着レベル（CAL）の部位割合が重度であった。COPD患者はコントロール群に比べ， , および , の平均値が比較的高い傾向にあったが，その差は有意ではなかった．また，一部の歯周病菌と呼吸器系病原菌には正の相関が認められた（r =0.29～0.47，all < 0.05）．PCAグラフより，COPD群では対照群に比べ，病原体の分布が分散しているが，識別性は低いことが示された．PLI（= 0.045）およびCAL≧5mm部位割合（= 0.01）はCOPDのリスク上昇と有意に関連したが、病原体はCOPDと関連しなかった。

Results: COPD patients had fewer remaining teeth, higher plaque index (PLI), and more severe site percentages of clinical attachment level (CAL) than the controls. Although COPD patients tended to have relatively higher ranked means of , and than control participants, the differences were not significant. Some periodontal pathogens and respiratory pathogens were positively correlated with each other (r =0.29 to 0.47, all < 0.05). The PCA graph showed that the distributions of pathogens were more dispersed but less discriminated in the COPD group than those in the control group. PLI ( = 0.045) and CAL ≥ 5mm site percentages ( = 0.01) were significantly associated with an increased risk of COPD, while pathogens were not associated with COPD.

結論:

本研究の結果では，歯周状態の不良が COPD と有意に関連するにもかかわらず，歯周病原菌は COPD リスクの潜在的な予 測因子とはならないことが示唆された．

Conclusion: Our results from this study do not indicate periodontal pathogens as potential predictors of COPD risk, despite significantly poor periodontal status associated with COPD.