真性（生理的、病理的）口臭における全身性炎症の血液学的バイオマーカー

Hematological biomarkers of systemic inflammation in genuine (physiologic and pathologic) halitosis.

抄録

口臭は、口腔内から発生する不快な臭いのことで、その有病率は一般人口の30～50％といわれています。従来の診断方法は、口腔内の硫黄化合物の量を測定する口腔内空気分析が中心であり、口臭の原因を直接的に反映するものではなかった。また、口臭が健康状態の指標となる可能性も指摘されており、炎症が体臭の嫌悪感と常に関連している。そこで本研究では，病的口臭の有無およびその強さを予測しうる血液学的指標，臨床的特徴および口臭測定値の相互関係を検索することを目的とした．さらに，口臭と全身性炎症の有無との暫定的な関連についても検討した．総計125名の患者を，携帯型硫化物測定器による測定値から真性口臭群（値80ppb以上）103名と偽性口臭群（値80ppb未満）22名に分類した．臨床検査，炎症予後因子などの血液学的指標と，有機嗅覚検査，携帯型硫化物モニター，ガスクロマトグラフィーなどの口臭測定値を評価した．真性口臭群では疑似口臭群と比較して有意に白血球（WBC）数が多かった（< 0.01）．赤血球沈降速度（ESR）値および口臭期間（= 0.353，<0.05）は口臭強度と有意な関連を示し，好中球/リンパ球比（NLR）値（= 3.859，<0.05）は真性口臭診断と有意に関連した．WBCの新しいカットオフ値である5575は真性口臭の予測にほぼ同等の識別力を示した（曲線下面積0.661，<0.05）．本研究の結果、真性口臭ではWBC数が増加し、ESRやNLRなどの不顕性炎症の血液学的指標と強い関連を示したことから、炎症性血液マーカーは真性口臭の診断に有用であることが示唆された。

Halitosis is an unpleasant odor discharged through the oral cavity with a prevalence as high as 30%-50% of the general population. Conventional diagnostic methods have been focused on mouth air analysis measuring the amount of sulfur compounds which does not directly reflect the cause of halitosis. Also, the possible role of halitosis as an indicator of general health status has been steadily suggested and inflammation has been constantly associated with aversive body odor. Therefore, this study aimed to search for inter-relationships between hematologic indicators, clinical characteristics, and halitosis measurement that can predict the presence of pathologic halitosis and its intensity. Furthermore, the tentative relationship between halitosis and the presence of systemic inflammation was investigated. A total of 125 patients were divided into 103 patients in the genuine halitosis group (value ⩾80 ppb) and 22 patients in the pseudo halitosis group (value <80 ppb) based on portable sulfide monitor measurements. Clinical examination and hematological indices including inflammatory prognostic factors and halitosis measurements including organoleptic testing, portable sulfide monitor, and gas chromatography were evaluated. The genuine halitosis group showed a significantly higher white blood cell (WBC) count (< 0.01) compared to the pseudo halitosis group. Erythrocyte sedimentation rate (ESR,= 0.341,< 0.05) values and duration of halitosis (= 0.353,< 0.05) showed a significant association with halitosis intensity and neutrophil to lymphocyte ratio (NLR) values (= 3.859,< 0.05) were significantly related to genuine halitosis diagnosis. A new WBC cut-off value of 5575lshowed near to fair discriminative power in predicting genuine halitosis (area under the curve 0.661,< 0.05). The results of this study showing an increased WBC count in genuine halitosis and its strong association with hematologic indices of subclinical inflammation including ESR and NLR suggest inflammatory hematologic markers as potential diagnostic tools in the diagnosis of genuine halitosis.