SARS-CoV-2の発症と重症化における口腔衛生の役割：レトロスペクティブ・チャート・レビュー

The Role of Oral Health in the Acquisition and Severity of SARS-CoV-2: A Retrospective Chart Review.

抄録

目的:

研究により、歯肉溝が重要な侵入経路である可能性が示されている。しかし，COVID-19の獲得と重症度における口腔内の健康状態の役割は不明である．2019/12/1～2020/8/24に大規模都市型学術医療センターの電子カルテデータを用いてレトロスペクティブな解析を実施した。合計 387 例の COVID-19 陽性症例を特定し、COVID-19 診断のない対照者 387 例と年齢、性別、人種で 1：1 にマッチさせた。人口統計、欠損歯の数、歯槽堤の高さは、X線写真と医科・歯科のカルテから決定した。107人の症例と対照のサブグループで、歯槽堤高さの変化率も調べた。条件付きロジスティック回帰モデルを用いて、歯槽骨稜高および欠損歯と COVID-19 状態および COVID-19 症例における入院状況との関連性を評価した。

Objective: Studies have shown that gingival crevices may be a significant route for entry. However, the role of oral health in the acquisition and severity of COVID-19 is not known. A retrospective analysis was performed using electronic health record data from a large urban academic medical center between 12/1/2019 and 8/24/2020. A total of 387 COVID-19 positive cases were identified and matched 1:1 by age, sex, and race to 387 controls without COVID-19 diagnoses. Demographics, number of missing teeth and alveolar crestal height were determined from radiographs and medical/dental charts. In a subgroup of 107 cases and controls, we also examined the rate of change in alveolar crestal height. A conditional logistic regression model was utilized to assess association between alveolar crestal height and missing teeth with COVID-19 status and with hospitalization status among COVID-19 cases.

結果:

歯槽骨量の増加、OR=4.302 (2.510 - 7.376) 、欠損歯の減少、OR=0.897 (0.835 - 0.965) 、喫煙歴の欠如が COVID-19 症例と対照群を識別した。検査間隔を調整したところ，COVID-19症例は対照群と比較して歯槽骨の減少が大きかった（0.641±0.613 mm vs 0.260±0.631 mm，p＜0.01）． COVID-19症例では，欠損歯の数の増加OR＝2.1871（1.146-4.174）が入院と有意に関連し，欠損歯の数が少ないほど入院の必要性が高かった．

Results: Increased alveolar bone loss, OR=4.302 (2.510 - 7.376), fewer missing teeth, OR=0.897 (0.835 - 0.965) and lack of smoking history distinguished COVID-19 cases from controls. After adjusting for time between examinations, cases with COVID-19 had greater alveolar bone loss compared to controls (0.641+/- 0.613 mm vs 0.260 +/- 0.631 mm, p<0.01.) Among cases with COVID-19, increased number of missing teeth OR=2.1871 (1.146- 4.174) was significantly associated with hospitalization.

結論:

歯槽骨の減少および歯の欠損は，それぞれCOVID-19疾患の発症および重症度と正の相関がある．

Conclusions: Alveolar bone loss and missing teeth are positively associated with the acquisition and severity of COVID-19 disease, respectively.