不同年龄2型糖尿病患者牙周健康流行病学调查

doi:10.3969/j.issn.1674-8115.2021.02.014

摘要/Abstract

摘要：

目的·调查不同年龄2型糖尿病人群的牙周整体健康水平，探讨年龄对糖尿病患者牙周炎患病率的影响及相关危险因素。方法·对2018年11月—2018年12月至上海交通大学附属第六人民医院内分泌科就诊的2型糖尿病患者进行牙周检查及问卷调查。对指数牙的相关牙周指标进行检查和计分，检查指标包括探诊深度、探诊出血、临床附着丧失（clinical attachment loss，CAL）、牙石指数（calculus index，CI）和菌斑指数（plaque index，PLI）。依据牙周炎的诊断标准，将调查对象分为牙周炎组和非牙周炎组。比较不同年龄段2型糖尿病患者牙周炎的患病率及相关牙周指标的差异。结果·完成调查的916名2型糖尿病患者中，牙周炎组和非牙周炎组患者之间年龄的差异有统计学意义（χ²=100.1，P=0.001）。多因素Logistic回归分析提示，年龄是糖尿病牙周炎的高危因素（P=0.001，OR=2.13，95%CI 1.79~2.55）。相对于年龄较小的患者，高龄糖尿病患者更容易出现牙龈出血（χ²=36.4，P=0.001）、牙齿松动（χ²=25.9，P=0.002）、咀嚼无力（χ²=12.3，P=0.006）等牙周炎症状。不同年龄人群PLI（χ²=8.3，P=0.041）、CI（χ²=12.8，P=0.005）和CAL（χ²=32.5，P=0.001）的差异有统计学意义。在注意刷牙（χ²=18.8，P=0.001）、清水漱口（χ²=21.8，P=0.001）、刷牙频率（χ²=24.0，P=0.001）等多项口腔保健措施上的差异有统计学意义。结论·糖尿病患者的年龄是影响牙周炎患病率和严重程度的危险因素，需要关注高龄糖尿病患者的牙周健康状况，并对该人群开展具有针对性的口腔预防保健工作。

关键词: 2型糖尿病, 慢性牙周炎, 年龄, 危险因素, 口腔保健

Abstract:

Objective·To investigate the periodontal health status of different age groups with type 2 diabetes mellitus, and to explore the influence of age on the prevalence of periodontitis in diabetic patients and the related risk factors.

Methods·Periodontal examination and questionnaire survey were conducted on patients with type 2 diabetes mellitus who visited the Department of Endocrinology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University from November 2018 to December 2018. The periodontal indexes of index teeth were examined and scored, including probing depth, bleeding on probing, clinical attachment loss (CAL), calculus index (CI) and plaque index (PLI). According to the diagnostic criteria of periodontitis, the subjects were divided into periodontitis group and non-periodontitis group. The prevalence of periodontitis and related periodontal indexes in patients with type 2 diabetes mellitus of different ages were compared.

Results·In the 916 patients with type 2 diabetes mellitus, the difference of age between the periodontitis group and non-periodontitis group was statistically significant (χ²=100.1, P=0.001). Multivariate Logistic regression analysis indicated that age was a high-risk factor for type 2 diabetic periodontitis (P=0.001, OR=2.13, 95%CI 1.79?2.55). Compared with younger patients with diabetes mellitus, elderly patients with diabetes mellitus were more likely to have periodontal symptoms such as gingival bleeding (χ²=36.4, P=0.001), tooth loosening (χ²=25.9, P=0.002) and masticatory weakness (χ²=12.3, P=0.006). There were significant differences in PLI (χ²=8.3, P=0.041), CI (χ²=12.8, P=0.005) and CAL (χ²=32.5, P=0.001) among diabetic patients of different ages. There were significant differences in periodontal health care measures, such as brushing teeth (χ²=18.8, P=0.001), rinsing mouth with water (χ²=21.8, P=0.001) and frequency of tooth brushing (χ²=24.0, P=0.001).

Conclusion·The age of diabetic patients is a risk factor affecting the prevalence rate and severity of periodontitis. It is necessary to pay attention to the periodontal health of elderly diabetic patients and carry out targeted oral health care.

Key words: type 2 diabetes mellitus, chronic periodontitis, age, risk factor, oral health

中图分类号:

R780.1

丁远森, 王枫, 孙家悦, 邵正威, 邹德荣, 陆家瑜. 不同年龄2型糖尿病患者牙周健康流行病学调查[J]. 上海交通大学学报(医学版), 2021, 41(2): 217-222.

Yuan-sen DING, Feng WANG, Jia-yue SUN, Zheng-wei SHAO, De-rong ZOU, Jia-yu LU. Epidemiological survey of periodontal health in patients with type 2 diabetes mellitus of different ages[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(2): 217-222.

图/表 5

参考文献 19

1	Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases[J]. Nat Rev Endocrinol, 2011, 7(12): 738-748.
2	Chapple ILC, Genco R. Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases[J]. J Clin Periodontol, 2013, 40(): S106-S112.
3	Borgnakke WS, Ylöstalo PV, Taylor GW, et al. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence[J]. J Clin Periodontol, 2013, 40(): S135-S152.
4	卢怡, 施生根, 牛忠英, 等. 2型糖尿病患者牙周炎患病率与年龄、病程的相关性分析[J]. 解放军医学杂志, 2010, 35(7): 875-876.
5	Apoorva SM, Sridhar N, Suchetha A. Prevalence and severity of periodontal disease in type 2 diabetes mellitus (non-insulin-dependent diabetes mellitus) patients in Bangalore city: an epidemiological study[J]. J Indian Soc Periodontol, 2013, 17(1): 25-29.
6	王兴. 第四次全国口腔健康流行病学调查报告[M]. 北京: 人民卫生出版社, 2018: 40.
7	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中国实用内科杂志, 2018, 38(4): 292-344.
8	胡德渝. 口腔预防医学[M]. 6版. 北京: 人民卫生出版社, 2015: 23.
9	Borgnakke WS. IDF Diabetes Atlas: diabetes and oral health—a two-way relationship of clinical importance[J]. Diabetes Res Clin Pract, 2019, 157: 107839.
10	廖涌. 中国糖尿病的流行病学现状及展望[J]. 重庆医科大学学报, 2015, 40(7): 1042-1045.
11	Teeuw WJ, Kosho MX, Poland DC, et al. Periodontitis as a possible early sign of diabetes mellitus[J]. BMJ Open Diabetes Res Care, 2017, 5(1): e000326.
12	Casanova L, Hughes FJ, Preshaw PM. Diabetes and periodontal disease: a two-way relationship[J]. Br Dent J, 2014, 217(8): 433-437.
13	Demmer RT, Holtfreter B, Desvarieux M, et al. The influence of type 1 and type 2 diabetes on periodontal disease progression: prospective results from the Study of Health in Pomerania (SHIP)[J]. Diabetes Care, 2012, 35(10): 2036-2042.
14	Rajhans NS, Kohad RM, Chaudhari VG, et al. A clinical study of the relationship between diabetes mellitus and periodontal disease[J]. J Indian Soc Periodontol, 2011, 15(4): 388-392.
15	Eke PI, Dye BA, Wei L, et al. Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012[J]. J Periodontol, 2015, 86(5): 611-622.
16	Franceschi C, Bonafè M, Valensin S, et al. Inflamm-aging: an evolutionary perspective on immunosenescence[J]. Ann N Y Acad Sci, 2000, 908(1): 244-254.
17	Prattichizzo F, de Nigris V, de Nigris V, et al. “inflammaging” as a druggable target: a senescence-associated secretory phenotype-centered view of type 2 diabetes[J]. Oxid Med Cell Longev, 2016, 2016: 1810327.
18	Johnson SC, Dong X, Vijg J, et al. Genetic evidence for common pathways in human age-related diseases[J]. Aging Cell, 2015, 14(5): 809-817.
19	王琪, 周欣奕, 丁一. 炎性衰老在牙周炎中的作用[J]. 华西口腔医学杂志, 2018, 36(1): 99-103.

Group	Periodontal patients (n=670)	Non-periodontal patients (n=246)	χ²	Pvalue
Age/n (%)			100.1	0.001
<45 year	23 (3.4)	44 (17.9)
45?59 year	163 (24.3)	102 (41.5)
60?74 year	399 (59.6)	89 (36.2)
≥75 year	85 (12.7)	11 (4.5)
Gender/n (%)			0.4	0.529
Male	312 (46.6)	121 (49.2)
Female	358 (53.4)	125 (50.8)
Drug therapy/n (%)			6.3	0.012
Yes	614 (91.6)	211 (85.8)
No	56 (8.4)	35 (14.2)
Diet control/n (%)			1.4	0.238
Yes	554 (82.7)	205 (83.3)
No	116 (17.3)	41 (16.7)
Physical exercise/n (%)			1.6	0.203
Yes	543 (81.0)	209 (85.0)
No	127 (19.0)	37 (15.0)
Smoking History/n (%)			1.3	0.517
Yes	92 (13.7)	28 (11.4)
No	530 (79.1)	203 (82.5)
Smoking cessation	48 (7.2)	15 (6.1)
Alcoholic History/n (%)			3.0	0.220
Yes	116 (17.3)	52 (21.1)
No	540 (80.6)	186 (75.6)
Abstinence	14 (2.1)	8 (3.3)
Diabetic complications/n (%)			5.2	0.022
Yes	117 (17.5)	27 (11.0)
No	553 (82.5)	219 (89.0)
Diabetes duration/n (%)			15.4	0.004
<5 year	203 (30.3)	106 (43.1)
5?10 year	183 (27.3)	62 (25.2)
11?15 year	115 (17.2)	36 (14.6)
16?20 year	77 (11.5)	22 (8.9)
>20 year	92 (13.7)	20 (8.1)
FBG/n (%)			1.9	0.391
<7.0 mmoL·L^-1	138 (20.6)	61 (24.8)
7.0?11.1 mmoL·L^-1	442 (66.0)	153 (62.2)
>11.1 mmoL·L^-1	90 (13.4)	32 (13.0)

Group	Periodontal patients (n=670)	Non-periodontal patients (n=246)	χ²	Pvalue
Age/n (%)			100.1	0.001
<45 year	23 (3.4)	44 (17.9)
45?59 year	163 (24.3)	102 (41.5)
60?74 year	399 (59.6)	89 (36.2)
≥75 year	85 (12.7)	11 (4.5)
Gender/n (%)			0.4	0.529
Male	312 (46.6)	121 (49.2)
Female	358 (53.4)	125 (50.8)
Drug therapy/n (%)			6.3	0.012
Yes	614 (91.6)	211 (85.8)
No	56 (8.4)	35 (14.2)
Diet control/n (%)			1.4	0.238
Yes	554 (82.7)	205 (83.3)
No	116 (17.3)	41 (16.7)
Physical exercise/n (%)			1.6	0.203
Yes	543 (81.0)	209 (85.0)
No	127 (19.0)	37 (15.0)
Smoking History/n (%)			1.3	0.517
Yes	92 (13.7)	28 (11.4)
No	530 (79.1)	203 (82.5)
Smoking cessation	48 (7.2)	15 (6.1)
Alcoholic History/n (%)			3.0	0.220
Yes	116 (17.3)	52 (21.1)
No	540 (80.6)	186 (75.6)
Abstinence	14 (2.1)	8 (3.3)
Diabetic complications/n (%)			5.2	0.022
Yes	117 (17.5)	27 (11.0)
No	553 (82.5)	219 (89.0)
Diabetes duration/n (%)			15.4	0.004
<5 year	203 (30.3)	106 (43.1)
5?10 year	183 (27.3)	62 (25.2)
11?15 year	115 (17.2)	36 (14.6)
16?20 year	77 (11.5)	22 (8.9)
>20 year	92 (13.7)	20 (8.1)
FBG/n (%)			1.9	0.391
<7.0 mmoL·L^-1	138 (20.6)	61 (24.8)
7.0?11.1 mmoL·L^-1	442 (66.0)	153 (62.2)
>11.1 mmoL·L^-1	90 (13.4)	32 (13.0)

Variate	β value	SE	Wald χ²	P value
Age	0.07	0.019	9.12	0.001
Drug therapy	0.34	0.250	1.36	0.170
Diabetic complications	0.40	0.240	1.65	0.100
Diabetes duration	0.01	0.070	0.22	0.840
Glycemic control	0.15	0.080	1.77	0.080

Variate	β value	SE	Wald χ²	P value
Age	0.07	0.019	9.12	0.001
Drug therapy	0.34	0.250	1.36	0.170
Diabetic complications	0.40	0.240	1.65	0.100
Diabetes duration	0.01	0.070	0.22	0.840
Glycemic control	0.15	0.080	1.77	0.080

Age	N	Missing teeth/n	Gingival bleeding/n (%)	Gingival swelling/n (%)	Tooth loosening/n (%)	Automatic tooth loss/n (%)	Masticatory weakness/n (%)
<45 year	67	0 (0, 1)	31 (46.3)	24 (35.8)	10 (14.9)	5 (7.5)	9 (13.4)
45?59 year	265	1 (0, 3)	149 (57.1)	73 (28.0)	108 (41.4)	28 (10.7)	78 (29.9)
60?74 year	488	3 (1, 7)	348 (70.9)	149 (30.3)	219 (44.6)	69 (14.1)	151 (30.8)
≥75 year	96	6 (3, 15)	76 (78.4)	22 (22.7)	50 (51.5)	12 (12.4)	37 (38.1)
χ²	?	196.6	36.4	4.0	25.9	3.7	12.3
P value	?	0.001	0.001	0.260	0.002	0.300	0.006