| 摘要: | 背景：目前已有流行病學研究發現牙周病(periodontal disease)與糖尿病(diabetes)、心血管疾病(cardiovascular disease)以及骨質疏鬆症(osteoporosis)等病況之間的關聯，但眾多的研究結論仍缺乏一致的共識。本研究跟從目前牙周病病因模型的研究脈絡，欲更進一步以牙周病社區篩檢資料，了解骨密度與牙周疾病之間的關係。
材料與方法：研究對象為40至44歲共計7,298位社區居民，2003年至2009年間社區基礎篩檢中使用社區牙周指數訪查，以定量超音波測量骨質密度為骨質疏鬆症診斷標準。確立與骨質密度和牙周病相關的修飾顯著因子，更進一步評估兩者關係，控制其他推定因素包含分層分析顯著影響牙周病的修飾因子，使用羅吉斯?A歸模型評估骨質密度對罹患牙周病風險之影響。使用存活模型預測牙周病存活，顯示各項修飾因子相關的牙周病存活風險比。
結果：骨質疏鬆症等相關因子中牙周病發生率幾乎高於35%，並列有每項牙周病相關的可能風險因子粗勝算比。骨質疏鬆症與牙周病有相關風險(勝算比，1.24；95%信賴區間，1.10-1.40)，其他顯著因子包含年齡、肥胖、第二型糖尿病、吸菸、男性、代謝症候群風險因子。安排顯著因子為控制組，骨質密度最低組對牙周病風險為正相關(調整勝算比，1.36；95%信賴區間，1.19- 1.57)。另自世代追蹤之存活分析發現，僅男性為牙周病發生之風險因子，骨質密度與牙周病發生風險之關係並不顯著。
結論：本研究橫斷型資料明確指出骨質密度與牙周病之間的關係，並建議骨質密差的群體與牙周病之間顯著的關係。在年輕成人中，骨質疏鬆症與罹患牙周病的風險因子相關，此群體可能視為骨質疏鬆於預防牙周病計畫的介入的開始。
Backgroud:
Currently, numerous epidemiological studies have found associates between periodontal disease and conditions such as diabetes, cardiovascular disease(CVD), and osteoporosis, among others, but there is a lack of consensus on these study conclusions. Furthermore, we investigated the association between bone mineral density(BMD) and periodontal disease(PD) in context of the current periodontal etiology model based on a large community-based PD survey.
Material and Methods:
In total, 7,298 community residents aged 40-44 years were invited to a community-based survey between 2003 and 2009 using the community periodontal index. Data on quantitative ultrasound(QUS) for measurement of BMD was collected for diagnostic criteria of osteoporosis.
Significant factors modifying in the association between BMD and PD were ascertained. We further assessed the association between BMD and PD, within strata of significant effect modifiers, after controlling for other putative factors. A logistic regression model was used to assess the effect of BMD on the risk for PD. Survival model was used to predict a life of PD, showed that the hazard ratio on PD survivability associated each modifying factors.
Results:
The prevalence of PD was 35% higher in subjects with osteoporosis than in those without. The crude OR for each possible risk factors in association with the risk for PD. Osteoporosis was associated with the risk for PD (OR:1.24,95% CI:1.10-1.40). Other significant factors included age, obesity, type Ⅱ diabetes mellitus, smoking, male, metabolic syndrome components. After controlling for significant factors, the worst BMD group was positively associated with the risk for PD(adjusted odds ratio=1.36, 95% CI：1.19- 1.57).The significant effect of BMD was not found in Cox regression model.
Conclusion:
The association between osteoporosis and the risk for PD among young adults was demonstrated. Intervention program for prevention of PD and osteoporosis may be considered starting from the young adults. |
