牙周状况对糖尿病肾病患者血糖控制的影响

doi:10.3969/j.issn.1006-7795.2021.02.024

摘要/Abstract

摘要： 目的研究不同血糖控制水平的糖尿病肾病(diabetic nephropathy,DN)患者的牙周状况及特点,探讨牙周炎症程度对糖尿病肾病患者血糖控制的作用。方法纳入119例糖尿病肾病患者,分为两组,糖化血红蛋白(glycosylated hemoglobin,HbA1c)良好(HbA1c<7%)组27例和糖化血红蛋白不良(HbA1c≥7%)组92例。牙周检查内容包括探诊深度(probing depth, PD)、出血指数(blood index, BI)、临床附着丧失(clinical attachment loss,CAL)以及口内余留牙数,口腔健康问卷包括口腔健康行为等。血清检测指标包括HbA1c、空腹血糖、总胆固醇等。结果与HbA1c<7%组的患者相比,HbA1c≥7%组患者的PD(3.99±1.05 vs 3.49±0.93,P=0.031)、BI(3.45±0.58 vs 3.10±0.67,P=0.001)、CAL (6.40±2.18 vs 5.37±1.99,P=0.003)、PD≥4 mm 百分率(中位数:54.17% vs 38.15%,P=0.001), PD≥5mm百分率 (中位数:24.13% vs 12.85%,P=0.028)增加,差异具有统计学意义。多因素Logistic回归分析结果表明,除空腹血糖增加与HbA1c控制不良高度相关外,牙周检查指标CAL增加与DN患者HbA1c控制不良亦高度相关(OR=1.36,95%CI:1.01-1.83,P=0.043)。结论糖尿病肾病患者的HbA1c控制情况与牙周炎症程度有关,CAL增加与糖尿病肾病患者HbA1c控制不良高度相关。

关键词: 糖尿病肾病, 糖化血红蛋白, 牙周炎, 临床附着丧失

Abstract: Objective This study explores the association between periodontal status and glycosylated hemoglobin (HbA1c)in patients with diabetic nephropathy (DN).Methods An observational study was conducted in 119 patients with DN. Patients were divided into two groups according to the presence of HbA1c<7% group (n=27) and HbA1c≥7% group (n=92), and oral health behavior-related variables were obtained by questionnaire. All patients underwent clinical examination, including probing depth(PD), bleeding index, clinical attachment loss(CAL) and the number of remaining teeth in the mouth. Laboratory tests include fasting blood glucose, glycosylated hemoglobin, creatinine and urine protein, etc. Results Comparied with HbA1c<7% group patients, probing depth (3.99±1.05 vs 3.49±0.93, P=0.031), blood index (3.45±0.58 vs 3.10±0.67, P=0.001), CAL (6.40±2.18 vs 5.37±1.99, P=0.003),the percentage of PD≥4 mm (median: 54.17% vs 38.15%, P=0.001) and PD≥5 mm (median: 24.13% vs 12.85%, P=0.028) were increased in HbA1c≥7% group patients. The results of multivariate Logistic regression analysis showed that in addition to fasting blood glucose, increasing of CAL was highly correlated with HbA1c ≥7% (OR=1.36, 95% CI:1.01-1.83,P=0.043) in DN patients. Conclusion There was a relationship between periodontal disease and HbA1c in patients with DN, increased CAL is highly correlated with poor HbA1c control in patients with diabetic nephropathy in DN.

Key words: diabetic nephropathy, HbA1c, periodontitis, clinical attachment loss

中图分类号:

R781.4

张冬雪, 林梅, 周璿, 刘文燕, 谷雅楠, 王左敏. 牙周状况对糖尿病肾病患者血糖控制的影响[J]. 首都医科大学学报, 2021, 42(2): 306-311.

Zhang Dongxue, Lin Mei, Zhou Xuan, Liu Wenyan, Gu Yanan, Wang Zuomin. Effect of periodontal status on blood glucose control in patients with diabetic nephropathy[J]. Journal of Capital Medical University, 2021, 42(2): 306-311.

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