在美國成年人口人群中，牙周炎與慢性肝病有關

StephenW

Periodontitis is associated with chronic liver disease in a population-based cohort of US adults

Gum Infection Tied to Worse Liver Fibrosis in Nationwide US Cohort

AASLD The Liver Meeting Digital Experience, November 13-16, 2020

Mark Mascolini

Periodontal disease (gum infection), especially severe periodontal disease, independently boosted odds of a high fibrosis score, a marker of chronic liver disease, in an 11,909-person US analysis [1]. Because good oral hygiene can prevent or delay periodontitis, the findings may mean gum disease could be a modifiable risk factor for liver disease.

University of North Carolina (UNC) researchers who conducted this study reminded colleagues that chronic liver disease prevalence and resulting death continue to climb across the United States. Periodontal inflammation and gum destruction already raise chances of heart disease and diabetes [2]. The UNC team wondered whether periodontal disease also affects risk of liver fibrosis and thus chronic liver disease.

The researchers focused on 2009-2014 participants in the National Health and Nutrition Examination Survey (NHANES). Analyzing NHANES dental records, the investigators selected adults at least 30 years old who had periodontal exams. Using standard definitions, they grouped participants into those with no, mild/moderate, or severe periodontitis They used a noninvasive method, the FIB-4 score, to rank participants by fibrosis status: low (below 1.30), intermediate (1.30 to 2.67), or high (above 2.67) likelihood of significant fibrosis. The UNC team assessed the impact of periodontitis on chances of severe fibrosis in a logistic regression model that adjusted for age, sex, race/ethnicity, body mass index, income above versus below 130% of the poverty level, smoking status, unhealthy alcohol use, and diabetes.

The analysis focused on 11,909 people participating in NHANES in 2009-2014, including 2521 with no periodontitis, 8189 with mild/moderate periodontitis, and 1199 with severe periodontitis. Compared with people who had no periodontal disease, those with mild/moderate periodontitis, and severe periodontitis, proved more likely to be older, male (37%, 51%, 72%), non-Hispanic black (7%, 11%, 20%), below 130% of the poverty level (14%, 25%, 38%), a current smoker (11%, 18%, 38%), and a person with metabolic syndrome (44%, 51%, 60%).

Significant fibrosis (FIB-4 above 2.67) affected 1% with no periodontitis, 4% with mild/moderate periodontitis, and 6% with severe periodontitis. Adjusted logistic regression analysis determined that mild/moderate periodontal disease versus no periodontal disease almost doubled the odds of a FIB-4 score above 2.67 versus below 1.30 (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.1 to 2.8), while severe periodontitis almost tripled the odds (aOR 2.8, 95% CI 1.5 to 5.3).

The UNC researchers believe their findings suggest that periodontitis “could be a modifiable risk factor for chronic liver disease” and that “monitoring of periodontal health may provide a tool for risk stratifying patients at high risk of liver disease progression.” They suggested that regular periodontal exams and therapy could help avert development of significant fibrosis or worsening fibrosis in people who already have chronic liver disease.

References
1. Moon A, Galanko JA, Barrit SA IV, et al. Periodontitis is associated with chronic liver disease in a population-based cohort of US adults. AASLD The Liver Meeting Digital Experience, November 13-16, 2020. Abstract 180.
2. National Health Service UK (NHS). The health risks of gum disease. https://www.nhs.uk/live-well/hea ... sks-of-gum-disease/

StephenW

在美國成年人口人群中，牙周炎與慢性肝病有關

美國全國范圍內的口香糖感染使肝纖維化惡化

AASLD肝臟會議數字體驗，2020年11月13日至16日

馬克·馬斯科利尼

在11,909人的美國分析中，牙周疾病（牙齦感染），尤其是嚴重的牙周疾病，獨立地提高了纖維化評分高（慢性肝病的標誌）的機率[1]。由於良好的口腔衛生可以預防或延遲牙周炎，因此該發現可能意味著牙齦疾病可能是可改變的肝病危險因素。

進行這項研究的北卡羅來納大學（UNC）研究人員提醒同事，在美國，慢性肝病的患病率和死亡人數繼續攀升。牙周炎症和牙齦破壞已經增加了心髒病和糖尿病的機會[2]。 UNC團隊想知道牙周疾病是否還會影響肝纖維化的風險，進而影響慢性肝病。

研究人員將重點放在2009-2014年國家健康與營養檢查調查（NHANES）的參與者上。分析了NHANES的牙齒記錄後，研究人員選擇了至少30歲並接受牙周檢查的成年人。根據標准定義，他們將參與者分為沒有，輕度/中度或嚴重牙周炎的參與者。他們使用無創方法FIB-4評分，根據纖維化狀態對參與者進行排名：低（低於1.30），中度（1.30至2.67） ，或發生嚴重纖維化的可能性較高（高於2.67）。 UNC小組在邏輯回歸模型中評估了牙周炎對嚴重纖維化機會的影響，該模型根據年齡，性別，種族/族裔，體重指數，高於或低於貧困線130％的收入，吸煙狀況，不健康飲酒進行了調整和糖尿病。

該分析集中於2009-2014年參加NHANES的11909人，包括2521例無牙周炎，8189例輕/中度牙周炎和1199例嚴重牙周炎。與沒有牙周疾病的人相比，患有輕度/中度牙周炎和重度牙周炎的人被證明年齡更大，男性（37％，51％，72％），非西班牙裔黑人（7％，11％， 20％），低於貧困線的130％（14％，25％，38％），當前吸煙者（11％，18％，38％）和代謝綜合徵患者（44％，51％，60） ％）。

嚴重的纖維化（FIB-4高於2.67）影響1％（無牙周炎），4％（輕度/中度牙周炎）和6％（重度牙周炎）。調整後的邏輯回歸分析確定，輕度/中度牙周疾病與無牙周疾病相比，FIB-4得分高於2.67和低於1.30的機率幾乎翻倍（調整後的優勢比[aOR] 1.7，95％置信區間[CI] 1.1至2.8） ，而嚴重牙周炎的機率幾乎翻了三倍（aOR 2.8，95％CI 1.5至5.3）。

UNC研究人員認為，他們的發現表明，牙周炎“可能是慢性肝病的可改變危險因素”，並且“對牙周健康的監測可能為將高危肝病進展風險的患者進行危險分層提供了一種工具。”他們認為，定期的牙周檢查和治療可以幫助避免已經患有慢性肝病的人發生明顯的纖維化或使纖維化惡化。

參考文獻
1. Moon A，Galanko JA，Barrit SA IV等。在美國成年人口人群中，牙周炎與慢性肝病有關。 AASLD肝臟會議數字體驗，2020年11月13日至16日。摘要180。
2.英國國家衛生局（NHS）。牙齦疾病的健康風險。 https://www.nhs.uk/live-well/hea ... sks-of-gum-disease/