国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (2): 165-172.doi: 10.7518/gjkq.2021040

• 论著 • 上一篇    下一篇

牙周病和心肌梗死发生风险相关性队列研究的Meta分析

秦小茹(),刘梦圆   

  1. 山西医科大学汾阳学院临床医学系 汾阳 032200
  • 收稿日期:2020-09-26 修回日期:2020-11-20 出版日期:2021-03-01 发布日期:2021-03-17
  • 通讯作者: 秦小茹
  • 作者简介:秦小茹,学士,Email: a13546432963@126.com
  • 基金资助:
    山西省教育厅大学生创新创业训练计划项目(2019825)

Association between periodontal disease and myocardial infarction: a Meta-analysis of cohort studies

Qin Xiaoru(),Liu Mengyuan   

  1. Dept. of Clinical Medicine, Fenyang College, Shanxi Medical University, Fenyang 032200, China
  • Received:2020-09-26 Revised:2020-11-20 Online:2021-03-01 Published:2021-03-17
  • Contact: Xiaoru Qin
  • Supported by:
    Innovation and Entrepreneurship Training Projects for College Students of Shanxi Province Education Department(2019825)

摘要:

目的 采用Meta分析探讨牙周病和心肌梗死(MI)发生风险的相关性。方法 采用计算机检索PubMed、Embase、Cochrane library、CNKI、万方、维普和中国生物医学文献数据库中关于牙周病与MI相关性的队列研究,检索时限均为建库至2020年8月31日。由2位研究人员独立筛选文献并提取资料,采用纽卡斯尔-渥太华量表(NOS)评价所纳入研究的偏移风险,采用Review Manager 5.3软件进行Meta分析,计算纳入文献的合并危险比(RR)及95%置信区间(CI),并进行亚组分析和敏感性分析以确定异质性来源。结果 共纳入8个队列研究,涉及的总研究人数为207 922例。Meta分析结果显示:牙周病患者发生MI风险增加(RR=1.21,95%CI为1.05~1.40,P=0.008);敏感性分析表明:Meta分析结果的稳健性良好;亚组分析结果显示:性别(女性:RR=1.39,95%CI为1.17~1.65,P=0.000 2;男性:RR=1.05,95%CI为0.89~1.24,P=0.580)、测量指标、效应值、研究质量对结果有明显影响。结论 牙周病与MI发生有相关性,在女性人群中尤其明显。

关键词: 牙周病, 心肌梗死, 队列研究, Meta分析

Abstract:

Objective This meta-analysis aimed to systematically assess the association between periodontal disease (PD) and myocardial infarction (MI) in cohort studies. Methods We searched the PubMed, Embase, Cochrane library, CNKI, WanFang Data, VIP database, and China Biology Medicine disc database from inception to August 31, 2020 for eligible cohort studies on the association between PD and MI. Two independent reviewers performed the data extraction and assessed the study quality by using the Newcastle-Ottawa scale. A Meta-analysis was performed to pool the risk ratios (RRs) and 95% confidence intervals (CIs) by using the Review Manager 5.3 software. Then, the source of heterogeneity was determined through the subgroup and the sensitivity analyses. Results Eight cohort studies involving 207 922 participants met the inclusion criteria. This Meta-analysis showed that the pooled RR for the association between PD and MI was 1.21 (95% CI: 1.05-1.40, P=0.008). The sensitivity analysis indicated that the results were robust. The subgroup analyses revealed that gender (female: RR=1.39, 95% CI: 1.17-1.65, P=0.000 2; male: RR=1.05, 95% CI: 0.89-1.24, P=0.580), measurement index, effect value, and quality of literature affected the results. Conclusion Given the high-quality evidence from the included cohort studies, results support the presence of a considerable association between PD and MI especially in women.

Key words: periodontal disease, myocardial infarction, cohort studies, Meta-analysis

中图分类号: 

  • R781.4

图1

文献筛选流程及结果"

表1

纳入研究的基本特征"

纳入研究 国家 研究设计 样本量
(男/女)
病例数 研究
时间/年
年龄/岁
(病例/对照)
测量指标 效应量
(95% CI)
校正因素
Joshipura
1996[4]
美国 回顾性队列
研究
44 119
(男)
757 6 40~75 未报告 RR=1.04
(0.86~1.25)
年龄、体质量指数、运动、吸烟饮酒、MI家族史、维生素E
Howell
2001[5]
美国 回顾性队列
研究
2 653
(男)
797 13 40~84 未报告 RR=1.01
(0.82~1.24)
年龄、阿司匹林、β-胡萝卜素治疗、吸烟、饮酒、高血压、体质量指数、糖尿病、体育活动、MI家族病史
Dorn
2010[6]
美国 前瞻性队列
研究
884
(668/216)
154 8 54.5±8.4 CAL HR=1.48
(0.95~2.31)
年龄、性别、教育程度、糖尿病、射血分数、高血压、体育活动、胆固醇、降脂药物、体质量指数、水果/蔬菜摄入量、磷酸肌酸酶
Noguchi
2014[7]
日本 回顾性队列
研究
3 081
(男)
17 5 36~59 未报告 OR=2.26
(0.84~6.02)
年龄、体质量指数、吸烟史、高血压、糖尿病、血脂异常及家族心脏病史
Yu
2015[8]
美国 回顾性队列
研究
39 863
(女)
642 3 48.7~60.3 未报告 HR=1.39
(1.17~1.64)
年龄
Liljestrand
2015[9]
芬兰 回顾性队列
研究
7 629
(3 754/3 875)
253 13 25~74 缺牙数 HR=1.92
(1.42~2.59)
收缩压、血压治疗(0~7 d内用药,有或无)、TC、HDL-C、教育程度(3类)、现患有糖尿病
Hansen
2016[10]
丹麦 回顾性队列
研究
100 694
(57 421/43 273)
未报告 14 57.3±15.1/56.6±15.0 未报告 RR=1.16
(1.04~1.30)
年龄、性别、吸烟、并发症、药物和社会经济地位
Holmlund
2017[11]
瑞士 前瞻性队列
研究
8 999
(3 870/5 129)
672 33 50±13 牙齿数,深牙周袋数*,探诊出血 RR=0.99
(0.92~1.06)
年龄、性别、教育程度和吸烟

表2

纳入研究的NOS评分"

纳入研究 暴露队列的代表性 非暴露队列的选择 暴露的确定 研究开始时未
出现结局事件
基于设计或分析所得的队列可比性 结局事件
评估
随访时间
是否充足
随访队列
是否充足
总分
Joshipura 1996[4] 1 1 0 1 0 1 1 1 6
Howell 2001[5] 1 1 0 1 0 1 1 0 5
Dorn 2010[6] 1 1 1 1 2 0 1 1 8
Noguchi 2014[7] 1 1 1 1 0 0 0 0 4
Yu 2015[8] 0 1 0 1 0 1 1 1 5
Liljestrand 2015[9] 1 1 1 1 0 1 1 1 7
Hansen 2016[10] 1 1 1 1 2 1 1 1 9
Holmlund 2017[11] 1 0 1 1 0 1 1 0 5

图2

牙周病与MI发生风险相关性的森林图"

表3

牙周病与MI发生风险相关性的亚组分析"

亚组 指标 纳入研究数 效应模型 异质性检验 Meta 分析结果
I2/% P RR(95%CI) P
性别 3[4-5,7] 随机 18 0.3 1.05(0.89~1.24) 0.580
1[8] 随机 - - 1.39(1.17~1.65) 0.000 2
测量指标 CAL 1[6] 随机 - - 1.48(0.95~2.31) 0.08
其他 2[9,11] 随机 94 <0.000 1 1.36(0.71~2.59) 0.36
未报告 5[4-5,7-8,10] 随机 55 0.06 1.16(1.02~1.33) 0.03
效应值 RR 4[4-5,10-11] 随机 47 0.13 1.05(0.96~1.15) 0.29
OR 1[7] 随机 - - 2.26(0.84~6.08) 0.11
HR 3[6,8-9] 随机 40 0.19 1.55(1.26~1.91) <0.000 1
研究质量 中等 5[4-5,7-8,11] 随机 73 0.005 1.11(0.95~1.31) 0.20
3[6,9-10] 随机 80 0.006 1.46(1.02~2.07) 0.04

表 4

牙周病与MI发生风险相关性的敏感性分析(逐一剔除研究)"

排除研究 效应模型 异质性检验 Meta 分析结果
I2/% P RR(95%CI) P
Joshipura 1996[4] 随机 82 <0.000 01 1.26(1.06~1.48) 0.008
Howell 2001[5] 随机 82 <0.000 01 1.26(1.07~1.48) 0.006
Dorn 2010[6] 随机 81 <0.000 01 1.20(1.03~1.39) 0.02
Noguchi 2014[7] 随机 81 <0.000 01 1.20(1.04~1.38) 0.01
Yu 2015[8] 随机 70 0.003 1.14(1.01~1.28) 0.04
Liljestrand 2015[9] 随机 76 0.000 3 1.18(1.02~1.37) 0.03
Hansen 2016[10] 随机 81 <0.000 1 1.25(1.03~1.50) 0.02
Holmlund 2017[11] 随机 70 0.003 1.27(1.09~1.49) 0.003
[1] Xu S, Song MB, Xiong Y, et al. The association between periodontal disease and the risk of myocardial infarction: a pooled analysis of observational studies[J]. BMC Cardiovasc Disord, 2017,17(1):1-11.
doi: 10.1186/s12872-016-0436-7 pmid: 28052754
[2] Ma LY, Chen WW, Gao RL, et al. China cardiovascular diseases report 2018: an updated summary[J]. J Geriatr Cardiol, 2020,17(1):1-8.
pmid: 32133031
[3] Mattila KJ, Nieminen MS, Valtonen VV, et al. Association between dental health and acute myocardial infarction[J]. BMJ, 1989,298(6676):779-781.
doi: 10.1136/bmj.298.6676.779 pmid: 2496855
[4] Joshipura KJ, Rimm EB, Douglass CW, et al. Poor oral health and coronary heart disease[J]. J Dent Res, 1996,75(9):1631-1636.
doi: 10.1177/00220345960750090301 pmid: 8952614
[5] Howell TH, Ridker PM, Ajani UA, et al. Periodontal disease and risk of subsequent cardiovascular disease in US male physicians[J]. J Am Coll Cardiol, 2001,37(2):445-450.
[6] Dorn JM, Genco RJ, Grossi SG, et al. Periodontal disease and recurrent cardiovascular events in survivors of myocardial infarction (MI): the Western New York Acute MI Study[J]. J Periodontol, 2010,81(4):502-511.
doi: 10.1902/jop.2009.090499 pmid: 20367093
[7] Noguchi S, Toyokawa S, Miyoshi Y, et al. Five-year follow-up study of the association between periodontal disease and myocardial infarction among Japanese male workers: MY Health Up Study[J]. J Public Health (Oxf), 2015, 37(4): 605-611. Epub 2014, Oct 7.
[8] Yu YH, Chasman DI, Buring JE, et al. Cardiovascular risks associated with incident and prevalent pe-riodontal disease[J]. J Clin Periodontol, 2015,42(1):21-28.
pmid: 25385537
[9] Liljestrand JM, Havulinna AS, Paju S, et al. Missing teeth predict incident cardiovascular events, diabetes, and death[J]. J Dent Res, 2015,94(8):1055-1062.
pmid: 25991651
[10] Hansen GM, Egeberg A, Holmstrup P, et al. Relation of periodontitis to risk of cardiovascular and all-cause mortality (from a Danish nationwide cohort study)[J]. Am J Cardiol, 2016,118(4):489-493.
[11] Holmlund A, Lampa E, Lind L. Oral health and cardiovascular disease risk in a cohort of periodontitis patients[J]. Atherosclerosis, 2017,262:101-106.
doi: 10.1016/j.atherosclerosis.2017.05.009 pmid: 28531825
[12] Park SY, Kim SH, Kang SH, et al. Improved oral hygiene care attenuates the cardiovascular risk of oral health disease: a population-based study from Korea[J]. Eur Heart J, 2019,40(14):1138-1145.
doi: 10.1093/eurheartj/ehy836 pmid: 30561631
[13] Emingil G, Buduneli E, Aliyev A, et al. Association between periodontal disease and acute myocardial infarction[J]. J Periodontol, 2000,71(12):1882-1886.
[14] Shi Q, Zhang B, Huo N, et al. Association between myocardial infarction and periodontitis: a meta-analysis of case-control studies[J]. Front Physiol, 2016,7:519.
doi: 10.3389/fphys.2016.00519 pmid: 27867362
[15] 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具[J]. 中国循证心血管医学杂志, 2012,4(4):297-299.
Zeng XT, Liu H, Chen X, et al. The fourth of Meta analysis series: quality evaluation tools for obser-vational research[J]. Chin J Evid-Based Cardiovasc Med, 2012,4(4):297-299.
[16] Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010,25(9):603-605.
doi: 10.1007/s10654-010-9491-z pmid: 20652370
[17] Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration[J]. BMJ, 2009,339:b2700.
doi: 10.1136/bmj.b2700 pmid: 19622552
[18] Walter SD, Cook RJ. A comparison of several point estimators of the odds ratio in a single 2×2 contingency table[J]. Biometrics, 1991,47(3):795-811.
[19] Andriankaja OM, Genco RJ, Dorn J, et al. Periodontal disease and risk of myocardial infarction: the role of gender and smoking[J]. Eur J Epidemiol, 2007,22(10):699-705.
pmid: 17828467
[20] Sanz M, Marco del Castillo A, Jepsen S, et al. Periodontitis and cardiovascular diseases: consensus report[J]. J Clin Periodontol, 2020,47(3):268-288.
doi: 10.1111/jcpe.13189 pmid: 32011025
[21] Yamazaki K, Honda T, Domon H, et al. Relationship of periodontal infection to serum antibody levels to periodontopathic bacteria and inflammatory markers in periodontitis patients with coronary heart disease[J]. Clin Exp Immunol, 2007,149(3):445-452.
doi: 10.1111/j.1365-2249.2007.03450.x pmid: 17645769
[22] Roeters van Lennep JE, Westerveld HT, Erkelens DW, et al. Risk factors for coronary heart disease: implications of gender[J]. Cardiovasc Res, 2002,53(3):538-549.
[23] Regitz-Zagrosek V, Lehmkuhl E, Weickert MO. Gender differences in the metabolic syndrome and their role for cardiovascular disease[J]. Clin Res Cardiol, 2006,95(3):136-147.
doi: 10.1007/s00392-006-0351-5 pmid: 16598526
[24] Kozarov EV, Dorn BR, Shelburne CE, et al. Human atherosclerotic plaque contains viable invasive Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis[J]. Arterioscler Thromb Vasc Biol, 2005,25(3):e17-e18.
pmid: 15662025
[25] Ross R. Atherosclerosis: an inflammatory disease[J]. N Engl J Med, 1999,340(2):115-126.
[26] Haraszthy VI, Zambon JJ, Trevisan M, et al. Identification of periodontal pathogens in atheromatous plaques[J]. J Periodontol, 2000,71(10):1554-1560.
pmid: 11063387
[27] 朱赟婕, 陈晖. 牙龈卟啉单胞菌与冠心病之间的关系[J]. 国际口腔医学杂志, 2012,39(6):782-785, 789.
Zhu YJ, Chen H. Relationship between Porphyromo-nas gingivalis and coronary heart disease[J]. Int J Stomatol, 2012,39(6):782-785, 789.
[28] 焦丽宁, 毕良佳, 林江. 单核细胞趋化蛋白-1和细胞间黏附分子-1与动脉粥样硬化和牙周病的关系[J]. 国际口腔医学杂志, 2012,39(1):105-109.
Jiao LN, Bi LJ, Lin J. Relation of monocyte chem-oattractant protein-1 and intercellular adhesion mole-cule-1 between atherosclerosis and periodontal disea-se[J]. Int J Stomatol, 2012,39(1):105-109.
[29] Schenkein HA, Loos BG. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases[J]. J Clin Periodontol, 2013,40(Suppl 14):S51-S69.
[30] Teeuw WJ, Slot DE, Susanto H, et al. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis[J]. J Clin Periodontol, 2014,41(1):70-79.
pmid: 24111886
[31] Chu DC, Lee YL, Hu HY, et al. Dental prophylaxis decreases the risk of acute myocardial infarction: a nationwide population-based study in Taiwan[J]. Clin Interv Aging, 2015: 175-182.
[32] Vidal F, Cordovil I, Figueredo CMS, et al. Non-surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study[J]. J Clin Periodontol, 2013,40(7):681-687.
pmid: 23639076
[33] Danesh J. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses[J]. BMJ, 2000,321(7255):199-204.
pmid: 10903648
[34] Ridker PM, Silvertown JD. Inflammation, C-reactive protein, and atherothrombosis[J]. J Periodontol, 2008,79(8 Suppl):1544-1551.
doi: 10.1902/jop.2008.080249 pmid: 18673009
[35] Schenkein HA, Papapanou PN, Genco R, et al. Mechanisms underlying the association between periodontitis and atherosclerotic disease[J]. Periodontol 2000, 2020,83(1):90-106.
[1] 刘玲,龚仁国,董秀华,刘入梦. 正畸联合双颌手术治疗前牙区严重骨性开长期稳定性的Meta分析[J]. 国际口腔医学杂志, 2021, 48(2): 173-179.
[2] 汪是琦,常雅琴,陈斌,谭葆春,泥艳红. 植骨术与植骨联用屏障膜在牙周再生治疗中临床疗效对比的系统评价与Meta分析[J]. 国际口腔医学杂志, 2020, 47(6): 644-651.
[3] 郏乐铭,贾小玥,杨燃,周学东,徐欣. 益生菌制剂在牙周病防治中的应用进展[J]. 国际口腔医学杂志, 2020, 47(5): 515-521.
[4] 侯亚丽,马利. 亚洲人群干扰素调节因子6基因多态性与非综合征型唇腭裂相关性研究的Meta分析[J]. 国际口腔医学杂志, 2020, 47(4): 397-405.
[5] 张琳琳,杜毅. 畸形舌侧沟的治疗进展[J]. 国际口腔医学杂志, 2020, 47(4): 458-462.
[6] 刘琳,周婕妤,吴亚菲,赵蕾. 益生菌生态调节在牙周病防治中的应用[J]. 国际口腔医学杂志, 2020, 47(2): 131-137.
[7] 程国平,丁一,郭淑娟. 静电纺丝纤维作为牙周药物传递系统的研究进展[J]. 国际口腔医学杂志, 2019, 46(5): 565-570.
[8] 高洁,马锐,葛振林. 热激活镍钛弓丝矫治效率的系统评价[J]. 国际口腔医学杂志, 2019, 46(4): 393-399.
[9] 胡竹林,赵诣,李茵. 口腔龈沟液生物标志物的检测分析现状及临床应用前景展望[J]. 国际口腔医学杂志, 2019, 46(3): 308-315.
[10] 郭淑娟, 刘倩, 丁一. 牙周病和植体周病国际新分类简介[J]. 国际口腔医学杂志, 2019, 46(2): 125-134.
[11] 潘韦霖,曹钰彬,刘畅,刘济远,李春洁,潘剑,华成舸. 不同翻瓣设计对下颌第三磨牙拔除术后疼痛的影响:系统评价与Meta分析[J]. 国际口腔医学杂志, 2019, 46(2): 142-148.
[12] 黄婕,林云红. 种植体周围角化龈宽度与种植体周围骨高度的相关性[J]. 国际口腔医学杂志, 2019, 46(2): 149-155.
[13] 闫凯娴,李纾. 非牙周病性龈病损[J]. 国际口腔医学杂志, 2019, 46(2): 177-185.
[14] 董正谋,刘锐,刘鲁川,温秀杰. 种子细胞在牙周组织再生治疗中的研究进展[J]. 国际口腔医学杂志, 2019, 46(1): 48-54.
[15] 叶畅畅, 赵蕾, 王冬青, 王晓丽, 王海燕, 游梦, 黄萍, 吴亚菲. 妊娠期牙周疾病的防治策略[J]. 国际口腔医学杂志, 2018, 45(5): 501-508.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 王昆润. 在种植体上制作固定义齿以后下颌骨密度的动态变化[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 王昆润. 修补颌骨缺损的新型生物学相容材料[J]. 国际口腔医学杂志, 1999, 26(06): .
[3] 王昆润. 二甲亚砜和双氯芬酸并用治疗根尖周炎[J]. 国际口腔医学杂志, 1999, 26(06): .
[4] 汤庆奋,王学侠. 17β-雌二醇对人类阴道和口腔颊粘膜的渗透性[J]. 国际口腔医学杂志, 1999, 26(06): .
[5] 宋红. 青少年牙周炎外周血分叶核粒细胞的趋化功能[J]. 国际口腔医学杂志, 1999, 26(06): .
[6] 高卫民,李幸红. 发达国家牙医学院口腔种植学教学现状[J]. 国际口腔医学杂志, 1999, 26(06): .
[7] 王昆润. 长期单侧鼻呼吸对头颅发育有不利影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[8] 潘劲松. 颈总动脉指压和颈内动脉球囊阻断试验在大脑血液动力学中的不同影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[9] 逄键梁. 两例外胚层发育不良儿童骨内植入种植体后牙槽骨生长情况[J]. 国际口腔医学杂志, 1999, 26(05): .
[10] 王昆润. 后牙冠根斜形牙折的治疗[J]. 国际口腔医学杂志, 1999, 26(05): .