牙周炎与阿尔茨海默病相关性的meta分析

目的： 系统评价牙周炎与阿尔茨海默病的相关性。方法： 计算机检索PubMed、Embase、中国知网、维普和万方数据库,检索时间截至2019年1月,纳入所有牙周炎与阿尔茨海默病相关性的观察性研究文献。由2名研究员独立筛选文献,对符合纳入标准的文献进行资料提取和交叉核对,采用RevMan 5.2软件进行meta分析。结果： 最终纳入的11项研究中,4项为病例对照研究,5项为横断面研究,2项为队列研究。其中,1项队列研究和4项病例对照研究视牙周炎为暴露因素,5项横断面研究和1项队列研究视阿尔茨海默病为暴露因素。Meta分析显示,牙周炎患者的阿尔茨海默病发生风险合并RR值为1.22（95%CI：1.13~1.33）,结果有统计学差异（P<0.00001）。中度牙周炎患者阿尔茨海默病发生风险合并RR值为1.19（95%CI：0.98~1.44）,无统计学差异（P=0.07>0.05）。重度牙周炎阿尔茨海默病发生风险合并RR值为1.54（95%CI：1.05~2.26）,结果有统计学差异（P=0.03<0.05）。牙周临床指标的meta分析显示,与对照组相比,阿尔茨海默病患者组的探诊深度（MD=2.58,95%CI：0.17~4.99,P=0.04<0.05）、附着丧失（MD=1.27,95%CI：0.43~2.10,P=0.003<0.05）、菌斑指数（MD=1.14,95%CI：0.85~1.44,P<0.00001）和探诊出血百分比（MD=21.11%,95%CI：18.23%~23.99%,P<0.00001）均较高,而口内的余留牙数（MD=-3.77,95%CI：-6.89~-0.65,P=0.02<0.05）较少。结论： 牙周炎与阿尔茨海默病存在相关性,牙周炎患者（尤其是重度牙周炎患者）可能有较高的阿尔茨海默病发病风险,且阿尔茨海默病患者的牙周健康往往较差。但现有研究数量有限,仍需更多临床证据支持。

Association between periodontitis and Alzheimer disease: a meta analysis

PURPOSE: To evaluate the association between periodontitis and Alzheimer's disease. METHODS: Databases of PubMed, Embase, CNKI, VIP and WanFang databases were searched for the relevant observational studies focusing on the association between periodontitis and Alzheimer's disease. The deadline was January 2019. Data quality evaluation and extraction were independently conducted by two authors. Meta analysis was performed using RevMan 5.2 software. RESULTS: Four case-control, five cross-sectional and two cohort studies were included. One cohort study and four case-control studies treated periodontitis as the exposure factor, all five cross-sectional studies and the other cohort study treated Alzheimer's disease as the exposure factor. The results of meta analysis showed that patients with periodontitis had a higher risk of Alzheimer's disease (RR=1.22, 95%CI: 1.13-1.33, P<0.00001), and the risk was more higher in patients with severe periodontitis(RR=1.54, 95%CI:1.05-2.26, P=0.03<0.05); but there was no significant difference in the risk of Alzheimer's disease in patients with moderate periodontitis (RR=1.19, 95%CI: 0.98-1.44, P=0.07>0.05). The results of meta-analysis also showed that probing depth in patients with Alzheimer's disease was significantly higher than that of the control group (MD=2.58, 95%CI: 0.17-4.99, P=0.04<0.05), as well as clinical attachment loss (MD=1.27, 95%CI: 0.43-2.10, P=0.003<0.05), plaque index (MD=1.14, 95%CI: 0.85-1.44, P<0.00001) and the percentage of bleeding on probing (MD=21.11%, 95%CI: 18.23%-23.99%, P<0.00001). Furthermore, the number of present teeth in patients with Alzheimer's disease was significantly less than that of the control group (MD=-3.77, 95% CI: -6.89- -0.65, P=0.02<0.05). CONCLUSIONS: The current evidence indicates that periodontitis is associated with Alzheimer's disease and patients with periodontitis (especially severe periodontitis) probably have a higher risk of developing Alzheimer's disease, and patients with Alzheimer's disease tend to have poorer periodontal health. However, the number of existing studies is limited and more clinical evidences are needed to support the correlation between these two diseases.