脳梗塞および糖尿病性腎不全患者におけるAggregatibacter actinomycetemcomitans感染の高発生率：横断的研究

High incidence of Aggregatibacter actinomycetemcomitans infection in patients with cerebral infarction and diabetic renal failure: a cross-sectional study.

抄録

背景:

近年の疫学研究から、歯周炎は腎不全や脳梗塞の主要なリスクファクターであることが示唆されている。本研究の目的は，歯周炎と腎不全および脳梗塞の関連性を微生物学的および免疫学的な特徴を中心に検討することである．

BACKGROUND: Recent epidemiological studies suggest that periodontitis is a major risk factor for renal failure and cerebral infarction. The aim of this study was to evaluate the association among periodontitis, renal failure, and cerebral infarction, focusing on microbiological and immunological features.

方法:

本研究では，血液透析（HD）患者21名を登録した．内訳は，糖尿病性腎症8名，非糖尿病性腎症13名であった．血液検査，歯周病検査，脳磁気共鳴画像（MRI），歯科X線撮影を全例に実施した．歯垢，唾液および血液から，歯周病菌であるAggregatibacter actinomycetemcomitans（A. actinomycetemcomitans），Porphyromonas gingivalis（P. gingivalis）およびPrebotella intermedia（P. intermedia）について定量リアルタイムPCR（qRT-PCR）と酵素結合免疫吸着法（ELISA）により分析を行い，以下の結果を得た．

METHODS: Twenty-one patients treated with hemodialysis (HD) were enrolled in this study. They were 8 with diabetic nephropathy and 13 with non-diabetic nephropathy. Blood examination, periodontal examination, brain magnetic resonance image (MRI), and dental radiography were performed on all patients. Subgingival plaque, saliva, and blood samples were analyzed for the periodontal pathogens, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), and Prevotella intermedia (P. intermedia) using quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA).

結果:

糖尿病性腎症患者では、非糖尿病性腎症患者に比べ、歯垢中にA. actinomycetemcomitansが多く認められた（P=0.038）。さらに，糖尿病性腎症患者では，非糖尿病性腎症患者に比べ，脳梗塞の発症率が有意に高かった（P＝0.029）．また，糖尿病性腎症群では非糖尿病性腎症群に比べ，口腔内臨床検査およびX線検査のスコアが高い傾向がみられた．

RESULTS: We found that the patients with diabetic nephropathy had more A. actinomycetemcomitans compared with non-diabetic nephropathy (P = 0.038) in dental plaque. Furthermore, the patients with diabetic nephropathy showed a significantly higher incidence of cerebral infarction compared with those with non-diabetic nephropathy (P = 0.029). Clinical oral and radiographic scores tended to be higher among patients in the diabetic nephropathy group than in the non-diabetic nephropathy group.

結論:

日本人の糖尿病性腎症患者では，歯周病原体，特にA. actinomycetemcomitansが脳梗塞の発症に少なくとも一役買っている可能性が示唆された．

CONCLUSIONS: Periodontal pathogens, particularly A. actinomycetemcomitans, may play a role, at least a part, in the development of cerebral infarction in Japanese HD patients with diabetic nephropathy.