血友病患者は一般人口に比べてう蝕のリスクが高いのか？

Do hemophiliacs have a higher risk for dental caries than the general population?

抄録

目的:

本研究の目的は、血友病患者が一般人口と比較して虫歯のリスクが高いかどうかを検討することである。

OBJECTIVE: The aim of this study was to examine if patients with hemophilia were at increased risk for dental decay as compared to the general population.

材料と方法:

この症例対照研究では、国勢調査を用いて症例（血友病患者）を募集し、一般人口から無作為に募集した対照群の個人は、性別、年齢、居住地に基づいて症例と一致させた。臨床検査では，歯の健康状態と唾液の評価（流量，緩衝能，う蝕関連細菌）を行い，社会経済的地位と歯の健康に関連する行動についての構造化質問票を作成した。

MATERIALS AND METHODS: Census sampling was used in this case-control study to recruit cases (patients with hemophilia) and a control group individuals recruited randomly from the general population, which were matched with cases based on gender, age and place of residence. Clinical examinations included dental health and salivary assessments (flow rate, buffer capacity, caries-associated bacteria) and a structured questionnaire which inquired about socioeconomic status and dental health-related behaviors.

結果:

乳歯列では，血友病患者（2.6±2.6）とマッチさせた健常対照者（6.1±2.5）との間で，全体的なう蝕経験（dmf）が統計的に有意に異なっていた（P=0.003）．二変量解析では，血友病患者よりも健常対照者の方が乳歯列において高い細菌数が認められたことを除いて，唾液の機能に関して症例と対照者の間に有意な差は認められなかった（P=0.019）。血友病でない子供は，血友病患者よりも社会経済的地位の高い家庭の出身であったが（P=0.004），成人ではそのような違いは見られなかった（P=0.090）。健康な成人と比較すると、成人の血友病患者は、歯磨き時だけでなく、安静時にも歯肉からの出血が多く（P<0.001）、対照群と比較して清涼飲料水の摂取量も多かった（P=0.025）。

RESULTS: In the deciduous dentition, the overall caries experience (dmf) differed statistically significantly (P=0.003) between the hemophiliacs (2.6±2.6) and their matched healthy controls (6.1±2.5). Bivariate analyses did not reveal significant differences between cases and controls regarding salivary functions, except that higher bacteriological counts were found in healthy controls in deciduous dentitions than in patients with hemophilia (P=0.019). Children without hemophilia were from higher socioeconomic status families than hemophiliacs (P=0.004), but such differences were not found for adults (P=0.090). When compared to healthy adults, adult hemophiliacs had more gum bleeding at rest (P<0.001) as well as during their tooth brushing (P=0.007) and they also consumed more soft drinks than controls (P=0.025).

結論:

血友病患者の歯の健康状態は、血友病でない子どもと比較して良好であった。成人の血友病患者と一般の健康な対照者の間では、歯の健康状態に差はなかった。線形重回帰モデルでは、他の齲蝕決定要因を考慮しても、血友病が追加的な齲蝕リスクとなることは確認されなかった。

CONCLUSIONS: Better dental health was observed in children with hemophilia as compared to children without it. There were no differences in dental health between adult hemophiliacs and healthy controls from the general population. None of the linear multiple regression models confirmed hemophilia to be an additional caries risk when it was controlled for other caries determinants.