慢性歯周炎を有するCOPD患者の肺機能，歯周保健，唾液中のMatrix Metalloproteinase-8に対する非外科的歯周治療の影響．臨床生化学的研究（A Clinico-biochemical Study

Impact of Non-surgical Periodontal Therapy on Pulmonary functions, Periodontal Health and Salivary Matrix Metalloproteinase-8 of COPD Patients with Chronic Periodontitis: A Clinico-biochemical Study.

抄録

目的:

本研究の目的は、慢性歯周炎（CP）を併発した慢性閉塞性肺疾患（COPD）患者において、非外科的歯周治療（NSPT）が歯周臨床パラメータ、呼吸器系指標、唾液中の MMP-8 レベルに与える影響を全身的に健康な CP と比較検討することである。

OBJECTIVE: The aim of the study was to assess the impact of non-surgical periodontal therapy (NSPT) on periodontal clinical parameters, spirometric indices, and salivary MMP-8 levels in patients with chronic obstructive pulmonary disease (COPD) with concurrence of chronic periodontitis (CP) compared with systemically healthy CP.

材料および方法:

この前向き臨床生化学研究では、様々な社会経済層に属する合計 75 名の患者を、無作為に CP [少なくとも 20 歯以上、2 歯部位以上でポケットプロービングデプス (PPD) または臨床的付着力喪失 (CAL) 4mm 以上、プロービング時出血 (BOP) を伴う] を併発したケース、すなわち Global Initiative for Obstructive Lung Disease (GOLD) 基準による COPD 患者とコントロール (systemically healthy CP) とに分けて、試験を実施しました。両群ともNSPTを行い，ベースライン，3，6，12カ月目のプラーク指数（PI），歯肉指数（GI），PPD，CAL，BOPおよびスパイロメーター（FEV1/FVC）値，ベースラインと3カ月目の唾液中MMP-8濃度を評価した．

MATERIAL AND METHODS: In this prospective clinico-biochemical study, a total of 75 patients belonging to various socioeconomic strata were randomly divided into cases, that is, COPD patients as per the Global Initiative for Obstructive Lung Disease (GOLD) criteria with concurrence of CP [at least ≥ 20 teeth with ≥ 2 tooth sites having pocket probing depth (PPD) or clinical attachment loss (CAL) ≥ 4mm and bleeding on probing (BOP)] and controls (systemically healthy CP). Both groups underwent NSPT and were evaluated for plaque index (PI), gingival index (GI), PPD, CAL, and BOP and spirometry (FEV1/forced vital capacity (FVC)) values at baseline, 3, 6, and 12 months and for salivary MMP-8 levels at baseline and 3 months.

結果:

統計の結果、症例（CPを伴うCOPD、n=37）は対照（全身健康なCP、n=38）と比較して、有意に高齢（平均年齢56.16±9.01歳）、元喫煙者（48.6%）、男性優位（78.4%）、上位中流階級に属する（40.5%）ことが示された。NSPT後，3，6，12カ月後の両群でPI，GI，PPD，CAL，BOPの平均値に有意な改善が認められ，対照群ではより良好な結果が得られた。12ヵ月後のFEV1/FVCは，症例で有意な改善（P < 0.001）がみられたが，対照群では有意な変化はみられなかった．3 ヵ月後の MMP-8 値は，症例（P = .002）および対照群（P < .001）で有意に減少していた．

RESULTS: Statistical results showed that cases (COPD with CP; n = 37) were significantly older (mean age 56.16 ± 9.01 years), ex-smokers (48.6%) with male preponderance (78.4%), and belonged to the upper middle class (40.5%) as compared to controls (systemically healthy CP; n = 38). After NSPT, significant improvement in mean PI, GI, PPD, CAL, and BOP was observed in both groups at 3, 6, and 12 months with better results in controls. FEV1/FVC was significantly improved (P < .001) in cases with insignificant change in controls at 12 months. After 3 months, MMP-8 levels were significantly reduced in cases (P = .002) and controls (P < .001).

結論:

本研究は，COPD 患者が健常者に比べて歯周病状態が悪いことを示す重要なエビデンスである．さらに，これらの患者では，FEV1/FVC の改善が認められたが，試験終了時に NSPT を行ったにもかかわらず，唾液中の MMP-8 値が高く，肺疾患による全身的な炎症性負荷が関与している可能性が示唆された．

CONCLUSION: The present study provided substantial evidence that COPD patients have poorer periodontal health as compared to systemically healthy counterparts. Further, these patients showed improvement in FEV1/FVC, however, with higher salivary MMP-8 levels despite NSPT at the end of the study, indicating a possible role of systemic inflammatory overburden of pulmonary disease.