歯周炎の有無による慢性腎臓病患者の糖尿病および腎臓状態への赤色複合細菌とTNF-αレベルの影響

Impact of Red Complex Bacteria and TNF-α Levels on the Diabetic and Renal Status of Chronic Kidney Disease Patients in the Presence and Absence of Periodontitis.

抄録

歯周炎の病因と慢性腎臓病（CKD）には正の相関があることを示す科学的証拠がある。肥満、糖尿病、炎症などの様々な交絡因子もCKDの進行に重要な役割を果たすが、まだ未解明である。我々は、慢性腎臓病に関連する様々な交絡因子と赤色複合細菌の役割について仮説を立てている。本研究は、コントロール群（C）、CKDを持たない歯周炎被験者（P）、歯周病の健康な慢性腎臓病被験者（CKD）、歯周炎とCKDの両方を持つ被験者（P＋CKD）の4群に分類され、各群30名の合計120名で構成されている。人口統計学的変数，歯周病，腎臓，糖尿病の各パラメーターが記録された．TNF-α値および（），（），（）のような赤色複合細菌の値を評価し，得られた結果を統計的に分析した．様々な人口統計学的変数の中で、年齢が有意なレベルを示した。PI，GI，CAL，PPD（PPD≧5mm，CAL≧3mmの部位の割合）の平均値は，P＋CKD群で上昇した．空腹時血糖値（FBS）、HbA1c値などの糖尿病パラメータもP＋CKD群で高かった。eGFRや血清クレアチニン値などの腎臓パラメータはCKD患者においてより大きかった。赤色複合歯周病菌の推定値は，P群およびP+CKD群で， , および , レベルが有意に高かった．ピアソン相関分析の結果，赤色複合細菌はすべての変数と有意な相関が認められた．また，P群では， , および , のレベルが高く，糖尿病を交絡因子とする歯周炎およびCKDの炎症の開始および進行に重要な役割を担っていることが示唆された．また、TNF-α濃度と赤色複合細菌の間には対数線形関係が確認され、歯周病の進行における炎症性バイオマーカーの役割は、CKDなどの全身性炎症の発症に寄与する可能性があることが示された。

Scientific evidence shows a positive association in the etiopathogenesis of periodontitis and chronic kidney disease (CKD). Various confounding factors, such as obesity, diabetes, and inflammation, also play a significant role in the progression of CKD, which remains unexplored. We hypothesise the role of red complex bacteria with various confounding factors associated with chronic kidney disease. The study comprised a total of 120 participants categorised into 4 groups: the control group (C), periodontitis subjects without CKD (P), periodontally healthy chronic kidney disease subjects (CKD), and subjects having both periodontitis and CKD (P + CKD), with 30 subjects in each group. Demographic variables, and periodontal, renal, and diabetic parameters were recorded. Tumour necrosis factor (TNF)-α levels and those of red complex bacteria such as (), (), () were assessed, and the obtained results were statistically analysed. Among the various demographic variables, age showed a level of significance. Mean PI, GI, CAL, and PPD (the proportion of sites with PPD ≥ 5 mm and CAL ≥ 3 mm) were elevated in the P + CKD group. Diabetic parameters such as fasting blood sugar (FBS) and HbA1c levels were also greater in the P + CKD group. Renal parameters such as eGFR and serum creatinine levels were greater in CKD patients. The estimation of red complex periodontal pathogens such as , and levels were significantly greater in the P and P + CKD groups. Pearson correlation analysis revealed significant correlation of red complex bacteria with all variables. Greater levels of , and were found in the P groups, thus indicating their important role in the initiation and progression of inflammation of periodontitis and CKD, with diabetes as one of the confounding factors. The study also confirmed a log-linear relationship between TNF-α levels and red complex bacteria, thereby demonstrating the role of inflammatory biomarkers in periodontal disease progression that could contribute to the development of systemic inflammation such as CKD.