歯周病と唾液分泌促進が虚血性脳卒中急性期の経過に与える影響について

The Influence of Periodontal Diseases and the Stimulation of Saliva Secretion on the Course of the Acute Phase of Ischemic Stroke.

抄録

背景と目的:

虚血性脳卒中の経過は多くの要因に左右される。歯周病と唾液分泌促進が脳梗塞の経過や重症度に及ぼす影響については未解決のままである。そこで本研究の目的は、歯周病と唾液刺激の有無による虚血性脳卒中の重症度について解析することである。

BACKGROUND AND PURPOSE: The course of an ischemic stroke depends on many factors. The influence of periodontal diseases and the stimulation of salivation on the course and severity of stroke remains unresolved. Therefore, the aim of the study was to analyze the severity of ischemic stroke depending on the occurrence of periodontal diseases and saliva stimulation.

方法:

脳梗塞発症 1 日目，3 日目，7 日目に NIHSS スケールを用いて神経学的状態の重症度を評価した．歯周病の発生率は，脳卒中発症1日目にHallの尺度を用いて分類した．脳卒中発症1日目と7日目に，唾液中のIL-1β，MMP-8，OPG，RANKLの濃度をElisa法により測定した．同時に，脳卒中発症1日目，3日目，7日目にCRPと末梢血白血球数を検査し，上気道感染症と尿路感染症の発生率を評価した．

METHODS: The severity of the neurological condition was assessed using the NIHSS scale on days one, three and seven of stroke. The incidence of periodontal diseases was classified using the Hall's scale in the first day of stroke. On days one and seven of stroke, the concentration of IL-1β, MMP-8, OPG and RANKL in the patients' saliva was assessed using the Elisa technique. At the same time, the level of CRP and the number of leukocytes in the peripheral blood were tested on days one, three and seven of the stroke, and the incidence of upper respiratory and urinary tract infections was assessed.

結果:

初発の虚血性脳卒中患者100例を連続登録した。無作為に抽出した56名の患者に唾液分泌の刺激を与え、残りの患者には刺激を与えなかった。脳卒中発症3日目と7日目にNIHSスケールを用いて神経症状の重症度を調べたところ，歯周病のない患者の欠損度は歯周病のある患者と比較してそれぞれ有意に改善した（ < 0.01, = 0.01 ）．刺激群の患者は，ベースラインでより重度の神経学的欠損を示した（= 0.04）．神経学的フォローアップの3日目と7日目には、両グループの患者の状態は改善し、刺激を受けていないグループが刺激を受けているグループよりもさらに明確に有利であった（それぞれ = 0.03 と < 0.001 ）。両群の患者において、CRPとリンパ球のレベルは、初日と比較して7日目に統計的に有意な減少が観察された。

RESULTS: 100 consecutive patients with their first ever ischemic stroke were enrolled in the study. 56 randomly selected patients were subjected to the stimulation of salivation, the remaining patients were not stimulated. In the study of the severity of the neurological condition using the NIHS scale on days three and seven of stroke, the degree of deficit in patients without periodontal disease significantly improved compared to patients with periodontal disease, respectively ( &lt; 0.01 and = 0.01). Patients from the stimulated group had more severe neurological deficit at baseline ( = 0.04). On days three and seven of neurological follow-up, the condition of patients from both groups improved with a further distinct advantage of the unstimulated group over the stimulated group, respectively ( = 0.03 and &lt; 0.001). In patients from both groups, a statistically significant decrease in CRP and lymphocyte levels was observed on day seven in relation to day one.

結論:

脳卒中患者における歯周病の発生は，脳卒中の重症度に影響を及ぼす．このような患者において口腔内と唾液腺を刺激することは，神経症状の動態を考慮すると，脳卒中の経過に良い影響を与える可能性がある．

CONCLUSIONS: The occurrence of periodontal disease in a patient with stroke affects the severity of stroke. Stimulation of the mouth and salivary glands in these patients may have a positive effect on the course of stroke, taking into account the dynamics of neurological symptoms.