統合失調症患者における口腔保健状態と口腔保健に関連する因子：マッチドケースコントロール観察研究

Oral Health Status and Factors Related to Oral Health in Patients with Schizophrenia: A Matched Case-Control Observational Study.

抄録

統合失調症（SCZ）患者は、疾患の病態生理、薬物関連の副作用、歯科医療サービスの利用率の低さなどの多次元的な要因のために、口腔保健の転帰が不釣り合いに悪い。本観察研究の目的は、SCZ患者における歯および歯周の健康指標を非罹患の健常対照群と比較することであり、さらに、口腔の健康状態に及ぼす様々なアナムネティック因子および生活習慣の影響も評価した。 セゲド大学精神科で治療を受けている寛解期のSCZ患者50人と、セゲド大学歯学部に通う年齢・性別をマッチさせた健常対照者50人を比較した。参加者の歯（虫歯、欠損、充填面［DMF-S］、虫歯、欠損、充填歯［DMF-T］）および歯周（プラーク指数［％］、プロービング時出血［BOP％］、ポケットの深さ［PD］、アタッチメントロス［AL］）の状態を世界保健機関（WHO）の基準に従って測定した。 SCZ患者の74.0％、80.0％、78.0％がそれぞれ第2世代抗精神病薬、ベンゾジアゼピン系薬剤、気分安定薬を服用していた。SCZ患者では、DMFs（81.30±40.16 vs. 61.64±40.56; = 0.010）、D（8.18±7.73 vs. 4.18±4.22;<0.001）、DMF-T（18.20±8.36 vs. 14.42±8.21;=0.024）が有意に高かったが、F（1.84±0.29点 vs. 4.62±3.98点；＜0.001点）；男性ではDMF（74.52±39.72点 vs. 90.67±39.1点；＝0.020点）およびDMF-T（16.52±8.12点 vs. 20.52±8.32点；＝0.031点）が有意に低かった。さらに、SCZ患者はプラーク指数（56.96±23.19 vs. 27.44±17.53；＜0.001）、BOP％（58.96±22.89 vs. 23.56±17.53；＜0.001）、DMF-Tスコア（16.52±8.12 vs. 20.52±8.32；＝0.031）が有意に高かった。53；＜0.001）、PD（2.84±0.67 vs. 2.19±0.49；＝0.024）、AL（3.39±1.72 vs. 2.49±0.76；＜0.001）の値が対照群と比較して高かった。喫煙量が10本/日を超えると歯および歯周病指数が悪化し、アルコールの摂取量が4単位/週を超えると歯周病指数が悪化した（いずれも0.05未満）。対照的に、コーヒー摂取率およびビタミン補給の有無は、口腔の健康状態指標に有意な影響を及ぼさなかった。 本研究は、SCZ罹患者の口腔衛生状態が全体的に不良であること、および的を絞った予防的介入の必要性を浮き彫りにした。

Schizophrenia (SCZ) patients have disproportionately poor oral health outcomes owing to a multidimensional set of factors, such as pathophysiology of the disease, drug-related adverse effects and lower utilization rate of dental healthcare services. The aim of the present observational study was to compare the indicators of dental and periodontal health in patients with SCZ to those of nonaffected healthy controls; furthermore, the influence of various anamnestic factors and lifestyle habits on oral health status were also assessed. A total of 50 SCZ patients-in remission-receiving treatment at the Department of Psychiatry, University of Szeged, were compared with 50 age- and gender-matched healthy controls attending the Faculty of Dentistry, University of Szeged. Participants' dental (decayed, missing and filled surfaces [DMF-S] and decayed, missing and filled teeth [DMF-T]) and periodontal (plaque index [%], bleeding on probing [BOP%], pocket depth [PD] and attachment loss [AL]) status was measured according to the World Health Organization (WHO) criteria. In total, 74.0%, 80.0% and 78.0% of SCZ patients received second-generation antipsychotics, benzodiazepines and mood stabilizers, respectively. Patients with SCZ had significantly higher DMFs (81.30 ± 40.16 vs. 61.64 ± 40.56; = 0.010), D (8.18 ± 7.73 vs. 4.18 ± 4.22; < 0.001) and DMF-T (18.20 ± 8.36 vs. 14.42 ± 8.21; = 0.024) scores but significantly lower F (1.84 ± 0.29 vs. 4.62 ± 3.98; < 0.001) scores compared to the controls; male subjects had significantly lower DMFs (74.52 ± 39.72 vs. 90.67 ± 39.1; = 0.020) and DMF-T (16.52 ± 8.12 vs. 20.52 ± 8.32; = 0.031) scores. Additionally, SCZ patients had significantly higher plaque indices (56.96 ± 23.19 vs. 27.44 ± 17.53; < 0.001), BOP% (58.96 ± 22.89 vs. 23.56 ± 17.53; < 0.001), PD (2.84 ± 0.67 vs. 2.19 ± 0.49; = 0.024) and AL (3.39 ± 1.72 vs. 2.49 ± 0.76; < 0.001) values compared to controls. Smoking > 10 cigarettes/day was associated with worse dental and periodontal indices, while consuming ≥ 4 units/week of alcohol was associated with worse periodontal indices, respectively ( < 0.05 in all cases). In contrast, coffee consumption rates and vitamin supplementation status had no significant effect on oral health status indicators. Our study highlights the overall poor oral health status of individuals affected by SCZ and the need for targeted preventive interventions.