以多階層模式探討牙周病與代謝症候群之相關

Abstract

中文摘要 背景:牙周病為牙齒周圍組織的破壞，可導致缺牙、影響咀嚼和說話能力。有研究亦指出牙周病和心血管疾病、糖尿病、中風等與代謝症候群有關的疾病相關。傳統上針對牙周病危險因子的探討僅在於個人層次，忽略同一口腔內不同牙周的差異。牙周病可分為六個Sextants去看，而其間又存在高度的相關性，故可採用多階層模式，利用隨機效應（random effect）去處理同一人在不同Sextants之間的相關性，提昇資料的價值。此外，大型牙周盛行率亦存有區域間的差異，故亦可用多階層模式去處理區域及個人間不同分析單位的問題。 研究目的:本研究將採用多階層模式進行牙周病相關危險因子分析，並比較一般以個人為單位之分析模式與多階層模式分析之結果。 材料與方法: 本研究利用2007、2008年於台灣地區針對18歲以上之大規模社區牙周檢查資料，共進行4061位民眾之社區牙周指數（Community Periodontal Index , CPI）及附連喪失指數（Loss of Attachment, LA）的調查，並經由社區整合式篩檢之抽血和問卷訪視獲得生理生化檢驗值、口腔衛生保健行為和生活習慣等，透過調整其他危險因子後，分析代謝症候群與牙周病的相關。 結果: 若定義CPI≥3為牙周病個案，經年齡標準化後的整體盛行率為52.00%，其中男性之盛行率為56.89%，高於女性之48.89%；若定義LA≥1為牙周病個案，經年齡標準化後的整體盛行率為49.33%，其中男性之盛行率為57.31%，高於女性之44.09%。無論男女，牙周病盛行率有隨年齡增加而增加的趨勢。本研究分析結果顯示，相同變項下，變項對CPI和LA變化的解釋力不同，代表著影響CPI和LA變化的變項有所不同。腰圍、飯前血糖和總膽固醇只與LA有顯著相關；高血壓只與CPI有顯著相關。綜合來看，罹患牙周病的危險性會隨代謝症候群指標數的增加而增加。此外，sextant階層牙周觀察值的分析結果，與個人階層牙周觀察值的分析結果有所差別，單變項和多變項混合模式顯示出較多的顯著因子。 結論: 本研究結果顯示進行代謝症候群與牙周相關研究時，以測量部位為單位之多階層結構模式來分析比以個人為單位之資料分析較佳，保留完整訊息且取得最符合資料結構的估計結果。代謝症候群中不同指標，對CPI和LA影響不同。整體而言，牙周病病程指數，會隨著代謝症候群指標數的增加而增加。

Abstract Background: Periodontal diseases (PD), referring to the destruction of tissues surrounding the teeth, can cause teeth loss, and affect chewing function and speaking ability. In the past, most of investigations for periodontal disease focused on subject level. In this study, the periodontal status for subject was measured in 6 sextants, which are highly correlated in the same subject. To enhance the statistical efficiency and copy with correlated property among data of periodontal status on six sextants within the same subject, the multilevel models were used. Aim: In this study, multilevel models were applied to investigate the association between PD and metabolic syndrome adjusting with other risk factors. Methods and Materials: Data were from a large-scale periodontal diseases survey project which covered 99 different districts and was conducted between 2007 and 2008. A total of 4061 participants aged 18 or above were enrolled in this study. Periodontal status was measured with CPI and LA. Results of biochemical examination were recorded for each participant. Information of oral hygiene behavior and life style was obtained by interview with structured questionnaire. We used logistic regression to analyze the relationship between periodontal disease and metabolic syndrome. Furthermore, linear regression and generalized liner mixed models are used to correlate metabolic syndrome and the severity of periodontal disease in both CPI and LA. Results: The overall age-adjusted prevalence rate of PD, defined as CPI≥3, was 52.00%. Among male, the prevalence rate of PD was 56.89% which was higher than that among female, 48.89%. As PD was defined as LA≥1, the overall age-adjusted prevalence rate of PD was 49.33% (57.31% for male male, and 44.09% for female). Prevalence rate increased with age. Waist circumference, blood glucose and cholesterol are significantly associated with LA, but not with CPI. Blood pressure is significantly associated with CPI, but not with LA. Number of criteria for metabolic syndrome met was positively significantly associated with severity with CPI, both in linear regression and mixed models. For other confounders, mixed model was more efficient compared with linear regression model. Conclusion: Our study showed that results in sextant level with mixed model was more efficient compared to those in subject level with linear regression model when severity of periodontal disease was used. Nevertheless, number of criteria for metabolic syndrome met was positively significantly associated with severity with CPI in both models.