Pasquale LR, Hyman L, Wiggs JL, et al.
青光眼 原发性 前瞻性
目的：牙齿脱落或牙周病与全身内皮功能障碍有关，这与原发性开角型青光眼（POAG）有关。口腔健康与POAG之间的关系受到的关注有限。因此，我们评估了口腔健康史与POAG和POAG亚型风险之间的关联。设计：前瞻性队列研究。研究对象：1986年至2012年健康专业人员随访研究参与者（40536男性）每两年进行一次随访。在每2年风险期间，符合条件的参与者应在40岁以上，没有POAG，并报告眼睛检查。方法：使用经验证的问题，我们更新了参与者的自然牙齿数量，牙齿脱落情况，骨质疏松性牙周病，和牙根管治疗资料。主要观察指标：随访期间，485例POAG病例经病历确诊，并按诊断时眼压（IOP;≥或<22 mmHg）或视野（VF）缺失类型（外周缺失或早期中心缺失）进行亚型分类。并进行多变量相对风险（MVRR）和95％可信区间（CI）评估。结果：自然牙齿数量，牙周病和牙根管治疗情况与POAG无关。然而，与没有牙齿脱落的报告相比，过去2年内牙齿脱落的一份报告与POAG风险增加1.45倍相关（95％CI，1.06-1.97）；特别是，在过去2年内有关牙齿脱落和牙周病诊断的一份报告与POAG风险增加1.85倍相关（95％CI，1.07-3.18）。虽然与IOP <22mmHg亚型（MVRR，1.93; 95％CI，1.09-3.43）和早期外周视野缺失POAG（MVRR，2.27; 95％CI，1.32-3.88）亚型相关性最强，但与最近牙齿脱落POAG亚型关联性不强（P异质性≥0.36）。结论：尽管自然牙齿的数量与POAG风险无关，但最近的牙齿脱落与POAG风险增加相关。因为这些发现可能存在机会性，所以需要在更大的研究中确认。
PURPOSE:Tooth loss or periodontal disease is associated with systemic endothelial dysfunction, which has been implicated in primary open-angle glaucoma (POAG). The relationship between oral health and POAG has received limited attention. Thus, we evaluated the association between oral health history and risk of POAG and POAG subtypes.DESIGN:Prospective cohort study.PARTICIPANTS:Health Professionals Follow-up Study participants (40536 men) followed biennially from 1986 to 2012. At each 2-year risk period, eligible participants were aged 40+ years, were free of POAG, and reported eye examinations.METHODS:By using validated questions, we updated participants' status on number of natural teeth, teeth lost, periodontal disease with bone loss, and root canal treatments.MAIN OUTCOME MEASURES:During follow-up, 485 incident cases of POAG were confirmed with medical records and classified into subtypes defined by intraocular pressure (IOP; ≥ or <22 mmHg) or visual field (VF) loss pattern at diagnosis (peripheral loss only or early paracentral loss). Multivariable relative risks (MVRRs) and 95% confidence intervals (CIs) were estimated.RESULTS:Number of natural teeth, periodontal disease, and root canal treatment were not associated with POAG. However, compared with no report of tooth loss, a report of losing teeth within the past 2 years was associated with a 1.45-fold increased risk of POAG (95% CI, 1.06-1.97); in particular, a report within the past 2years of both losing teeth and having a prevalent diagnosis of periodontal disease was associated with a 1.85-fold increased risk of POAG (95% CI, 1.07-3.18). The associations with recent tooth loss were not significantly different for the POAG subtypes (P for heterogeneity ≥0.36), although associations were strongest in relation to the POAG subtypes with IOP <22 mmHg (MVRR, 1.93; 95% CI, 1.09-3.43) and early paracentral VF loss (MVRR, 2.27; 95% CI, 1.32-3.88).CONCLUSIONS:Although the number of natural teeth was not associated with risk of POAG, recent tooth loss was associated with an increased risk of POAG. Because these findings may be due to chance, they need confirmation in larger studies.