Inflammatory Activity in Oral Cavity is Associated With Carotid Plaque Inflammation Regardless of Systemic Inflammation

초록

Introduction: Periodontitis is one of candidates associated with elevated levels of C-reactive protein (CRP) and other inflammatory biomarkers. Epidemiologic studies have shown that periodontitis is associated with endothelial dysfunction, atherosclerosis, and an increased risk of coronary heart disease and stroke. Purpose: We would like to know whether synchronization between focal periodontal inflammation and carotid plaque inflammation is associated with systemic inflammation or not. Method: We examined carotid vascular inflammation and dental inflammation, represented as the standardized uptake value (SUV) measured using FDG-PET scans in 86 periodontitis subjects and 49 subjects without periodontal subjects. We also measured the correlation between endothelial dysfunction assessed by measurement of the diameter of the brachial artery during flow (flow-mediated dilatation) and dental inflammation and carotid arterial inflammation. Other systemic inflammatory markers including hsCRP, ESR, fibrinogen and WBC count were measured to evaluate their relationship. Results: The average maximum SUV levels of dental lesion was higher in patients with periodontitis than control induviduals(2.9 + 0.7 vs 1.1+ 0.8, p<0.001). The correlation coefficient was 0.719(p<0.0001) blotted by carotid SUV and dental SUV. But there was no significant association between dental inflammation measured by maximal SUV and endothelial function(p=0.755) by FMD or other systemic inflammatory markers. Conclusion: Carotid plaque inflammation measured using FDG-PET was increased in accordance with degree of periodontal FDG-uptake, but its association was not related to circulatory inflammatory markers. This finding can in part explain a mechanism that periodontitis patients would have higher incidence of stroke related to local influence regardless of systemic inflammation.