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BMC Oral Health:发展中国家慢性肾病患者的口腔病损管理

2015-03-27 MedSci译 MedSci原创

BMC Oral Health:慢性肾病与口腔病损对控制全身性疾病包括慢性肾病(CKD)的患者,口腔健康保健的重要性已广为人知。很多CKD患者都有相关的口腔表现,然而,大众对口腔健康保健的重视仍然不足,尤其是在肾脏疾病所造成的医疗负担较大的发展中国家。研究纳入并检查了90例健康对照组,90例CKD患者,共180例研究对象。基于WHO指导的口腔黏膜病的诊断和流行病学评估口腔黏膜。确定尿常规、血肌酐水


对控制全身性疾病包括慢性肾病(CKD)的患者,口腔健康保健的重要性已广为人知。很多CKD患者都有相关的口腔表现,然而,大众对口腔健康保健的重视仍然不足,尤其是在肾脏疾病所造成的医疗负担较大的发展中国家。

研究纳入并检查了90例健康对照组,90例CKD患者,共180例研究对象。基于WHO指导的口腔黏膜病的诊断和流行病学评估口腔黏膜。确定尿常规、血肌酐水平。使用Cockcroft和Gault公式计算每位患者的肾小球滤过率(GFR)。

90例CKD患者中86例(96.5%)表现出口腔病损,90例健康对照组中15例(16.7%)表现出口腔病损。唇部异常色素沉着是最常见的表现,90例CKD患者中81例(90%)表现出了唇部异常色素沉着。其他重要的发现是牙龈出血、口干、白色念珠菌感染、灼口症及味觉异常。健康对照组中,相比于无口腔病损的人,伴有口腔病损的患者平均GFR较低(P<0.001)。

CKD和GFR降低的健康对照组是口腔病损的危险因素。CKD患者口腔病损患病率较高,必须强制口腔筛选以确定肾功能恶化的患者。这些病损的控制将会提高发展中国家CKD患者的总体幸福感。

注:肾小球滤过率和口腔表现

大部分研究报道正常人GFR的范围为90-120ml/1.73m2,,GFR的值较低表明肾功能较差。据观察,伴有口腔病损的研究对象的平均GFR显著低于无口腔病损的研究对象(P<0.001),表明口腔病损与GFR降低(尤其是CKD患者)之间具有较强的相关关系。口腔感染引起的全身性炎症可能对心脏和肾脏的微循环有影响。口腔感染如牙周炎与心脏疾病之间具有双向关系,现在普遍认为口腔病损与肾脏疾病也具有双向关系。这可能解释了无口腔病损的CKD患者GFR相对较高,伴口腔病变的CKD患者的平均GFR相对较低的原因。

原始出处:

Elijah O Oyetola, Foluso J Owotade, Gbemisola A Agbelusi, Olawumi A Fatusi, Abubarkar A Sanusi. Oral Findings in Chronic Kidney Disease: Implications for Management in Developing Countries. BMC Oral Health

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time=2015-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518519, encodeId=4238151851988, content=<a href='/topic/show?id=37773e8234a' target=_blank style='color:#2F92EE;'>#发展中国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37823, encryptionId=37773e8234a, topicName=发展中国家)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b64511152089, createdName=fengyqf, createdTime=Sun Mar 29 10:50:00 CST 2015, time=2015-03-29, status=1, ipAttribution=)]
    2016-09-13 1e10c84am36(暂无匿称)

    好文章,还会关注

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time=2015-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518519, encodeId=4238151851988, content=<a href='/topic/show?id=37773e8234a' target=_blank style='color:#2F92EE;'>#发展中国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37823, encryptionId=37773e8234a, topicName=发展中国家)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b64511152089, createdName=fengyqf, createdTime=Sun Mar 29 10:50:00 CST 2015, time=2015-03-29, status=1, ipAttribution=)]
    2015-07-13 shizhenshan
  3. 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time=2015-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518519, encodeId=4238151851988, content=<a href='/topic/show?id=37773e8234a' target=_blank style='color:#2F92EE;'>#发展中国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37823, encryptionId=37773e8234a, topicName=发展中国家)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b64511152089, createdName=fengyqf, createdTime=Sun Mar 29 10:50:00 CST 2015, time=2015-03-29, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=125375, encodeId=10b71253e5d4, content=好文章,还会关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 13 14:32:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1861002, encodeId=de9a18610029d, content=<a href='/topic/show?id=401a23e102' target=_blank style='color:#2F92EE;'>#ALT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2371, encryptionId=401a23e102, topicName=ALT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Mon Jul 13 13:50:00 CST 2015, time=2015-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1974598, encodeId=cca519e459862, content=<a href='/topic/show?id=f145355379' target=_blank style='color:#2F92EE;'>#BMC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3553, encryptionId=f145355379, topicName=BMC)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/363C99735735B7F4CB11D5F78F580525/100, createdBy=aab22500211, createdName=ms3025846204744509, createdTime=Fri Jun 19 11:50:00 CST 2015, time=2015-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2020160, encodeId=4cf32020160db, content=<a href='/topic/show?id=1584134451c' target=_blank style='color:#2F92EE;'>#Oral#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13445, encryptionId=1584134451c, topicName=Oral)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Mon Mar 07 13:50:00 CST 2016, time=2016-03-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055927, encodeId=023b205592e1b, content=<a href='/topic/show?id=d088536467a' target=_blank style='color:#2F92EE;'>#慢性肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53646, encryptionId=d088536467a, topicName=慢性肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Fri Aug 21 13:50:00 CST 2015, time=2015-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33738, encodeId=191733e38b6, content=以后要注意患者口腔, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3ykRSkuxjt93yc9tvDWfIQItrwiaKSCps5kyrTyDlwic2FgoCWe88wR3ZiaggKYGueDIp26zVgnbzriaQ/0, createdBy=89d71602869, createdName=sundong, createdTime=Wed Jul 29 10:51:00 CST 2015, time=2015-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025777, encodeId=b4822025e77c8, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Mon Feb 29 21:50:00 CST 2016, time=2016-02-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19201, encodeId=35701920182, content=病损的控制将会提高发展中国家CKD患者的总体幸福感。 <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Tue Mar 31 23:25:00 CST 2015, time=2015-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19075, encodeId=6132190e5f4, content=牙周医学, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=ixiaochengdudu, createdTime=Mon Mar 30 16:44:00 CST 2015, time=2015-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518519, encodeId=4238151851988, content=<a href='/topic/show?id=37773e8234a' target=_blank style='color:#2F92EE;'>#发展中国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37823, encryptionId=37773e8234a, topicName=发展中国家)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b64511152089, createdName=fengyqf, createdTime=Sun Mar 29 10:50:00 CST 2015, time=2015-03-29, status=1, ipAttribution=)]
    2016-03-07 小几洁
  5. 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GetPortalCommentsPageByObjectIdResponse(id=33738, encodeId=191733e38b6, content=以后要注意患者口腔, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3ykRSkuxjt93yc9tvDWfIQItrwiaKSCps5kyrTyDlwic2FgoCWe88wR3ZiaggKYGueDIp26zVgnbzriaQ/0, createdBy=89d71602869, createdName=sundong, createdTime=Wed Jul 29 10:51:00 CST 2015, time=2015-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025777, encodeId=b4822025e77c8, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Mon Feb 29 21:50:00 CST 2016, time=2016-02-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19201, encodeId=35701920182, content=病损的控制将会提高发展中国家CKD患者的总体幸福感。 <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Tue Mar 31 23:25:00 CST 2015, time=2015-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19075, encodeId=6132190e5f4, content=牙周医学, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=ixiaochengdudu, createdTime=Mon Mar 30 16:44:00 CST 2015, time=2015-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518519, encodeId=4238151851988, content=<a href='/topic/show?id=37773e8234a' target=_blank style='color:#2F92EE;'>#发展中国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37823, encryptionId=37773e8234a, topicName=发展中国家)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b64511152089, createdName=fengyqf, createdTime=Sun Mar 29 10:50:00 CST 2015, time=2015-03-29, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=125375, encodeId=10b71253e5d4, content=好文章,还会关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 13 14:32:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1861002, encodeId=de9a18610029d, content=<a href='/topic/show?id=401a23e102' target=_blank style='color:#2F92EE;'>#ALT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2371, encryptionId=401a23e102, topicName=ALT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, 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GetPortalCommentsPageByObjectIdResponse(id=33738, encodeId=191733e38b6, content=以后要注意患者口腔, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3ykRSkuxjt93yc9tvDWfIQItrwiaKSCps5kyrTyDlwic2FgoCWe88wR3ZiaggKYGueDIp26zVgnbzriaQ/0, createdBy=89d71602869, createdName=sundong, createdTime=Wed Jul 29 10:51:00 CST 2015, time=2015-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025777, encodeId=b4822025e77c8, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Mon Feb 29 21:50:00 CST 2016, time=2016-02-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19201, encodeId=35701920182, content=病损的控制将会提高发展中国家CKD患者的总体幸福感。 <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Tue Mar 31 23:25:00 CST 2015, time=2015-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19075, encodeId=6132190e5f4, content=牙周医学, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=ixiaochengdudu, createdTime=Mon Mar 30 16:44:00 CST 2015, time=2015-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518519, encodeId=4238151851988, content=<a href='/topic/show?id=37773e8234a' target=_blank style='color:#2F92EE;'>#发展中国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37823, encryptionId=37773e8234a, topicName=发展中国家)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b64511152089, createdName=fengyqf, createdTime=Sun Mar 29 10:50:00 CST 2015, time=2015-03-29, status=1, ipAttribution=)]
    2015-07-29 sundong

    以后要注意患者口腔

    0

  7. 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time=2015-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518519, encodeId=4238151851988, content=<a href='/topic/show?id=37773e8234a' target=_blank style='color:#2F92EE;'>#发展中国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37823, encryptionId=37773e8234a, topicName=发展中国家)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b64511152089, createdName=fengyqf, createdTime=Sun Mar 29 10:50:00 CST 2015, time=2015-03-29, status=1, ipAttribution=)]
  8. 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time=2015-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518519, encodeId=4238151851988, content=<a href='/topic/show?id=37773e8234a' target=_blank style='color:#2F92EE;'>#发展中国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37823, encryptionId=37773e8234a, topicName=发展中国家)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b64511152089, createdName=fengyqf, createdTime=Sun Mar 29 10:50:00 CST 2015, time=2015-03-29, status=1, ipAttribution=)]
    2015-03-31 x35042875

    病损的控制将会提高发展中国家CKD患者的总体幸福感。

    0

  9. 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time=2015-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1518519, encodeId=4238151851988, content=<a href='/topic/show?id=37773e8234a' target=_blank style='color:#2F92EE;'>#发展中国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37823, encryptionId=37773e8234a, topicName=发展中国家)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b64511152089, createdName=fengyqf, createdTime=Sun Mar 29 10:50:00 CST 2015, time=2015-03-29, status=1, ipAttribution=)]
    2015-03-30 ixiaochengdudu

    牙周医学

    0

  10. 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