發(fā)表在《柳葉刀·腫瘤學》上的最新研究表明，胰腺癌或許跟牙周病有關(guān),。而補充維生素D則能降低罹患牙周炎的風險。
哈佛大學公共衛(wèi)生學院和達那癌癥研究所的多米尼克·米歇爾教授通過分析和總結(jié)22年來收集的數(shù)據(jù)得到胰腺癌也許與牙周炎有關(guān)的結(jié)論,。從哈佛畢業(yè)后,，他就加入了“衛(wèi)生職業(yè)者隨訪研究”（Health Professionals Follow-up Study, HPFS）項目。這是從1986年由哈佛大學公共衛(wèi)生學院發(fā)起的一個活動,，他們在美國各地征募到5萬多名從事醫(yī)藥衛(wèi)生工作的男性志愿者參與這項研究,。從那個時候起，他們就每兩年給志愿者寄去一個健康調(diào)查問卷,，問卷的內(nèi)容非常詳盡,，包括志愿者的生活習慣，飲食搭配,，健康狀況和疾病情況等等,，并且還會通過不定期的抽查體檢，來獲得更為詳細的生理健康數(shù)據(jù),。“通過這些調(diào)查數(shù)據(jù),，我們就可以發(fā)現(xiàn)不同的營養(yǎng)條件和生活習慣對于一系列重要疾病的影響,，其中包括死亡率最高的癌癥，心臟病和其他心血管疾病,。”米歇爾教授在報告的幻燈片里寫到,。
米歇爾的研究重點在口腔健康和各種癌癥的相關(guān)性上。2008年,，米歇爾和他的同事在著名的醫(yī)學雜志《柳葉刀》上發(fā)表了一篇論文,，就20多年來的隨訪調(diào)查的結(jié)果進行了分析和總結(jié)。結(jié)果卻讓他們有一些意外,。在排除諸如吸煙,、飲食、年齡等已知的影響因素后,，他們發(fā)現(xiàn)與牙齒,、牙周健康的男性相比，患有牙周病和牙齒缺損的男性得癌癥的概率要高14%,，其中,，肺癌的危險度要高出36%，腎癌的危險度要高49%,，血癌是30%,，而最高的是胰腺癌，居然高出54%,。
這串數(shù)字加上它們的前綴不禁讓人覺得有些觸目驚心,。可是這樣的關(guān)聯(lián)是怎么產(chǎn)生的呢,，米歇爾教授在報告中進一步給我們解釋道：“細菌感染牙周并逐漸破壞牙周骨后,，就會引發(fā)各種牙周疾病。這會導致患者口腔內(nèi)細菌產(chǎn)生的致癌化合物水平上升,，進而還誘發(fā)體內(nèi)組織出現(xiàn)一系列炎癥,，而反復炎癥往往會提高致癌的幾率。在這項研究中雖然未能最終確認牙周病直接誘發(fā)癌癥,，但卻得出了兩者相關(guān)的強有力證據(jù),。”
而米歇爾的同行，舊金山營養(yǎng)健康研究所的威廉姆·格蘭特教授卻對此持有不同的看法,，他在對米歇爾論文的評論中說：“最近發(fā)現(xiàn)牙周炎和牙齒脫落與不同類型的癌癥都有相關(guān),，認為可能是由于口腔細菌引起的炎癥反應(yīng)造成這樣的相關(guān)性。但是這些都還只是假設(shè),，真正的幕后操縱者有可能是維生素D,。我們都知道，缺乏維生素D會使鈣被酸化而進一步導致牙齒脫落,，口腔發(fā)炎,。而另一方面,，那些表現(xiàn)出和牙周炎高度相關(guān)的癌癥同樣也會被維生素D水平過低引起，因為維生素D和鈣水平過低會影響細胞之間介質(zhì)交換,，從而導致癌癥的發(fā)生,。而HPFS的研究也表明，維生素D水平攝入較高的人群得癌癥的幾率要比其他人群低得多,。當然,，這也只是另一種可能性，目前我們還需要更多的證據(jù)去證明它,。”
在中國,，胰腺癌的發(fā)病率也在逐年上升，近20年增長了4倍,?；疾≌咭?5歲以上者最為多見，男性高于女性,。并且由于其早期癥狀不明顯,，臨床上尚無簡單可靠的早期發(fā)現(xiàn)方法，約有85％的胰腺癌患者就診時已屬晚期,。所以往往發(fā)現(xiàn)之后,，患者的平均生存時間僅有4到6個月。顯然HPFS的研究為預(yù)防胰腺癌帶來了一絲曙光,，在5萬多的調(diào)查者中,，有216名參與者在22年的隨訪中被發(fā)現(xiàn)患有胰腺癌。研究者最先發(fā)現(xiàn)和胰腺癌相關(guān)的因素是吸煙和肥胖,。除此之外,，科學家們發(fā)現(xiàn)，與牙齒,、牙周健康的男性相比，患有牙周病的男性得胰腺癌的概率要高1.5倍,，而適當?shù)难a充維生素D可以改善這一狀況,。（生物谷Bioon.com）
生物谷推薦原始出處：
The Lancet Oncology, Volume 9, Issue 6, Pages 550 - 558, June 2008
Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study
Original TextDr Dominique S Michaud ScD a b , Yan Liu MS c, Mara Meyer ScM b, Prof Edward Giovannucci ScD b c d, Prof Kaumudi Joshipura ScD b e f
Background
Studies suggest that tooth loss and periodontal disease might increase the risk of developing various cancers; however, smoking might have confounded the reported associations. We aimed to assess whether periodontal disease or tooth loss is associated with cancer risk.
Methods
The analysis was done in a prospective study (the Health Professionals Follow-Up Study [HPFS]), which was initiated in 1986 when US male health professionals aged 40—75 years responded to questionnaires posted by the Department of Nutrition, Harvard University School of Public Health, Boston, MA, USA. In addition to the baseline questionnaires, follow-up questionnaires were posted to all living participants every 2 years and dietary questionnaires every 4 years. At baseline, participants were asked whether they had a history of periodontal disease with bone loss. Participants also reported number of natural teeth at baseline and any tooth loss during the previous 2 years was reported on the follow-up questionnaires. Smoking status and history of smoking were obtained at baseline and in all subsequent questionnaires. Additionally at baseline, participants reported their mean frequency of food intake over the previous year on a 131-item semiquantitative food-frequency questionnaire. Participants reported any new cancer diagnosis on the follow-up questionnaires. Endpoints for this study were risk of total cancer and individual cancers with more than 100 cases. Multivariate hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazard models according to periodontal disease status and number of teeth at baseline.
Findings
In the main analyses, 48 375 men with median follow-up of 17·7 years (1986 to Jan 31, 2004) were eligible after excluding participants diagnosed with cancer before 1986 (other than non-melanoma skin cancer, n=2076) and those with missing data on periodontal disease (n=1078). 5720 incident cancer cases were documented (excluding non-melanoma skin cancer and non-aggressive prostate cancer). The five most common cancers were colorectal (n=1043), melanoma of the skin (n=698), lung (n=678), bladder (n=543), and advanced prostate (n=541). After adjusting for known risk factors, including detailed smoking history and dietary factors, participants with a history of periodontal disease had an increased risk of total cancer (HR 1·14 [95% CI 1·07—1·22]) compared with those with no history of periodontal disease. By cancer site, significant associations for those with a history of peridontal disease were noted for lung (1·36 [1·15—1·60]), kidney (1·49 [1·12—1·97]), pancreas (1·54 [1·16—2·04]; findings previously published), and haematological cancers (1·30 [1·11—1·53]). Fewer teeth at baseline (0—16) was associated with an increase in risk of lung cancer (1·70 [1·37—2·11]) for those with 0—16 teeth versus those with 25—32 teeth. In never-smokers, periodontal disease was associated with significant increases in total (1·21 [1·06—1·39]) and haematological cancers (1·35 [1·01—1·81]). By contrast, no association was noted for lung cancer (0·96 [0·46—1·98]).
