| Objectives:Periodontitis is a chronic inflammatory disease caused by microorganisms.As the sixth most common human disease,periodontitis has become a major public health problem as well as an increasing burden on the healthcare system.The link between periodontitis and systemic diseases may help to promote oral and systemic health using a multidisciplinary approach.Diabetes and other metabolic diseases have been shown to be associated with the development of periodontitis,but the relationship between serum uric acid(SUA)levels,hyperuricemia and periodontitis is unclear.Given the high prevalence of hyperuricemia and periodontitis,it is critical to clarify the relationship between them as SUA may directly or indirectly influence the global burden of periodontitis.We conducted a large clinical crosssectional study using the National Health Nutrition Examination Survey(NHANES)database to investigate the relationship between SUA,hyperuricemia and periodontitis,and thus to inform the clinical prevention and treatment of periodontitis.Methods:The study was a cross-sectional study,using NHANES data from 2011-2014,collected from people aged 30 years and older with complete periodontal examination and SUA data;a total of 6,606 participants were included in the study(3,369 females and3,237 males).SUA levels were obtained from standard biochemical information from laboratory data.Clinical attachment loss(CAL)and probing depth(PD)from four interproximal sites per tooth(mesio-buccal,disto-buccal,mesio-lingual,disto-lingual)on all teeth except third molars were used to define periodontitis.We used multiple imputation method to maximize statistical power and minimize bias that might occur due to the missing data.As SUA metabolism varies by gender,the total population was divided into females and males and analyzed separately.Differences between groups were compared using t-tests(normal distribution),Wilcoxon rank sum tests(skewed distribution)and chisquare tests(categorical variables),and univariate and multivariate logistic regression analyses were used to assess the relationship between SUA,hyperuricemia and periodontitis,with odds ratios(ORs)and 95% confidence interval(95% CI)for associations.Restricted cubic spline(RCS)regression was performed at four nodes at the5 th,35th,65 th and 95 th percentiles of SUA to assess linearity and examine the doseresponse curves between SUA and periodontitis.Finally,heterogeneity between subgroups was assessed by multivariate logistic regression analysis,and the interaction between subgroups and SUA was examined using likelihood ratio tests.All data collation and analysis were completed using the statistical package R 3.3.2 and Free Statistics software(version 1.7.1).Results:In the female population,individuals with periodontitis had higher SUA levels and a higher prevalence of hyperuricemia than non-periodontitis individuals,while there were no significant differences in the male population.In females,fully adjusted multivariate logistic regression analysis showed that SUA(4.1-4.3 mg/dl)was associated with a higher risk of periodontitis(OR=1.43;95% CI: 1.0～2.03,p=0.047),using SUA(≤3.3 mg/dl)as a reference.We found a slight but non-statistically significant trend towards an increased risk of periodontitis with increasing SUA levels in women,with the adverse effects occurring only when SUA increased to a certain level,after which a plateau was reached.In the male population,the fully adjusted OR values in SUA(4.9-5.2mg/dl),SUA(5.3-5.5mg/dl),SUA(5.9-6.2mg/dl),and SUA(6.3-6.5mg/dl)were 0.66(95% CI: 0.45～0.96,p=0.029),0.58(95%CI: 0.40～0.85,p=0.006),0.67(95% CI: 0.47～0.97,p=0.035),and 0.67(95% CI: 0.45～0.99,p=0.043),respectively,with SUA(≤4.3mg/dl)as reference.Combined with the doseresponse relationship between SUA and periodontitis,we found a curvilinear relationship between SUA and periodontitis in men,with a protective effect on periodontitis at a range of elevated SUA and a loss of protection beyond this range.Conclusion:People with periodontitis require special attention to lifestyle(diet,smoking,alcohol consumption,exercise,etc.),weight control,prevention and treatment of metabolic and cardiovascular diseases,and the use of medications to control their SUA levels,which may help to reduce the risk of periodontitis.Future prospective longitudinal studies are needed to further confirm whether treatment to control SUA is an effective adjunct to systemic periodontal therapy and whether SUA can be used as a diagnostic biomarker to assess the risk or progression of periodontitis,which is important for the prevention and treatment of periodontitis and the balance and maintenance of systemic health. |
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