口腔中的细菌被释放到唾液,唾液中的致病菌吸入下呼吸道引起或加重感染 口腔是各种微生物的栖息地,多达700种细菌、病毒和真菌可在口腔内定植,以中间假单胞菌、变形链球菌、细胞核假丝酵母菌和牙龈假单胞菌最为重要。口腔细菌定植引发呼吸道感染有以下机制:· 口腔病原体吸入肺部;· 牙周病相关酶可以使呼吸道致病菌更容易在粘膜表面粘附和定植;· 牙周病相关酶可以破坏细菌的唾液膜,阻碍细菌从黏膜表面清除;· 牙周病相关细胞因子改变呼吸道上皮组织,促进呼吸道致病菌的感染。 口腔卫生与其他疾病 口腔生物膜中的细菌极易进入呼吸道,有助于引发或发展肺炎或败血症等疾病。口腔中的高细菌和病毒载量可进一步加重心血管疾病、癌症、神经退行性疾病和自身免疫性疾病等全身性疾病,可见口腔卫生对全身各系统的影响。糖尿病、高血压和心脏病与具核梭杆菌、中间假单胞菌和牙龈卟啉单胞菌的数量增加存在联系,并与牙周病的进展有关。牙周病患者患心血管疾病的风险增加25%,患糖尿病的风险增加三倍,患高血压的风险增加20%。牙周病患者患心血管疾病的风险增加了25%,患糖尿病的风险增加三倍,高血压风险增加20%。病变牙周组织产生的细胞因子等上皮敏感性和促炎性介质的血行扩散可增加全身炎症并影响肺通气,刺激肝脏产生急性时相蛋白(IL-6等)可加重肺部和身体其他部位的炎症反应。严重COVID-19感染的患者也表现出全身炎症,IL-6、IL-2、IL-10、TNF和CRP水平显著升高。一项系统性综述认为老年患者通过改善口腔卫生可将肺炎相关死亡减少1/10。此外,改善口腔护理可以显著降低ICU患者呼吸机相关性肺炎的发生率。是时候重视口腔卫生了! 基于此,英国口腔协会建议:SARS-CoV-2感染者应保持口腔卫生,以减少口腔中的细菌数量和细菌重叠感染的风险。口腔卫生不良是病毒感染后细菌性并发症的危险因素,特别是对于有糖尿病、高血压或心血管基础疾病,容易引起生物膜破坏的患者。COVID-19患者改善口腔卫生有助于将肺部并发症的风险降到最低。参考文献:1.WWorld Health Organisation. Clinical Management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected. 2020. Available online at https://apps.who.int/iris/handle/10665/330893 (accessed June 2020).2. Sampson V, Kamona N, Sampson A. Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections?. Br Dent J. 2020;228(12):971-975.3. Cox M J, Loman N, Bogaert D, O’Grady J. Co-infections: potentially lethal and unexplored in COVID-19. Lancet2020; DOI: 10.1016/S2666-5247(20)30009-4.4. Golda A, Malek N, Dudek B et al. Infection with human coronavirus NL63 enhances streptococcal adherence to epithelial cells. J Gen Virol 2011; 92: 1358–1368.5. Zheng M, Gao Y, Wang G et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients. Cell Mol Immunol 2020; 17: 533–535.6. Sjögren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. A systematic review of the preventative effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomised controlled trials. J Am Geriatr Soc 2008; 56: 2124–2130.7. DeStefano F, Anda R F, Kahn H S, Williamson D F, Russell C M. Dental disease and the risk of coronary heart disease and mortality. BMJ 1993; 306: 688–691.8. Paizan M L M, Vilela-Martin J F. Is There an Association between Periodontitis and Hypertension? Curr Cardiol Rev 2014; 10: 355–361.9. Preshaw P M, Alba A L, Herrera D et al. Periodontitis and diabetes: a two-way relationship. Diabetologia2012; 55: 21–31.10. Aguilera E M, Suvan J, Buti J et al. Periodontitis is associated with hypertension: a systematic review and meta-analysis. Cardiovasc Res 2020; 116: 28–39.11. Gomes-Filho I S, Seixas da Cruz S, Trindade S C et al. Periodontitis and respiratory diseases: a systematic review with meta-analysis. Oral Dis 2020; 26:439–446.